Monovalent Rotavirus Vaccine Effectiveness and Impact on Rotavirus Hospitalizations in Zanzibar, Tanzania: Data From the First 3 Years After Introduction

Abeid, Khamis Ali; Jani, Bhavin; Cortese, Margaret M.; Kamugisha, Christopher; Mwenda, Jason M.; Pandu, Aziza Salim; Msaada, Kazija Ali; Mohamed, A.S.R.; Khamis, Asha Ussi; Parashar, Umesh D.; Saleh, Abdulhamid A.

doi:10.1093/infdis/jiw524

Cited by 25 publications

(20 citation statements)

References 20 publications

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“…Similar findings were observed in Tanga, where the prevalence of RVA declined from 29-41% [20,37] to 10-29% [37]. These results are complemented by other similar case control studies conducted in the post-vaccination era, which found a 44.9% reduction in rotavirus hospitalization in Manyara in 2015 [47] and reductions of 40%, 46%, and 69% in Zanzibar in 2013, 2014, and 2015, respectively [33]. The progressive reduction in rotavirus hospitalizations in Zanzibar, Mbeya, Dodoma and Moshi could be attributed to the increasing coverage of the rotavirus vaccine.…”

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vasupporting

confidence: 84%

“…In 2008, rotavirus alone accounted for one-third of diarrhea-related hospitalization and over 72% (8171/11,391) of diarrhea-related deaths in children under five in Tanzania [28,45,46]. The prevalence of RVA infection based on the detection of the RVA antigen in fecal samples from children under five in Tanzania has been reported to range from 9.5% to 51% (Figure 1), with most cases occurring in children under two years of age [20,[33][34][35][36]40,42]. A study in Mwanza in 2009 showed that children with rotavirus infection had prolonged hospital stays of 3.66 days compared to 2.5 days for children without rotavirus infection [42].…”

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vamentioning

confidence: 99%

“…Before vaccine introduction, the peak months were May 2009 and August 2011 in Tanga, May 2012 in Mwanza, May-July of 2010-2012 in Manyara and July 2010 and May of 2011-2012 in Zanzibar [33,37,47]. After vaccine introduction, the peaks in rotavirus cases were delayed for 1-4 months towards the end of the year; in Tanga, the peak was in September of 2014-2015; in Mwanza, it was in July 2014 and July and August of 2015; in Manyara, it was in August-October of 2013-2015 and in Zanzibar, it was in June and July of 2013, September 2014 and October 2015 [33,37]. This information on the changes in seasonal peaks after vaccine introduction is crucial for the timing of rotavirus investigations.…”

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vamentioning

confidence: 99%

“…The level of vaccine coverage was 85% 97%, 98%, 96%, and 100% in 2013, 2014, 2015, 2016, and 2017, respectively [32]. Several studies were conducted to determine the prevalence and genetic diversity of rotavirus in children under five before and after rotavirus vaccine introduction [20][21][22]31,[33][34][35][36][37][38][39][40][41][42][43][44]. The purpose of this review article is to elucidate the genetic diversity of rotavirus, potential changes in strain type and the change in rotavirus burden after the introduction of the rotavirus vaccine in Tanzania.…”

Section: Introductionmentioning

confidence: 99%

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Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

et al. 2019

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In Tanzania, rotavirus infections are responsible for 72% of diarrhea deaths in children under five. The Rotarix vaccine was introduced in early 2013 to mitigate rotavirus infections. Understanding the disease burden and virus genotype trends over time is important for assessing the impact of rotavirus vaccine in Tanzania. When assessing the data for this review, we found that deaths of children under five declined after vaccine introduction, from 8171/11,391 (72% of diarrhea deaths) in 2008 to 2552/7087 (36% of diarrhea deaths) in 2013. Prior to vaccination, the prevalence of rotavirus infections in children under five was 18.1–43.4%, 9.8–51%, and 29–41% in Dar es Salaam, Mwanza and Tanga, respectively, and after the introduction of vaccines, these percentages declined to 17.4–23.5%, 16–19%, and 10–29%, respectively. Rotaviruses in Tanzania are highly diverse, and include genotypes of animal origin in children under five. Of the genotypes, 10%, 28%, and 7% of the strains are untypable in Dar es Salaam, Tanga, and Zanzibar, respectively. Mixed rotavirus genotype infection accounts for 31%, 29%, and 12% of genotypes in Mwanza, Tanga and Zanzibar, respectively. The vaccine effectiveness ranges between 53% and 75% in Mwanza, Manyara and Zanzibar. Rotavirus vaccination has successfully reduced the rotavirus burden in Tanzania; however, further studies are needed to better understand the relationship between the wildtype strain and the vaccine strain as well as the zoonotic potential of rotavirus in the post-vaccine era.

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Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vasupporting

confidence: 84%

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vamentioning

confidence: 99%

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

et al. 2019

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“…Using this test-negative design, evaluations for rotavirus effectiveness have recently been reported in Malawi [89,90]. Studies of rotavirus effectiveness conducted in a range of LMICs from Africa and Latin America have also applied this design [91][92][93][94][95].…”

Section: Presentation and Packagingmentioning

confidence: 99%

Introducing new vaccines in low- and middle-income countries: challenges and approaches

Guignard

Praet

Jusot

et al. 2019

Expert Review of Vaccines

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Introduction: The number of new vaccine introductions (NVIs) in low and middle-income countries (LMICs) has markedly increased since 2010, raising challenges to often overstretched and underfunded health care systems. Areas covered: We present an overview of some of these challenges, focusing on programmatic decisions, delivery strategy, information and communication, pharmacovigilance and post-licensure evaluation. We also highlight field-based initiatives that may facilitate NVI. Expert commentary: Some new vaccines targeting populations other than infants require alternative delivery strategies. NVIs impact upon existing supply chain management, in particular vaccines with novel characteristics. A lack of understanding about immunization and misconceptions may be detrimental to NVI, as well as insufficient or poorly trained health care workforce. Many barriers exist to achieving good vaccination coverage. Real-world evaluation of vaccine safety, effectiveness and impact in LMICs may be limited by lack of robust demographic and disease epidemiology data, as well as limited health care and surveillance infrastructure. A thorough planning phase is crucial to define the most suitable delivery strategy based on the vaccine's and country's specificities. A communication plan and social mobilization are essential. Implementation research and innovative approaches applied to logistics, delivery, communication and program evaluation can facilitate NVI. ARTICLE HISTORY

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The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji

Jenney

Reyburn

Ratu

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: In 2012, Fiji became the first independent Pacific island country to introduce rotavirus vaccine. We describe the impact of rotavirus vaccine on all-cause diarrhoea admissions in all ages, and rotavirus diarrhoea in children < 5 years of age. Methods: An observational study was conducted retrospectively on all admissions to the public tertiary hospitals in Fiji (2007-2018) and prospectively on all rotavirus-positive diarrhoea admissions in children < 5 years at two hospital sites (2006-2018, and 2010-2015), along with rotavirus diarrhoea outpatient presentations at one secondary public hospital (2010-2015). The impact of rotavirus vaccine was determined using incidence rate ratios (IRR) of all-cause diarrhoea admissions and rotavirus diarrhoea, comparing the pre-vaccine and post-vaccine periods. All-cause admissions were used as a control. Multiple imputation was used to impute missing stool samples. Findings: All-cause diarrhoea admissions declined among all age groups except among infants ≤2 months old and adults ≥55 years. For children < 5 years, all-cause diarrhoea admissions declined by 39% (IRR) = 0 • 61, 95%CI; 0 • 57-0 • 65, p-value < 0 • 001). There was an 81% (95%CI; 51-94%) reduction in mortality among all-cause diarrhoea admissions in children under < 5 years. Rotavirus diarrhoea admissions at the largest hospital among children < 5 years declined by 87% (IRR = 0 • 13, 95%CI; 0 • 10-0 • 17, p-value < 0 • 001). Among rotavirus diarrhoea outpatient presentations, the IRR was 0 • 39 (95%CI; 0 • 11, 1.21, p-value = 0.077). Interpretations: Morbidity and mortality due to rotavirus and all-cause diarrhoea in Fiji has declined in people aged 2 months to 54 years after the introduction of the RV vaccine.

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Monovalent Rotavirus Vaccine Effectiveness and Impact on Rotavirus Hospitalizations in Zanzibar, Tanzania: Data From the First 3 Years After Introduction

Abstract: With data encompassing 3 years before and 3 years after vaccine introduction, our results indicate that successful delivery of RV1 on the current World Health Organization schedule can provide substantial health benefits in a resource-limited setting.

Cited by 25 publications

References 20 publications

Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

Introducing new vaccines in low- and middle-income countries: challenges and approaches

The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji

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