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Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: A Multisite Prospective Case-Control Study.
Clin Infect Dis. 2016 May 01; 62 Suppl 2:S161-7.CI

Abstract

BACKGROUND

Botswana introduced monovalent G1P rotavirus vaccine (RV1) in July 2012, providing one of the first opportunities to assess the effectiveness of routine RV1 vaccination in a high-burden setting in Africa. We sought to determine the effectiveness of RV1 against rotavirus diarrhea hospitalization using a case-control evaluation.

METHODS

Vaccine age-eligible children <5 years of age admitted with diarrhea at 4 hospitals in Botswana were enrolled from June 2013 to April 2015. Card-confirmed vaccine history was compared between case patients (children with laboratory-confirmed rotavirus diarrhea) and nonrotavirus "test-negative" diarrhea controls. Vaccine effectiveness (VE) was computed using unconditional logistic regression models adjusting for age, birth month/year, and hospital. Sequence-based genotyping was performed on antigen-positive samples.

RESULTS

Among 242 case patients and 368 controls, 82% (199/242) and 92% (339/368), respectively, had received ≥1 doses of RV1. Effectiveness of a full series (2 doses) of RV1 against rotavirus diarrhea requiring hospitalization was 54% (95% confidence interval [CI], 23%-73%); 1 dose of RV1 was 48% (95% CI, 1%-72%) effective. Effectiveness was 59% (95% CI, 4%-83%) against rotavirus caused by G2P, the most common (37%) circulating genotype. However, the effectiveness of 2 RV1 doses was significantly higher in children with no undernutrition (VE, 75% [95% CI, 41%-89%]), compared to those with moderate or severe undernutrition (VE, -28% [95% CI, -309% to 60%]) (P= .02).

CONCLUSIONS

Routine RV1 vaccination in Botswana showed effectiveness similar to that in clinical trials in Africa, including against a serotype fully heterotypic to the vaccine. Undernutrition may in part explain the lower rotavirus VE in low-income settings.

Authors+Show Affiliations

Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Department of Paediatrics and Adolescent Health, University of Botswana Botswana-UPenn Partnership, Gaborone Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.Department of Medical Laboratory Sciences, University of Botswana and National Health Laboratory.Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Botswana Ministry of Health, Gaborone.Division of Infectious Disease, Department of Pediatrics, McMaster University, Hamilton, Canada.Department of Paediatrics and Adolescent Health, University of Botswana Department of Pediatrics, Princess Marina Hospital, Gaborone, Botswana.Department of Pathology and Molecular Medicine, McMaster University, Hamilton.Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.Department of Paediatrics and Adolescent Health, University of Botswana Botswana-UPenn Partnership, Gaborone University of British Columbia, Vancouver, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

27059351

Citation

Gastañaduy, Paul A., et al. "Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: a Multisite Prospective Case-Control Study." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 62 Suppl 2, 2016, pp. S161-7.
Gastañaduy PA, Steenhoff AP, Mokomane M, et al. Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: A Multisite Prospective Case-Control Study. Clin Infect Dis. 2016;62 Suppl 2:S161-7.
Gastañaduy, P. A., Steenhoff, A. P., Mokomane, M., Esona, M. D., Bowen, M. D., Jibril, H., Pernica, J. M., Mazhani, L., Smieja, M., Tate, J. E., Parashar, U. D., & Goldfarb, D. M. (2016). Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: A Multisite Prospective Case-Control Study. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 62 Suppl 2, S161-7. https://doi.org/10.1093/cid/civ1207
Gastañaduy PA, et al. Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: a Multisite Prospective Case-Control Study. Clin Infect Dis. 2016 May 1;62 Suppl 2:S161-7. PubMed PMID: 27059351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of Monovalent Rotavirus Vaccine After Programmatic Implementation in Botswana: A Multisite Prospective Case-Control Study. AU - Gastañaduy,Paul A, AU - Steenhoff,Andrew P, AU - Mokomane,Margaret, AU - Esona,Mathew D, AU - Bowen,Michael D, AU - Jibril,Haruna, AU - Pernica,Jeffrey M, AU - Mazhani,Loeto, AU - Smieja,Marek, AU - Tate,Jacqueline E, AU - Parashar,Umesh D, AU - Goldfarb,David M, PY - 2016/4/10/entrez PY - 2016/4/10/pubmed PY - 2016/12/29/medline KW - Africa KW - diarrhea KW - rotavirus KW - rotavirus vaccine KW - vaccine effectiveness SP - S161 EP - 7 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 62 Suppl 2 N2 - BACKGROUND: Botswana introduced monovalent G1P rotavirus vaccine (RV1) in July 2012, providing one of the first opportunities to assess the effectiveness of routine RV1 vaccination in a high-burden setting in Africa. We sought to determine the effectiveness of RV1 against rotavirus diarrhea hospitalization using a case-control evaluation. METHODS: Vaccine age-eligible children <5 years of age admitted with diarrhea at 4 hospitals in Botswana were enrolled from June 2013 to April 2015. Card-confirmed vaccine history was compared between case patients (children with laboratory-confirmed rotavirus diarrhea) and nonrotavirus "test-negative" diarrhea controls. Vaccine effectiveness (VE) was computed using unconditional logistic regression models adjusting for age, birth month/year, and hospital. Sequence-based genotyping was performed on antigen-positive samples. RESULTS: Among 242 case patients and 368 controls, 82% (199/242) and 92% (339/368), respectively, had received ≥1 doses of RV1. Effectiveness of a full series (2 doses) of RV1 against rotavirus diarrhea requiring hospitalization was 54% (95% confidence interval [CI], 23%-73%); 1 dose of RV1 was 48% (95% CI, 1%-72%) effective. Effectiveness was 59% (95% CI, 4%-83%) against rotavirus caused by G2P, the most common (37%) circulating genotype. However, the effectiveness of 2 RV1 doses was significantly higher in children with no undernutrition (VE, 75% [95% CI, 41%-89%]), compared to those with moderate or severe undernutrition (VE, -28% [95% CI, -309% to 60%]) (P= .02). CONCLUSIONS: Routine RV1 vaccination in Botswana showed effectiveness similar to that in clinical trials in Africa, including against a serotype fully heterotypic to the vaccine. Undernutrition may in part explain the lower rotavirus VE in low-income settings. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/27059351/Effectiveness_of_Monovalent_Rotavirus_Vaccine_After_Programmatic_Implementation_in_Botswana:_A_Multisite_Prospective_Case_Control_Study_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ1207 DB - PRIME DP - Unbound Medicine ER -