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Clin Infect Dis. 2018 Dec 23. doi: 10.1093/cid/ciy1096. [Epub ahead of print]

Monovalent rotavirus vaccine effectiveness against rotavirus hospitalizations among children in Zimbabwe.

Author information

1
Harare Central Hospital, University of Zimbabwe, Harare, Zimbabwe.
2
Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe.
3
Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
4
Parirenyatwa Group Hospitals, Harare, Zimbabwe.
5
Chitungwiza Central Hospital, Chitungwiza, Zimbabwe.
6
National Virology Laboratory, Harare, Zimbabwe.
7
Epidemiology and Disease Control, Ministry of Health and Child Care, Harare, Zimbabwe.
8
World Health Organization Country Office, Harare, Zimbabwe.
9
World Health Organization, Intercountry Support Team, Harare, Zimbabwe.
10
World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo.

Abstract

Background:

Rotavirus is a leading cause of mortality among children <5 years old. Zimbabwe introduced rotavirus vaccine in May 2014. We evaluated monovalent rotavirus vaccine effectiveness (VE) under conditions of routine use at two surveillance sites in Harare, Zimbabwe.

Methods:

Children <5 years of age hospitalized or treated in the accident and emergency department (A&E) for acute watery diarrhea were enrolled for routine surveillance. Copies of vaccination cards were collected and reviewed to document the vaccination status of enrolled children. Among children age-eligible to receive rotavirus vaccine, we estimated VE, calculated as 1-odds ratio, using a test-negative case-control design.

Results:

We included 903 rotavirus positive cases and 2,685 rotavirus negative controls in the analysis; 99% had verified vaccination status. Rotavirus positive children had more severe diarrhea than rotavirus negative children; 61% of cases and 46% of controls had a Vesikari score ≥11 (p<0.01). Among cases, 31% were stunted for their age; 37% of controls were stunted (p<0.01). Among children 6-11 months old, adjusted 2-dose VE against hospitalization or treatment in A&E due to rotavirus of any severity was 61% (95%CI: 21, 81) and 68% (95%CI: 13, 88) against severe rotavirus disease. Stratified by nutritional status, adjusted VE was 45% (95%CI: -148, 88) among stunted infants and 71% (95%CI: 29, 88) among infants with a normal height-for-age.

Conclusion :

onovalent rotavirus vaccine is effective in preventing hospitalizations due to severe rotavirus diarrhea among infants in Zimbabwe providing additional evidence for countries considering rotavirus vaccine introduction that live, oral rotavirus vaccines are effective in high child mortality settings.

PMID:
30590488
DOI:
10.1093/cid/ciy1096

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