Effectiveness of Monovalent Rotavirus Vaccine Against Hospitalization With Acute Rotavirus Gastroenteritis in Kenyan Children

• Type of Material: Article
• Authors: Sammy Khagayi, Kenya Medical Research Institute (KEMRI); Richard Omore, Kenya Medical Research Institute (KEMRI); Grieven P. Otieno, KEMRI Wellcome Trust Research Programme; Billy Ogwel, Kenya Medical Research Institute (KEMRI); John B. Ochieng, Kenya Medical Research Institute (KEMRI); Jane Juma, Kenya Medical Research Institute (KEMRI); Evans Apondi, Kenya Medical Research Institute (KEMRI); Godfrey Bigogo, Kenya Medical Research Institute (KEMRI); Clayton Onyango, Centers for Disease Control and Prevention; Mwanajuma Ngama, KEMRI Wellcome Trust Research Programme; Regina Njeru, KEMRI Wellcome Trust Research Programme; Betty E. Owor, KEMRI Wellcome Trust Research Programme; Mike J. Mwanga, KEMRI Wellcome Trust Research Programme; O. Addo, Emory University; Collins Tabu, Ministry of Health, Kenya; Anyangu Amwayi, Ministry of Health, Kenya; Jason M. Mwenda, World Health Organization; Jacqueline Tate, Centers for Disease Control and Prevention; Umesh D. Parashar, Centers for Disease Control and Prevention; Robert Breiman, Emory University; D. James Nokes, Kenya Medical Research Institute (KEMRI); Jennifer Verani, Emory University
• Language: English
• Date: 2020-06-01
• Publisher: Oxford University Press Inc.
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciz664
• Title of Journal or Parent Work: Clinical Infectious Disease
• Volume: 70
• Issue: 11
• Start Page: 2298
• End Page: 2305
• Grant/Funding Information: This study was funded by Gavi, the Vaccine Alliance under the Rotavirus Immunization Programme Evaluation in Kenya study (grant number PP42191214), a collaboration between Emory University, the CDC in Atlanta and in Nairobi, Kenya, the KEMRI–Wellcome Trust Research Programme, the Centre for Geographic Medicine Research-Coast, Kilifi, and KEMRI-CGHR, Kisumu, Kenya. The KEMRI–Wellcome Trust Research Programme (KWTRP) surveillance activities are funded by the Wellcome Trust (grant reference numbers 203077 and 102975).; Both the KEMRI-CGHR surveillance at Siaya and the population-based infectious disease surveillance platforms are funded by the CDC while the WHO Regional Office for Africa funded part of the rotavirus surveillance activities.
• Keywords: Diarrhea; Life Sciences & Biomedicine; Infectious Diseases; Kenya; acute gastroenteritis; Strains; Health; African; rotavirus; Admission; Kilifi; Impact; Immunology; Microbiology; vaccine effectiveness; Age; Science & Technology; Profiles
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health; Biology, Microbiology; Biology, Virology

Abstract

Background: Rotavirus remains a leading cause of pediatric diarrheal illness and death worldwide. Data on rotavirus vaccine effectiveness in sub-Saharan Africa are limited. Kenya introduced monovalent rotavirus vaccine (RV1) in July 2014. We assessed RV1 effectiveness against rotavirus-associated hospitalization in Kenyan children. Methods: Between July 2014 and December 2017, we conducted surveillance for acute gastroenteritis (AGE) in 3 Kenyan hospitals. From children age-eligible for ≥1 RV1 dose, with stool tested for rotavirus and confirmed vaccination history we compared RV1 coverage among rotavirus positive (cases) vs rotavirus negative (controls) using multivariable logistic regression and calculated effectiveness based on adjusted odds ratio. Results: Among 677 eligible children, 110 (16%) were rotavirus positive. Vaccination data were available for 91 (83%) cases; 51 (56%) had 2 RV1 doses and 33 (36%) 0 doses. Among 567 controls, 418 (74%) had vaccination data; 308 (74%) had 2 doses and 69 (16%) 0 doses. Overall 2-dose effectiveness was 64% (95% confidence interval [CI], 35%-80%); effectiveness was 67% (95% CI, 30%-84%) for children aged <12 months and 72% (95% CI, 10%-91%) for children aged ≥12 months. Significant effectiveness was seen in children with normal weight for age, length/height for age and weight for length/height; however, no protection was found among underweight, stunted, or wasted children. Conclusions: RV1 in the Kenyan immunization program provides significant protection against rotavirus-associated hospitalization which persisted beyond infancy. Malnutrition appears to diminish vaccine effectiveness. Efforts to improve rotavirus uptake and nutritional status are important to maximize vaccine benefit.