The Sustained Rotavirus Vaccination Impact on Nosocomial Infection, Duration of Hospital Stay, and Age: The RotaBIS Study (2005–2012)

Abstract

IntroductionThe benefits of rotavirus (RV) vaccination in developed countries have focused on reductions in mortality, hospitalization and medical visits, and herd protection. We investigated other aspects related to RV-induced nosocomial infection, duration of hospital stay, age shift, and sustained vaccine impact (VI) over time.MethodRotaBIS (Rotavirus Belgian Impact Study; ClinicalTrials.gov identifier, NCT01563146) annually collects retrospective data on hospitalization linked to RV testing in children up to 5 years old from 11 pediatric wards located all over Belgium. Data from 2005 to 2012 have been split in pre- (2005–2006) and post-vaccination (2007–2012) period. Information was collected on age, gender, RV test result, nosocomial infection caused by RV and duration of hospital stay.ResultsOver the 6-year period after the introduction of the RV vaccine, an 85% reduction in nosocomial infections was observed (221 in 2005 to 33 in 2012, p < 0.001). A significant reduction of almost 2 days in average duration of hospital stay per event was observed overall (7.62 days in 2005 to 5.77 days in 2012, p < 0.001). The difference is mainly explained by the higher reduction in number of nosocomial infections. A pronounced age shift (+24%, p < 0.01) of RV nosocomial infection to infants ≤2 months old was observed, increasing with length of post-vaccination period. VI was maintained over the follow-up (±79% VI per birth cohort). A decrease was seen depending on age, 85% (95% CI 76–91%) in the youngest to 63% (95% CI 22–92%) in the oldest age group.ConclusionThe higher reduction in nosocomial infection may affect the overall average duration of hospital stay for RV infection. No change in VI by birth cohort, but a reduction by age group was observed. These findings could be important for decision-makers considering the introduction of universal mass RV vaccination programs.Trial registrationClinicalTrials.gov identifier, NCT01563146.FundingGlaxoSmithKline Biologicals SA (Rixensart, Belgium).

3. How comprehensive can we be in the economic assessment of vaccines?

“…The total value of the vaccine could then be considered poor and that is what decision-makers in European countries have looked at. However, because of the high herd protection level obtained during the first years after vaccine introduction (with a high coverage rate), we observe two benefits that have been poorly investigated and reported in the literature [43,44]. One is the quality of care improvement in the hospital environment during the winter periods after the introduction of the vaccine, which could be critical for hospital managers and healthcare providers as they improve the quality of care of their institutions [45].…”

Vaccine Safety and Efficacy in Preventing Rotavirus Infection

“…Популяционный иммунитет приводит к снижению количества случаев заболеваний ротавирусным гастроэнтеритом, требующих госпитализации, и таких осложнений РВИ, как почечная недостаточность, судороги, энцефалит и энцефалопатия [9][10][11]. Все это способствует значительному снижению затрат на медицинское обслуживание как в амбулаторном, так и госпитальном секторах (с учетом внутрибольничных инфекций) 11 [12].…”

“…Целесообразность массовой вакцинации в странах мира связана с оценкой бюджетных затрат на ее проведение в соответствии с предлагаемыми ВОЗ механизмами оценки 12 [13][14][15] [5]), ягненка LLR G10P [12] (Lanzhou lamb rotavirus vaccine). Эффективность вакцины против ротавирусного гастроэнтерита (на основе штамма RIT4237) колебалась от 0 до 64 %, а против тяжелых форм -от 0 до 84 %.…”

2. How is the economic assessment of vaccines performed today?

“…For instance, when rotavirus vaccine was introduced in the European market in 2006, it took time (years) to have the vaccination implemented because of lack of budget availability, organisational changes required to start a new vaccination program, and the need to convince many stakeholders of the hidden benefits of the vaccine. The introduction could have been better prepared, with better understanding of the data from the randomised clinical trial, and identifying specific gains such as the reduction in nosocomial infections that were not measured during the trial [13]. …”