Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa

BACKGROUND: The public health impact of rotavirus vaccination in African settings with a high human immunodeficiency virus (HIV) infection prevalence is yet to be established. We evaluated trends in all-cause diarrheal hospitalizations in Soweto Johannesburg before and after the introduction of rotavirus vaccine into South Africas national immunization program in August 2009. METHODS: Hospitalizations in children <5 years of age with a diagnosis of diarrhea defined byInternational Classification of Diseases Tenth Revisioncodes A00-A05 A06.0-A06.3 A06.9 A07.0-A07.2 A07.9 and A08-A09 were identified at the Chris Hani Baragwanath Academic Hospital from 1 January 2006 to 31 December 2014. The median annual prevaccine (2006-2008) hospitalization incidence was compared to that of the vaccine era (2010-2014) and stratified by age group and HIV infection status. RESULTS: Incidence reductions (per 1000 population) were greatest in children aged <12 months: 54.4 in the prevaccine era vs 30.0 23.6 20.0 18.8 and 18.9 in the postvaccine years 2010-2014 respectively (a 44.9%-65.4% reduction). Lower incidence reductions (39.8%-49.4%) were observed among children aged 12-24 months from the second year post-vaccine introduction onward. Reductions were observed in both HIV-infected and HIV-uninfected children. There was a change in the seasonal pattern of diarrheal hospitalizations post-vaccine introduction with flattening of the autumn-winter peaks seen in the prevaccine years. CONCLUSIONS: An accelerated and sustained decline in all-cause diarrheal hospitalizations temporally associated with rotavirus vaccine introduction was observed in children <2 years of age. However the impact of other interventions such as improved sanitation and changes in HIV management cannot be discounted. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.