Rotavirus gastroenteritis hospitalizations in provinces with different vaccination coverage rates in Spain, 2013–2018

Abstract

Background Rotavirus (RV) vaccines are available in Spain since 2006 but are not included in the National Immunization Program. RV vaccination has reached an intermediate vaccination coverage rate (VCR) but with substantial differences between provinces. The aim of this study was to assess the ratio of RV gastroenteritis (RVGE) admissions to all-cause hospitalizations in children under 5 years of age in areas with different VCR. Methods Observational, multicenter, cross-sectional, medical record-based study. All children admitted to the study hospitals with a RVGE confirmed diagnosis during a 5-year period were selected. The annual ratio of RVGE to the total number of all-cause hospitalizations in children < 5 years of age were calculated. The proportion of RVGE hospitalizations were compared in areas with low (< 30%), intermediate (31–59%) and high (> 60%) VCR. Results From June 2013 to May 2018, data from 1731 RVGE hospitalizations (16.47% of which were nosocomial) were collected from the 12 study hospitals. RVGE hospital admissions accounted for 2.82% (95 CI 2.72–3.00) and 43.84% (95% CI 40.53–47.21) of all-cause and Acute Gastroenteritis (AGE) hospitalizations in children under 5 years of age, respectively. The likelihood of hospitalization due to RVGE was 56% (IC95%, 51–61%) and 27% (IC95%, 18–35%) lower in areas with high and intermediate VCR, respectively, compared to the low VCR areas. Conclusions RVGE hospitalization ratios are highly dependent on the RV VCR. Increasing VCR in areas with intermediate and low coverage rates would significantly reduce the severe burden of RVGE that requires hospital management in Spain. Clinical trial registration Not applicable

The Economic Value of Rotavirus Vaccination When Optimally Implemented in a High-Income Country

“…Modelling these elements has helped to clarify the indirect effects of the vaccine that increase or reduce the herd effect, influencing the net vaccine effect and explaining the appearance of new disease peaks over time with a shift to older children as the primary source of infection [ 22 ]. The data from Spain confirm the findings in Belgium with a sub-optimal launch of rotavirus vaccination [ 32 , 47 ]. The data from Finland and the UK may prove that initiating the vaccine programme earlier in the year and with an immediately high coverage achieves greater reductions in hospitalisation, compared with what was observed in Belgium [ 38 , 48 , 49 ].…”

“…Countries across Europe have launched rotavirus vaccination programmes that differ from the Belgian launch in their initial vaccine coverage rates and date of initiating the vaccination programme. Figure 7 A shows hospitalisation rates in the vaccine uptake period in three other countries in Europe that introduced rotavirus vaccination and for which data were available in the public domain [ 30 , 31 , 32 ]. Figure 7 B shows the results when these data are applied in the model for the full 13-year period.…”

“…An intermediate launch scenario was considered with a launch in October and an initial vaccine coverage rate of 67% to evaluate intermediate effects (intermediate) in contrast to the optimum launch strategy (optimal) or the borderline cost-impact results (Belgium). Launch data from other countries in Europe, Finland, the UK, and Spain, [ 30 , 31 , 32 ] could help to assess these simulations.…”

Clinical characteristics, health care resource utilization and direct medical costs of Rotavirus hospitalizations in Spain (2013–2018)

“…Our findings showed a significant health resource utilization and costs related to the management of severe cases of RVGE requiring hospital treatment in a country with intermediate vaccination coverage rate. Results from a previous analysis in the hospitals participating in this study, published elsewhere, 10 showed that the RVGE-related hospitalization ratios were highly dependent on the vaccination coverage rates, suggesting that the increase in the vaccination coverage rate would significantly impact the related healthcare resource utilizations and costs.…”

“…They are used under pediatricians’ recommendations and fully paid by parents, reaching an intermediate vaccination coverage rate with significant differences among regions. It has been shown that, in this context of suboptimal vaccination, the burden of hospitalization due to RVGE in Spain is still relevant 10 and, therefore, may lead to a substantial economic impact to the healthcare system.…”