burden of rotavirus disease & impact of rotavirus vaccination umesh d. parashar, mbbs, mph lead,...
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Burden of Rotavirus Disease &Impact of Rotavirus Vaccination
Umesh D. Parashar, MBBS, MPHLead, Viral Gastroenteritis Epidemiology TeamCenters for Disease Control PreventionAtlanta, GA
TM
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Rotavirus is the Leading Cause Of Severe Gastroenteritis in Children <5 Years
2
OtherOther
Bacterial Bacterial
Rotavirus
Developed Countries Developing Countries
Unknown Unknown Rotavirus
A. Kapikian, Fields Virology 2003
The face of rotavirus
DiarrheaVomiting
DehydrationShock Death
4
Burden of Rotavirus in the US in 2006Burden of Rotavirus in the US in 2006
20-60 Deaths
55-70,000 Hospitalizations
500,000 Outpatient visits
3.2 Million episodes
Cost: $300 M medical; >$1 B total CDC, MMWR, 2006
51 dot = 250 deaths
Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children
Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children
Parashar et al, JID, 2009
2006 -- Phase 3 Trials of Two Rotavirus Vaccines
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• Trials of 60-70,000 infants• No increased risk of intussusception or other SAE• Efficacy of 85%-98% against severe disease
Vesikari et al and Ruiz-Palacios et al, NEJM 2006
Countries in the Americas with Rotavirus Vaccine Programs
Rotarix only
No program
Rotateq & Rotarix
Rotateq only
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Rotavirus Vaccines in USA
• Feb 2006 – RotaTeq recommended• June 2008 – Rotarix recommended
National Rotavirus Laboratory Surveillance
• Network of 67 laboratories reporting since 2000
• Weekly reporting: – # specimens tested for rotavirus– # positive tests
Total number of rotavirus tests and number of positive test results* from 27 continuously reporting laboratories - National Respiratory and Enteric Virus Surveillance System, United
States, July 2, 2000-February 20, 2010
0
100
200
300
400
500
600
700
800
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Month and year
Nu
mb
er
Total no. tests
No. positive results
* 3-week moving averages
Vaccine introduced
Total and Positive Rotavirus Tests, July 2000-Mar 2010
Tate et al, Pediatrics 2009 and CDC unpublished data
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Active Rotavirus Surveillance
Payne et al, PAS 2009
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Total AGE and Rotavirus AGE HospitalizationsNVSN, 2006-2008
181 179
139
9181
9
020406080
100120140160180200
2006 2007 2008
Num
ber o
f cas
es
Total AGE Rotavirus
50 %
Rota+
45 %
Rota+
6 % Rota
+
National reduction of 45,000-62,000 hospitalizations in 2008
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Age Decline in rotavirus hospitalization rate
(2008 vs. 2006)
Rotavirus vaccine coverage in 2008
(>=1 dose)
< 1 year 66% 56%
1 -< 2 years 95% 44%
2 -< 3 years 85% <1%
This age cohort was ineligible to receive rotavirus vaccine
Age-Specific Rotavirus Hospitalization Rate Reduction and Vaccine Coverage, NVSN
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Rotavirus Vaccination in El Salvador
• October 2006 – Rotarix recommended
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Reduction in Rotavirus Admissions in Children < 5 Years after Rotarix Introduction, El Salvador
70-80% reduction in rotavirus hospitalizations children < 5 years
1771
1066
863
1092 1117
171
342
2274
0
500
1000
1500
2000
2500
2006 2007 2008 2009
Surveillance year
Nu
mb
er o
f h
osp
ital
izat
ion
s
Total diarrhoea cases
Rotavirus positive cases
Vaccination (October, 2006)
In press, BMJ, 2010
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Richardson et al, NEJM 2010
0
50
100
150
200
250
Nu
mb
er o
f d
iarr
hea
dea
ths
Month-Year
Age ≤11 months
Age 12-23 months
Age 24-59 months
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Marked Decline in Childhood Diarrhea Deaths After Rotarix Introduction, Mexico
Vaccine Introduction(May 2007)
2008
2009
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Winter Blunting of Diarrhea Deaths Suggests Effect Against Rotavirus
Age 0-11 months
0
20
40
60
80
100
120
140
160
180
200
Jan-
2007
Feb
Mar
Apr
May Jun
Jul
Aug Se
p
Oct
Nov Dec
Jan-
2008
Feb
Mar
Apr
May Jun
Jul
Aug Se
p
Oct
Nov Dec
Jan-
2009
Feb
Mar
Apr
May
No.
dia
rrh
ea d
eath
s
2007-2009 observed deaths
2003-2006 maximum
2003-2006 median
2003-2006 minimum
Country-wide vaccine introduction, May, 2007
191 dot = 250 deaths
Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children
Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children
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Rotarix Trial in Malawi & So. Africa
RegionVaccine
Efficacy 95% CI
No. of rotavirus cases prevented
per 100 vaccinated
Malawi49% 19, 68 6.7
South Africa 77% 40, 88 4.1
Madhi, S et al. NEJM 2010
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2006-2010Incredible years for rotavirus vaccines!....
And great promise for the future!!
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