A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel

Abstract

Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008–2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011–2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0–23 months (60–61%) than in toddlers aged 24–59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.

Keywords:

• children
• impact
• Israel
• RotaTeq
• rotavirus
• universal vaccination

Disclosure of Potential Conflicts of Interest

No potential conflicts of interest were disclosed.

Acknowledgments

We would like to thank the research staff at the participating medical centers: Fatma Abu Rakia, Sarit Primer, Tali Zim, Pninit Shaked-Mishan, Meissa Yunes and Ana Rimer. We would also like to thank Dr. Emilia Anis from the Ministry of Health for providing rotavirus vaccine coverage data, and Anya Bialik and Michael Brik from Tel Aviv University for technical assistance in conducting the study.

Funding

The first year of the study was funded by the World Health Organization, Department of Immunization, Vaccination and Biologicals (V27–181–190). Funding for the remaining years was provided by the Israel National Institute for Health Policy and Research (grant 2011/15).