All-cause gastroenteritis hospitalisations of children decreased after the introduction of rotavirus vaccine in Stockholm

Abstract

Background

In Stockholm, Sweden, rotavirus vaccination was offered to children born after 1 March 2014. Our aim was to describe rates of hospitalisation due to community-acquired gastroenteritis before and after the introduction of the vaccine, and aetiology, underlying medical conditions and complications in admitted children.

Methods

We retrospectively included patients from our catchment area hospitalised with a diagnosis of gastroenteritis during ten infection seasons 2008/2009–2017/2018, whereof six seasons prevaccination and four seasons postvaccination. We studied virus detection data and the patients’ medical records.

Results

We included 3718 episodes in 3513 children. In 2967 (80%), stools were tested with virus isolation, ELISA, PCR, or bacterial culture; 479 (16%) tested negative. The incidence rates, with 95% confidence intervals, for children <5 years hospitalised for rotavirus gastroenteritis were 2.9 (2.8–3.1) per 1000 person-years prevaccination and 0.65 (0.56–0.74) postvaccination, for a rate ratio (RR) of 0.22 (0.19–0.26, p < .001). The rates for all-cause gastroenteritis were 5.6 (5.4–5.9) prevaccination and 2.5 (2.3–2.7) postvaccination, RR 0.45 (0.42–0.50, p < .001). In 5–17-year-old children norovirus dominated with little change over time. Of patients <5 years, those with underlying conditions constituted a larger proportion postvaccination than prevaccination (30.7% vs. 24.2%, p < .001). A complication other than dehydration, most commonly seizures, arose in 8.8% of the patients <5 years prevaccination and 11.4% postvaccination (p < .05).

Conclusions

Rotavirus vaccination reduced the number of children <5 years requiring hospital care for gastroenteritis. We saw no replacement of rotavirus by other viruses.

Keywords:

• Gastroenteritis
• children
• complication
• epidemiology
• rotavirus vaccination
• risk factor

Ethics approval

The study was approved by Stockholm Regional Ethics Review Board (Registration number 2017/2181-31).

Author contribution

SOÅ, ME and RB designed the study; they collected, had full access to and took responsibility for the integrity of the data. RB undertook the statistical analyses and took responsibility for its accuracy. MRÖ and BH were responsible for microbiologic analyses and laboratory data collection. SOÅ wrote the first draft of the paper. All authors contributed to writing the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.