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RV5 decreased amount of acute gastroenteritis-related health care use
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An increase in pentavalent rotavirus vaccine use within a large network of pediatric practices cut acute gastroenteritis-related office visits and hospitalizations since its introduction in 2006, said researchers from the Louisiana State University Health Sciences Center and Children’s Hospital, New Orleans.
The researchers analyzed surveillance data on patients aged younger than 5 years who were seen by a group of 38 pediatricians included in the Children’s Hospital Medical Practice Corporation (CHMPC) at different sites in Louisiana to explore the effect that the pentavalent rotavirus vaccine (RV5, RotaTeq, Merck) had on acute gastroenteritis-related episodes.
“Our group has been interested in the impact of RV5 on the overall burden of [rotavirus] in health care use; not only hospitalization but also outpatient office visits from a primary pediatric practice point of view,” the researchers wrote. The study was supported in part by a grant from Merck.
Data collection began in 2004 and continued through 2009, although Hurricane Katrina caused disruptions that may have led to inaccuracies in information for 2005-2006, the researchers noted.
Information on rotavirus seasons, acute gastroenteritis (AGE) incidence and the amount of children vaccinated with at least one dose of RV5 were included. The researchers also tested samples from hospitalized children or those seen in the ED for evidence of rotavirus-positive AGE.
CHMPC providers saw approximately 16,000 children aged younger than 5 years annually during the study period. From 2004 to 2006, no children received RV5, yet the number who received at least one dose of the vaccine steadily increased to 11.1% during 2006-2007, 40.3% during 2007-2008 and 45.6% during 2008-2009.
Excluding 2005-2006 data, results indicated that overall incidence of all-cause AGE cases dropped by 20% during 2007-2008 when compared with 2004-2005, according to the researchers, with office visits declining by 18% and hospitalizations by 50%. Similarly, overall rates of all-cause AGE episodes decreased by 28% during 2008-2009. The number of AGE-related office visits fell by 27% and hospitalizations by 50% at the time.
Similarly, the percentage of rotavirus-positive AGE-related ED visits or hospitalizations declined during 2007-2008 and 2008-2009 by 85% and 50% respectively. These decreases were especially noticeable among children aged younger than 1 year, 85%, and among those aged 1 to 2 years, 78%, when compared with 2004-2005. Additionally, the reduction in cases among children aged 2 to 5 years was 41%. They noted the protection observed among the older children, who were ineligible for vaccination, suggested a potential herd-immunity effect. – by Melissa Foster
Begue RE. Pediatrics. 2010; 126:e40-e45.
This study is yet another study that suggests that rotavirus vaccine is effective in preventing disease that leads to visits to physicians — in this case in an office-based practice. One should be a bit cautious in interpreting these data, since there are known natural variations in the annual incidence of rotavirus that occurred before introduction of the vaccine (as well as variation in gastroenteritis due to other causes), and this study did not assess actual effectiveness in individuals who did or did not receive the vaccine. However, the data do support a hypothesis that the vaccine reduces frequency and/or severity of rotavirus gastroenteritis sufficiently to have an effect on use of medical resources for gastroenteritis in young children.
– Eugene Shapiro, MD
Infectious
Diseases in Children Editorial Board