Journal List > Pediatr Infect Vaccine > v.25(1) > 1098701

Yoon, Han, Yoon, Kim, and Oh: Changes in the Occurrence of Rotavirus Gastroenteritis before and after the Introduction of Rotavirus Vaccine among Hospitalized Pediatric Patients and Estimates of Rotavirus Vaccine Effectiveness

Abstract

Purpose

This study aimed to investigate the changes in the occurrence of rotavirus gastroenteritis (RGE) after the introduction of rotavirus vaccine and estimate rotavirus vaccine effectiveness in hospitalized children.

Methods

We compared the retrospective data of 671 patients with acute gastroenteritis (AGE) admitted to the Department of Pediatrics, Hanyang University Seoul Hospital from January 1, 2014, to December 31, 2015, with retrospective data of 1,243 patients admitted to the same institution with AGE from January 1, 2004, to December 31, 2005. The vaccine effectiveness was estimated using a case-positive control test-negative study.

Results

The proportion of RGE in AGE was significantly lower in 2014 to 2015 (9.0%, 48/531) than in 2004 to 2005 (22.7%, 282/1,243) (P<0.001). In particular, there was a significant decrease in the 6- to 11-, 12- to 23-, and 24- to 35-month-old groups (P<0.001), whose rotavirus vaccination rates were higher than the remaining age groups. The monthly distribution of patients with RGE in 2004 to 2005 was higher from November to May, peaked in January, followed by December and February. In 2014 to 2015, the monthly distribution of patients with RGE slightly peaked in January. In 2014 to 2015 study, the complete rotavirus vaccination rate was 66.0% (332/503) and incomplete vaccination rate was 6.2% (31/503). Presumed rotavirus vaccine effectiveness was 83.3% (95% confidence interval [CI], 60.5% to 92.9%) in the complete vaccination group and 27.4% (95% CI, –163.7% to 80.0%) in the incomplete group.

Conclusions

The proportion of RGE in AGE has markedly decreased since the introduction of rotavirus vaccines, and improving vaccination coverage will further reduce the burden of RGE in Korea.

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Fig. 1.
Monthly distribution of patients with rotavirus gastro enteritis (RGE) and acute gastroenteritis (AGE).
piv-25-26f1.tif
Table 1.
Age Distribution of Patients with Acute Gastroenteritis and Rotavirus Gastroenteritis
Age group 2004–2005 2014–2015 P-value
AGE RGE RGE/AGE (%) AGE RGE RGE/AGE (%)
0–5 mo 278 (22.4) 39 (13.9) 14.0 152 (22.7) 20 (41.7) 13.2 1.000
6–11 mo 266 (21.4) 48 (17.0) 18.0 78 (11.6) 0 0 <0.001
12–23 mo 322 (25.9) 112 (39.7) 34.8 127 (18.9) 12 (25.0) 9.4 <0.001
24–35 mo 142 (11.4) 46 (16.3) 32.4 67 (10.0) 4 (8.4) 6.0 <0.001
36–47 mo 89 (7.2) 19 (6.8) 21.3 42 (6.3) 5 (10.4) 12.0 0.332
48–59 mo 68 (5.5) 13 (4.6) 19.1 35 (5.2) 1 (2.1) 2.9 1.000
60 mo–18 yr 78 (6.3) 5 (1.8) 6.4 170 (25.3) 6 (12.6) 3.5 0.546
Total 1,243 (100) 282 (100) 22.7 671 (100) 48 (100) 7.2 <0.001

Values are presented as number (%).

P-value was obtained by the chi-square test comparing the ratio of RGE to AGE in each age group between the two study periods.

Abbreviations: AGE, acute gastroenteritis; RGE, rotavirus gastroenteritis.

Table 2.
Rotavirus Vaccination Status in Patients with Acute Gastroenteritis in 2014 to 2015 Study
Vaccination status p Rotavirus (+) patients (n=29) Rotavirus (+) patients/ total AGE patients P-value
Received completely 8 (27.6) 8/332 (2.4) <0.001
Received incompletely 3 (10.3) 3/31 (9.7)  
Not received 18 (62.1) 18/140 (12.9)  
Total 29 (100.0) 29/503 (5.8)  

Values are presented as number (%).

The association between the status of rotavirus vaccination and the rate of positive stool rotavirus antigen test was analyzed by the Fisher exact test.

One hundred and sixty-eight patients with acute gastroenteritis and 19 patients with rotavirus gastroenteritis were excluded because they were not eligible for rotavirus vaccination since they were born before 2007 or under 2 months of age on study enrollment. The age of vaccinated children is between 2 and 93 months. Abbreviation: AGE, acute gastroenteritis.

Table 3.
Rotavirus Vaccination Rate by Birth Year in 2014 to 2015 Study
Birth year Vaccination rate
Complete Incomplete Total
2007 0/7 (0) 0/7 (0) 0/7 (0)
2008 5/34 (14.7) 1/34 (2.9) 6/34 (17.6)
2009 12/33 (36.4) 3/33 (9.1) 15/33 (45.5)
2010 24/41 (58.5) 1/41 (2.4) 25/41 (60.9)
2011 22/36 (61.1) 6/36 (16.7) 28/36 (77.8)
2012 55/79 (69.6) 5/79 (6.3) 60/79 (75.9)
2013 106/131 (80.9) 4/131 (3.1) 110/131 (84.0)
2014 81/106 (76.4) 5/106 (4.7) 86/106 (81.1)
2015 27/34 (79.4) 6/34 (17.6) 33/34 (97.0)
Total 332/501 (66.3) 31/501 (6.2) 363/501 (72.5)

Values are presented as number (%).

Table 4.
Comparison of Demographic and Clinical Characteristics of Rotavirus Gastroenteritis between Vaccinated Group and Unvaccinated Group (2014 to 2015)
Characteristic Vaccinated (n=11) Unvaccinated (n=37) P-value
Age (mo) 23.5±23.7 22.7±41.7 0.111
Sex ratio (male:female) 8:3 23:14 0.723
Hospital day 4.1±2.7 4.1±2.0 0.345
Fever 7 (63.6) 16 (43.2) 0.311
Duration of fever (day) 1.3±1.6 0.7±0.9 0.228
Vomit 7 (63.6) 21 (56.8) 0.741
Diarrhea 5 (45.6) 22 (59.5) 0.498

Values are presented as mean±standard deviation or number (%).

P-value was measured by t-test.

P-value was measured by chi-square test.

Table 5.
Rotavirus Vaccine Effectiveness in 2014 to 2015 Study
Vaccination status Rotavirus-positive patients (n=29) Rotavirus-negative control patients (n=474) VE (95% CI) (%)
Not received 18 (62.1) 122 (25.7) Reference
Incomplete vaccination 3 (10.3) 28 (5.9) 27.4 (–163.7 to 80.0)
Complete vaccination 8 (27.6) 324 (68.4) 83.3 (60.5 to 92.9)

Values are presented as number (%).

Adjusted for age at hospitalization, month/year of birth, and sex.

Abbreviations: VE, vaccine effectiveness; CI, confidence interval.

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