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J Epidemiol Community Health. 2019 Nov;73(11):1020-1025. doi: 10.1136/jech-2019-213055. Epub 2019 Sep 11.

Reduction in hospitalisations for acute gastroenteritis-associated childhood seizures since introduction of rotavirus vaccination: a time-series and change-point analysis of hospital admissions in England.

Author information

1
Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK d.hungerford@liverpool.ac.uk.
2
NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom.
3
NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom.
4
Field Service, National Infection Service, Public Health England, Liverpool, UK.
5
Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
6
Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, United Kingdom.
7
Centre for Health Informatics, Computing and Statistics, Lancaster University, Faculty of Health and Medicine, Lancaster, UK.
8
Department of Microbiology, Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, United Kingdom.

Abstract

INTRODUCTION:

The incidence of severe childhood diarrhoea has fallen substantially following the introduction of rotavirus vaccine in the UK in July 2013. Since children with rotavirus infection may experience febrile and afebrile seizures, we evaluated the impact of rotavirus vaccination on seizure hospitalisations in children in England.

METHODS:

Using data from Hospital Episode Statistics, we employed interrupted time-series analyses to assess changes in monthly hospital admissions for seizures among children aged <5 years from July 2000 to June 2017. Outcome measures comprised all seizures and febrile seizures, with and without a co-diagnosis of acute gastroenteritis (AGE). Models were adjusted for pneumococcal conjugate vaccine (PCV) introduction. Change-point analysis was used to independently identify step-changes in the time-series.

RESULTS:

Among hospitalised children aged <5 years, the incidence of any seizures and febrile seizures with AGE decreased post-vaccine introduction by 23% (95% CI: 11% to 33%) and 31% (95% CI: 19% to 41%), respectively. For febrile seizures with AGE, a single change-point was identified in July 2013 (95% CI: June 2013 to December 2013). Reductions in seizure incidence were higher during the rotavirus season (49%, 95% CI: 37% to 58%) compared with out-of-season (13%, 95% CI: -4 to 28%) and showed no relation to PCV introduction. There were small reductions in any seizures with any co-diagnosis (4%, 95% CI: 0% to 8%) and in febrile seizures with any co-diagnosis (10%, 95% CI: 2% to 16%).

CONCLUSION:

Rotavirus vaccination has reduced hospitalisations for seizures associated with AGE in England, providing additional evidence of population-level impact of rotavirus vaccination on seizure incidence in high-income countries.

KEYWORDS:

diarrhoea; effectiveness; epidemiological methods; time-series; vaccination

Conflict of interest statement

Competing interests: NAC, NF, MI-G, RV and DJH are in receipt of research grant support from GlaxoSmithKline (GSK) Biologicals. Outside of this study, MI-G and DJH are in receipt of research grant support on the topic of rotavirus vaccines from Sanofi Pasteur, and Merck & Co (Kenilworth, New Jersey, USA) after the closure of Sanofi Pasteur-MSD in December 2016. NAC has received honoraria for participation in GSK Rotavirus Vaccine DSMB meetings.

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