Impact of a twelve-year rotavirus vaccine program on acute diarrhea mortality and hospitalization in Brazil: 2006-2018

ABSTRACT

Background

Monitoring the impact of vaccine programs is necessary to identify changes in vaccine efficacy. We report the impact of the 12-year rotavirus vaccine program on diarrhea mortality and hospitalizations and their correlation to socioeconomic indicators.

Methods

this ecological study describes diarrhea hospitalizations and deaths from 2006 to 2018 in Brazil and correlates rotavirus vaccine coverage, hospitalizations and deaths to socioeconomic indicators and social vulnerability index (SVI) by state and region. Hospitalizations, deaths, and vaccine coverage trends were analyzed using Joinpoint regression models. Associations between hospitalizations, mortality and rotavirus vaccination coverage and socioeconomic and SVI indicators were established using Ordinary Least Square regressions.

Results

Rotavirus vaccine coverage remained stable between 2006 and 2018 (annual percentage changes (APC) [95%CI]: 4.4% [−0.3%, 9.2%]). Diarrhea hospitalization rates decreased 52.5% (−5.7% [−7.5%, −3.8%]), from 68.4 to 32.5 hospitalizations per 10,000 children <5 years-old between 2006 and 2018, with significant decreases in diarrhea mortality (−9.8% [−11.2%, −8.5%]). The Northeast region experienced the largest reductions (−13.9% [−15.7%, −12.2%]). Vaccination coverage and diarrhea-mortality were inversely correlated with the SVI.

Conclusion

The burden of childhood diarrhea has decreased over an extended period. States with high SVI, but high vaccination coverage had the largest reductions in hospitalizations and deaths.

KEYWORDS:

• Acute diarrhea
• rotavirus
• rotavirus vaccine
• mortality
• hospitalization
• Brazil

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received research grants and/or reimbursement for participating in meetings and Advisory Boards for Vaccine Producers: GlaxoSmithKline, Merck Sharp & Dohme, Pfizer, Sanofi Pasteur, and Seqirus. All other peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.