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Vaccine. 2014 Jun 5;32(27):3402-8. doi: 10.1016/j.vaccine.2014.04.015. Epub 2014 Apr 13.

Impact of rotavirus vaccination on diarrhea-related hospitalizations in São Paulo State, Brazil.

Author information

1
Field Epidemiology Training Program/São Paulo State (EPISUS-SP), Secretaria de Estado da Saúde de São Paulo, Avenida Dr Arnaldo, 35, 6th floor, São Paulo, SP 01246-000, Brazil. Electronic address: edergatti@hotmail.com.br.
2
Division of Immunization, São Paulo State Health Department, Avenida Dr Arnaldo, 35, 6th floor, São Paulo, SP 01246-000, Brazil. Electronic address: hsato@saude.sp.gov.br.
3
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Diseases Control and Prevention, 1600 Clifton Rd, MS A-34, Atlanta, GA 30333, United States. Electronic address: wgp9@cdc.gov.
4
Centers for Diseases Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States. Electronic address: bif4@cdc.gov.br.
5
Field Epidemiology Training Program/São Paulo State (EPISUS-SP), Secretaria de Estado da Saúde de São Paulo, Avenida Dr Arnaldo, 35, 6th floor, São Paulo, SP 01246-000, Brazil. Electronic address: tcroma@saude.sp.gov.br.
6
Departamento de Medicina Social, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr. Cesário Mota Jr., 61, 6th floor, São Paulo, SP 01221-020, Brazil. Electronic address: maria.veras@gmail.com.
7
Division of Viral Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Rd, MS A-34, Atlanta, GA 30333, United States. Electronic address: aul3@cdc.gov.

Abstract

INTRODUCTION:

Following introduction of routine infant rotavirus vaccination, severe diarrhea hospitalization rates declined among children aged <5 years throughout Brazil. Ensuring equity of rotavirus vaccine impact is important in countries that self-finance immunization programs. The objective of this study was to examine rotavirus vaccine impact on diarrhea admission rates among children aged <5 years in Brazil's public health system, according to area-based measures of human development in the state of São Paulo, Brazil.

METHODS:

Ecological analysis of public health system hospitalization rates for acute gastroenteritis among children aged <5 years in the state of São Paulo, Brazil, according to five categories of municipal development based on a modified Human Development Index for municipalities. Acute gastroenteritis hospitalization rates among children aged <5 years after national rotavirus vaccine introduction (2008-2011) were compared to rates in pre-vaccine years (2000-2005) to calculate percent decline in rates (1-rate ratio) and 95% confidence intervals (CI) for each municipal development category. Direct hospitalization costs during the two periods were compared.

RESULTS:

Annual rates declined by 40% (95% CI, 39-42%) from 631 diarrhea hospitalizations per 100,000 person years pre-rotavirus vaccination to 377 per 100,000 post-vaccination among children aged <5 years and 50% (95% CI, 48-52%) from 1009 to 505 per 100,000 among infants. Highest rates were observed in least developed municipalities. Significant declines of 26-52% among children <5 years and 41-63% among infants were observed in all categories of municipal development. Lower diarrhea hospitalization rates resulted in annual savings of approximately 2 million USD for the state of São Paulo. Savings in direct hospitalization costs benefitted municipalities in all five categories.

CONCLUSION:

The introduction of rotavirus vaccination was associated with substantial reductions of diarrhea-related admissions at all levels of municipal development in São Paulo State, Brazil.

KEYWORDS:

Brazil; Diarrhea; Rotavirus; Vaccine

PMID:
24736002
DOI:
10.1016/j.vaccine.2014.04.015
[Indexed for MEDLINE]
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