Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study

BMC Infectious Diseases

George Armah³  Stanley K Diamenu¹  Eric Sifah⁵  Isaac Boamah⁴  Christabel C Enweronu-Laryea² 

[1]World Health Organization, P O Box MB 142, Accra, Ghana

[2]Department of Child Health, University of Ghana Medical School, P O Box 4236, Accra, Ghana

[3]Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana

[4]Department of Microbiology, University of Ghana Medical School, Accra, Ghana

[5]Princess Marie Louis Children’s Hospital, Accra, Ghana

关键词: Ghana;    Vaccination;    Hospitalization;    Rotavirus;    Children;    Diarrhea;   

Others  :  1127216
DOI  :  10.1186/1471-2334-14-431

 received in 2014-03-28, accepted in 2014-07-30,  发布年份 2014

【 摘 要 】

Background

Almost all diarrhea deaths in young children occur in developing countries. Immunization against rotavirus, the leading cause of childhood severe dehydrating acute diarrhea may reduce the burden of severe diarrhea in developing countries. Ghana introduced rotavirus and pneumococcal vaccination in the national expanded program on immunization in May 2012.

Methods

Review of all-cause diarrheal hospitalization data for children aged 59 months and younger at 2 pediatric referral hospitals in southern Ghana from 2008 to 2014. The proportion of acute diarrhea (defined as 3 or more watery, non-bloody stools within 24 hours that has lasted for less than 7 days) cases caused by rotavirus was determined. Temporal trend and age group distribution of all-cause diarrhea and rotavirus gastroenteritis before and after introduction of the new vaccines were compared.

Results

Of the 5847 children hospitalized with all-cause diarrhea during the 74 months (January 2008 – February 2014), 3963 (67.8%) children were recruited for rotavirus surveillance and stool specimens were tested for rotavirus in 3160/3963 (79.7%). Median monthly hospitalization for all-cause diarrhea reduced from 84 [interquartile range (IQR) 62 – 105] during the 52 months pre-vaccination introduction to 46 (IQR 42 - 57) in the 22 months after implementation of vaccination. Significant decline in all-cause diarrhea hospitalization occurred in children aged 0 - 11 months: 56.3% (2711/4817) vs. 47.2% 486/1030 [p = 0.0001, 95% confidence interval (CI) 0.77 – 0.88] and there was significant reduction of rotavirus gastroenteritis hospitalization: 49.7% (1246/2505) vs. 27.8% (182/655) [p = 0.0001, 95% CI 0.32 - 0.47] before and after vaccine introduction respectively.

Conclusions

Implementation of rotavirus vaccination program may have resulted in significant reduction of severe diarrhea hospitalization even though this observational study could not exclude the effect of other confounding factors. Continued surveillance is recommended to monitor the progress of this program.

【 授权许可】

   
2014 Enweronu-Laryea et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 2.

【 参考文献 】

• [1]RE B, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, Eisele T, Liu L, Mathers C, for the Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010, 375:1969-1987.
• [2]Boschi-Pinto C, Velebit L, Shibuya K: Estimating child mortality due to diarrhea in developing countries. Bull World Health Organ 2008, 86:710-717.
• [3]Kosek M, Bern C, Guerrant RL: The global burden of diarrheal diseases, as estimated from studies published between 1992 and 2000. Bull World Health Organ 2003, 81:197-204.
• [4]Prashar UD, Alexander JP, Glass RI: Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2005, 55:1-13.
• [5]Mwenda JM, Ntoto KM, Abebe A, Enweronu-Laryea C, Amina I, Mchomvu J, Kiskye A, Mpabalwani EM, Pazvakavambwa I, Armah GE, Seheri LM, Kiulia NM, Page N, Widdowson M, Steele AD: Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network. J Infect Dis 2010, 202(Suppl 1):5-11.
• [6]Armah GE, Mingle JA, Dodoo AK, Anyanful A, Antwi R, Commey J, Nkrumah FK: Seasonality of rotavirus infection in Ghana. Ann Trop Paediatr 1994, 14:223-229.
• [7]Enweronu-Laryea CC, Sagoe KWC, Mwenda J, Armah GE: Severe acute rotavirus gastroenteritis in children less than 5 years in southern Ghana: 2006-2011. Pediatr Infect Dis J 2014, 33(Suppl 1):9-13.
• [8]Parashar UD, Burton A, Lanata C, Boschi-Pinto C, Shibuya K, Steele D, Birmingham M, Glass RI: Global mortality associated with rotavirus disease among children in 2004. J Infect Dis 2009, 200(Suppl 1):9-15.
• [9]Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O'Brien KL, Campbell H, Black RE: Global burden of childhood pneumonia and diarrhea. Lancet 2013, 381:1405-1416.
• [10]World Health Organization: Meeting of the Immunization Strategic Advisory Group of Experts, April 2009—conclusions and recommendations. Wkly Epidemiol Rec 2009, 84:220-236.
• [11]World Health Organization: Generic protocols (i) hospital-based surveillance to estimate the burden of rotavirus gastroenteritis in children and (ii) a community based survey on utilization of health care services for gastroenteritis in children. Geneva: World Health Organization; whqlibdoc.who.int/hq/2002/WHO_V&B_02.15.pdf
• [12]do Carmo GM, Yen C, Cortes J, Siqueira AA, de Oliveira WK, Cortez-Escalante JJ, Lopman B, Flannery B, de Oliveira LH, Carmo EH, Patel M: Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. PLoS Med 2011, 8:e1001024. doi:0.1371/journal.pmed.1001024
• [13]Lanzieri TM, Costa I, Shafi FA, Cunha MH, Ortega-Barria E, Linhares AC, Colindres RE: Trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years of age in Brazil before and after human rotavirus vaccine introduction, 1998-2007. Pediatr Infect Dis J 2010, 29:673-675.
• [14]de Oliveira LH, Danovaro-Holliday MC, Matus CR, Andrus JK: Rotavirus vaccine introduction in the Americas: progress and lessons learned. Expet Rev Vaccine 2008, 7:345-353.
• [15]Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, Ngwira B, Victor JC, Gillard PH, Cheuvart BB, Han HH, Neuzi KM: Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med 2010, 362:289-298.
• [16]Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year? Lancet 2003, 361:2226-2234.
• [17]Aikins M, Armah G, Akazili J, Hodgson A: Hospital health care cost of diarrheal disease in Northern Ghana. J Infect Dis 2010, 202(Suppl 1):126-130.
• [18]Arvay ML, Curns AT, Terp S, Armah G, Wontuo P, Prashar UD, Binka F, Glass GI, Widdowson M: How much could rotavirus vaccine reduce diarrhea-associated mortality in northern Ghana? A model to assess impact. J Infect Dis 2009, 200(Suppl 1):85-91.
• [19]Baqui AH, Sabir AA, Begum N, Arifeen SE, Mitra SN, Black RE: Causes of childhood deaths in Bangladesh: an update. Acta Paediatr 2001, 90:682-690.
• [20]Schmidt WP, Cairncross S, Barreto ML, Clasen T, Genser B: Recent diarrheal illness and risk of lower respiratory infections in children under the age of 5 years. Int J Epidemiol 2009, 38:766-772.
• [21]Yassin KM: Indices and sociodemographic determinants of childhood mortality in rural Upper Egypt. Soc Sci Med 2000, 51:185-197.
• [22]CL Perin J, Katz J, Tielsch JM, Black RE: Diarrhea as a risk factor for acute lower respiratory tract infections among young children in low income settings. J Glob Health 2013, 3(1):010402. doi:10.7189/jogh.03.010402