The results of rotavirus vaccine implementation in the Republic of Moldova
Keywords:
rotavirus, surveillance, vaccine effectivenessAbstract
The Republic of Moldova was one of the first countries with different incomes in the European region of the World Health Organization to introduce the rotavirus vaccine (July 2012). Intended purpose to evaluate the impact of the rotavirus vaccination program and to estimate the effectiveness of the rotavirus vaccine. Surveillance of rotavirus gastroenteritis was carried out in 2 hospitals of the capital Chisinau since September 2009. Monthly age-related rotavirus admissions were examined before and after the introduction of rotavirus vaccination using interrupted time-series molecular biology analyses. We conducted a case-control study of vaccine efficacy by comparing patients with rotavirus case with test-negative participants. Coverage with at least 1 dose of vaccine increased from 35% in the first year to 55% in the second year for children under 1 year of age. The percentage of positive admissions for rotavirus decreased from 45% in the post-vaccination period to 25%. Rate reduction of 36% (confidence interval [CI] 95%) in the first year and 14% (rate reduction, 67%) in the second year after vaccine introduction, among children under 5 years of age. The most pronounced reductions were among children up to 1 year old. These significant reductions in gastroenteritis among vaccinated cohorts with age for vaccination suggest indirect benefits. The effectiveness of the two-dose vaccine was 79% against hospitalization with rotaviruses and 84% against cases with moderate to severe manifestations. The results obtained consistently indicate the profound impact on the direct and group immunity of the rotavirus vaccination program in children up to 5 years of age. There remains the potential for further disease reduction.
References
1. Tate J.E., Burton A.H., Boschi-Pinto C,.et al. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12:136-41. https://doi.org/10.1016/S1473-3099(11)70253-5
2. Liu L., Johnson H.L., Cousens S. et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379:2151-61. https://doi.org/10.1016/S0140-6736(12)60560-1
3. Liu L., Oza S., Hogan D. et al. Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 2015; 385:430-40. https://doi.org/10.1016/S0140-6736(14)61698-6
4. Yen C., Tate J.E., Hyde T.B. et al. Rotavirus vaccines: current status and future considerations. Hum Vaccin Immunother 2014; 10:1436-48. https://doi.org/10.4161/hv.28857
5. World Health Organization. Generic protocols for (i) hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children and (ii) a community-based survey on utilization of health care services for gastroenteritis in children. Geneva, Switzerland. 2002. Available at: http://apps.who.int/iris/bitstream/10665/67743/1/WHO_v-b02.15_eng.pdf.
6. Ruuska T., Vesikari T. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis 1990; 22:259-67. https://doi.org/10.3109/00365549009027046
7. Hosmer D.W., Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley, 2000. https://doi.org/10.1002/0471722146
8. Soares-Weiser K., Maclehose H., Bergman H. et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev 2012; 11: CD008521. https://doi.org/10.1002/14651858.CD008521.pub2
9. de Palma O., Cruz L., Ramos H. et al. Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study. BMJ 2010; 340: c2825 https://doi.org/10.1136/bmj.c2825
10. Justino M.C., Linhares A.C., Lanzieri T.M. et al. Effectiveness of the monovalent G1P[2] human rotavirus vaccine against hospitalization for severe G2P[3] rotavirus gastroenteritis in Belem, Brazil. Pediatr Infect Dis J 2011; 30: 396-401. https://doi.org/10.1097/INF.0b013e3182055cc2
11. Patel M.M., Patzi M., Pastor D. et al. Effectiveness of monovalent rotavirus vaccine in Bolivia: case-control study. BMJ 2013; 346:f3726.
https://doi.org/10.1136/bmj.f3726
12. Ichihara M.Y., Rodrigues L.C., Teles Santos C.A. et al. Effectiveness of rotavirus vaccine against hospitalized rotavirus diarrhea: a case-control study. Vaccine 2014; 32:2740-7. https://doi.org/10.1016/j.vaccine.2014.01.007
13. Cotes-Cantillo K., Paternina-Caicedo A., Coronell-Rodriguez W. et al. Effectiveness of the monovalent rotavirus vaccine in Colombia: a case-control study. Vaccine 2014; 32:3035-40. https://doi.org/10.1016/j.vaccine.2014.03.064
14. Gastanaduy P.A., Curns A.T., Parashar U.D., Lopman B.A. Gastroenteritis hospitalizations in older children and adults in the United States before and after implementation of infant rotavirus vaccination. JAMA 2013; 310:851-3. https://doi.org/10.1001/jama.2013.170800
15. Yen C., Armero Guardado J.A., Alberto P. et al. Decline in rotavirus hospitalizations and health care visits for childhood diarrhea following rotavirus vaccination in El Salvador. Pediatr Infect Dis J 2011; 30(1 suppl):S6-10. https://doi.org/10.1097/INF.0b013e3181fefa05
16. Buttery J.P., Lambert S.B., Grimwood K. et al. Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australia's national childhood vaccine schedule. Pediatr Infect Dis J 2011; 30(1 suppl):S25-9. https://doi.org/10.1097/INF.0b013e3181fefdee
17. Paulke-Korinek M., Kundi M., Rendi-Wagner P. et al. Herd immunity after two years of the universal mass vaccination program against rotavirus gastroenteritis in Austria. Vaccine 2011; 29:2791-6. https://doi.org/10.1016/j.vaccine.2011.01.104
18. Standaert B., Gomez JA, Raes M., Debrus S., Velazquez FR, Postma MJ. Impact of rotavirus vaccination on hospitalisations in Belgium: comparing model predictions with observed data. PLoS One 2013; 8:e53864. https://doi.org/10.1371/journal.pone.0053864
19. Gheorghita S., Birca L., Donos A., Annemarie Wasley, Birca I., Cojocaru R., Melnick A., Ciobanu S., Mosina L., Margaret M. Cortese, Umesh D. Parashar and Ben Lopman. Impact of rotavirus vaccine introduction and vaccine effectiveness in the Republic of Moldova. In: Clinical Infectious Diseases. 2016, 62 (Suppl 2), 140-146, ISSN 1058-4838. https://doi.org/10.1093/cid/civ1209
20. Bîrcă I., Alsaliem T., Spînu C., Donos A., Burduniuc O. Aspecte epidemiologice şi clinico-evolutive ale infecției rotavirale la copiii sugari în Republica Moldova. Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale. 2017; 1(53): 33-35
21. Donos A., Spînu C., Alsaliem T., Gheorghiță S. şi alții. Boala diareică acută virală la copii. Editura PIM, Iaşi, România, 2021. ISBN 978-606-13-6648-4. 166 pagini.
22. Juravliov T., Bîrcă I., Spînu C., Bîrca L., Rusu G., Caterinciuc N., Cornilova S., Tatarciuc R. Caracteristica clinico-epidemiologică şi particularitățile molecular-genetice ale infecției rotavirale în Republica Moldova. Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale. 2017; 1(53): 97-100.
23. Alsaliem T. Impactul clinico-epidemiologic urmare a vaccinării în infecția cu rotavirusuri la copii sugari. Rezumatul tezei de doctor în ştiințe medicale. Editura "PRINT-CARO", 2020, 30 pagini.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
