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Vaccine. 2018 Nov 12;36(47):7135-7141. doi: 10.1016/j.vaccine.2018.01.072. Epub 2018 May 10.

Impact of routine rotavirus vaccination on all-cause and rotavirus hospitalizations during the first four years following vaccine introduction in Rwanda.

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Expanded Program of Immunization, Ministry of Health, Rwanda.
WHO Country Office, Kigali, Rwanda.
WHO Regional Office for Africa, Brazzaville, Congo.
Maternal Child Health (MCCH) Division, Ministry of Health, Rwanda.
WHO Country Office Consultant, Kigali, Rwanda.
Kigali University Teaching Hospital (CHUK), Rwanda.
CDC Atlanta, USA.
CDC Atlanta, USA. Electronic address:



Rwanda introduced pentavalent rotavirus vaccine into its national immunization program in 2012. To determine the long-term impact of rotavirus vaccine on disease burden in a high burden setting, we examined trends in rotavirus and all-cause diarrhea hospitalizations in the first four years following rotavirus vaccine introduction.


We used data from an active surveillance system, from a review of pediatric ward registries, and from the Health Management Information System to describe trends in rotavirus and all-cause diarrhea hospitalizations from January 2009 through December 2016. Percent reductions were calculated to compare the number of all-cause and rotavirus diarrhea hospitalizations pre- and post-rotavirus vaccine introduction.


The proportion of diarrhea hospitalizations due to rotavirus declined by 25-44% among all children <5 years of age during 2013-2015 with a shift in rotavirus hospitalizations to older age groups. The proportion of total hospitalizations due to diarrhea among children <5 years of age decreased from 19% pre-vaccine introduction to 12-13% post-vaccine introduction. In the national hospital discharge data, substantial decreases were observed in all-cause diarrhea hospitalizations among children <5 years of age in 2013 and 2014 but these gains lessened in 2015-2016.


Continued monitoring of long-term trends in all-cause diarrhea and rotavirus hospitalizations is important to ensure that the impact of the vaccination program is sustained over time and to better understand the changing age dynamics of diarrhea and rotavirus hospitalizations in the post-vaccine introduction era.


Rotavirus; Rotavirus vaccine; Rwanda

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