Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America

Desai, R; Parashar, UD; Lopman, B; de Oliveira, LH; Clark, AD; Sanderson, CFB; Tate, JE; Matus, CR; Andrus, JK; Patel, MM; (2012) Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America. Clinical infectious diseases, 54 (10). pp. 1397-1405. ISSN 1058-4838 DOI: https://doi.org/10.1093/cid/cis191

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Background. With the recent postlicensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must now weigh the health benefits versus risks to assess whether to continue vaccination. To inform policy considerations, we estimated excess intussusception cases and mortality potentially caused by rotavirus vaccine for each of the 14 countries and compared these estimates to hospitalizations and deaths expected to be averted through vaccination. Methods. We used regional rotavirus disease burden and rotavirus vaccine efficacy data, global natural intussusception and regional rotavirus vaccine-related risk estimates, and country-specific diphtheria, tetanus, and pertussus vaccination coverage rates to estimate rotavirus vaccine coverage rates. We performed a probabilistic sensitivity analysis to account for uncertainty in these parameters. Results. For an aggregate hypothetical birth cohort of 9.5 million infants in these 14 countries, rotavirus vaccine would annually prevent 144 746 (90% confidence interval [CI], 128 821-156 707) hospitalizations and 4124 deaths (90% CI, 3740-4239) due to rotavirus in their first 5 years of life but could cause an additional 172 hospitalizations (90% CI, 126-293) and 10 deaths (90% CI, 6-17) due to intussusception, yielding benefit-risk ratios for hospitalization and death of 841:1 (90% CI, 479:1 to 1142:1) and 395:1 (90% CI, 207:1 to 526:1), respectively. In an uncertainty analysis using 10 000 simulations of our probabilistic parameters, in comparing rotavirus disease averted to intussusception events caused, the hospitalization ratio was never below 100:1, and our death ratio fell below 100:1 only once. Conclusions. The health benefits of vaccination far outweigh the short-term risks and support continued rotavirus vaccination in Latin America.

Item Type: Article
Keywords: hospital-based surveillance, aged less-than-5 years, than 5 years, disease burden, molecular epidemiology, childhood diarrhea, discharge, data, hong-kong, children, gastroenteritis
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
PubMed ID: 22431803
Web of Science ID: 304049300009
URI: http://researchonline.lshtm.ac.uk/id/eprint/29596


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