Impact of the Introduction of Rotavirus Vaccine on Hospital Admissions for Diarrhea Among Children in Kenya: A Controlled Interrupted Time-Series Analysis

• Type of Material: Article
• Authors: Grieven Otieno, Kenya Medical Research Institute (KEMRI); Christian Bottomley, London School of Hygiene & Tropical Medicine; Sammy Khagayi, Kenya Medical Research Institute (KEMRI); Ifedayo Adetifa, Kenya Medical Research Institute (KEMRI); Mwanajuma Ngama, Kenya Medical Research Institute (KEMRI); Richard Omore, Kenya Medical Research Institute (KEMRI); Billy Ogwel, Kenya Medical Research Institute (KEMRI); Betty E. Owor, Kenya Medical Research Institute (KEMRI); Godfrey Bigogo, Kenya Medical Research Institute (KEMRI); John B. Ochieng, Kenya Medical Research Institute (KEMRI); Clayton Onyango, Centers for Disease Control and Prevention, Kenya; Jane Juma, Kenya Medical Research Institute (KEMRI); Jason Mwenda, World Health Organization; Collins Tabu, Ministry of Health Kenya; Jacqueline E. Tate, Emory University; O. Addo, Emory University; Tuck Britton, Emory University; Umesh D. Parashar, Emory University; Robert Breiman, Emory University; Jennifer Verani, Emory University; D. James Nokes, Kenya Medical Research Institute (KEMRI)
• Language: English
• Date: 2020-06-01
• Publisher: Oxford University Press Inc.
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciz912
• Title of Journal or Parent Work: Clinical Infectious Diseases
• Volume: 70
• Issue: 11
• Start Page: 2306
• End Page: 2313
• Grant/Funding Information: Kenya Medical Research Institute (KEMRI)–Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi; and the KEMRI Centre for Global Health Research, Kisumu, Kenya.; This study was funded by the GAVI (Global Alliance for Vaccines and Immunization) alliance under the Rotavirus Immunization Programme Evaluation in Kenya (RIPEK) Study, a collaboration between Emory University (USA); the Centers for Disease Control and Prevention in Atlanta, Georgia, USA; The study was also supported by the Wellcome Trust (grant numbers 203077 and 102975).
• Keywords: Science & Technology; Age; interrupted time series; Profile; Burden; Microbiology; Kilifi; Health; control; Infectious Diseases; Immunology; vaccine impact; Cost-effectiveness; rotavirus vaccine; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Immunology; Health Sciences, Public Health; Biology, Microbiology

Abstract

Background: Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs). Methods: Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre- and post-vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post-vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes). Results: Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8-80%) reduction in RVHs observed in the first year post-vaccine introduction in Kilifi and a 59% (95% CI, 20-79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46-93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61-92%); this reduction was sustained at both sites into the third year. Conclusions: A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction.