Acute Gastroenteritis Morbidity and Mortality Trends Following Universal Rotavirus Vaccination in Children in Peru: Ecological Database Study with Time-Trend Analysis,Infectious Diseases and Therapy

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Acute Gastroenteritis Morbidity and Mortality Trends Following Universal Rotavirus Vaccination in Children in Peru: Ecological Database Study with Time-Trend Analysis
Infectious Diseases and Therapy ( IF 4.7 ) Pub Date : 2021-09-05 , DOI: 10.1007/s40121-021-00532-5
Patricia Juliao ₁ , Adriana Guzman-Holst ₁ , Vinay Gupta ₂ , Claudia Velez ₂ , Veronica Petrozzi ₃ , Theresa J Ochoa ₄

Affiliation

Introduction

Rotavirus (RV) infection is the leading cause of severe diarrhea in children worldwide. It is responsible for around 25% of gastroenteritis (GE) cases, 33% of hospitalized GE cases, and an annual mortality rate of 113.4/100,000 in children < 5 years of age in Peru. RV infant vaccination is recommended by the World Health Organization and provides the best public health strategy to manage the disease. Universal RV vaccination was introduced in Peru in 2009.

Methods

Trends in GE ambulatory visits, hospitalizations, and deaths in children < 5 years of age are described in the pre-vaccination (2004–2008) versus post-vaccination (2010–2018) periods. Time-trend analysis was performed (using generalized linear regression models) to assess the impact of vaccination nationwide and by region after adjusting for variables.

Results

Between 2009 and 2011, vaccination coverage increased to over 80% in Peru. In infants < 1 year of age, GE ambulatory cases, hospitalizations, and deaths decreased in the post-vaccination period by 40.3%, 46.2%, and 55.5%, respectively (and in children < 5 years of age, by 34.4%, 41.9%, and 54.3%, respectively) compared with the pre-vaccination period. Results of the multivariate time-trend analysis also found significant decreases in the post-vaccination period of 10.7% (GE ambulatory cases), 17.2% (GE hospitalizations), and 37.3% (GE mortality) in children < 5 years of age. Data analyzed by region varied, with Costa and Sierra regions generally in line with the national findings; however, some findings were less robust for Selva due to fewer available data.

Conclusion

After 9 years of RV vaccination in Peru, there appears to be a statistically significant positive impact of vaccination, in terms of reducing GE-related mortality, hospitalizations, and ambulatory visits in infants and young children. For policymakers to understand regional differences and future vaccination needs, continued improvement in surveillance is needed.

Graphical Abstract

中文翻译：

秘鲁儿童普遍接种轮状病毒疫苗后急性胃肠炎的发病率和死亡率趋势：具有时间趋势分析的生态数据库研究

介绍

轮状病毒 (RV) 感染是全球儿童严重腹泻的主要原因。它导致了大约 25% 的胃肠炎 (GE) 病例、33% 的住院 GE 病例，以及秘鲁 5 岁以下儿童的年死亡率为 113.4/100,000。RV 婴儿疫苗接种是世界卫生组织推荐的，它提供了管理该疾病的最佳公共卫生策略。秘鲁于 2009 年引入了通用 RV 疫苗接种。

方法

接种前 (2004-2008) 与接种后 (2010-2018) 期间描述了 5 岁以下儿童的 GE 门诊就诊、住院和死亡的趋势。进行时间趋势分析（使用广义线性回归模型）以在调整变量后评估全国和各地区疫苗接种的影响。

结果

2009 年至 2011 年间，秘鲁的疫苗接种覆盖率增加到 80% 以上。在<1岁的婴儿中，接种疫苗后的GE门诊病例、住院和死亡分别减少了40.3%、46.2%和55.5%（而在<5岁儿童中，减少了34.4%、41.9 % 和 54.3%）与接种前相比。多变量时间趋势分析的结果还发现，< 5 岁儿童在接种后期间显着降低 10.7%（GE 门诊病例）、17.2%（GE 住院）和 37.3%（GE 死亡率）。各地区分析的数据各不相同，Costa 和 Sierra 地区总体上与国家调查结果一致；然而，由于可用数据较少，Selva 的一些研究结果不太可靠。