Effectiveness of rotavirus vaccination against childhood diarrhoea in El Salvador: case-control study.
OBJECTIVE
To evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America.


METHODS
Matched case-control study.


METHODS
Seven hospitals in cities across El Salvador, January 2007 to June 2009.


METHODS
323 children aged less than 2 years admitted with laboratory confirmed rotavirus diarrhoea and 969 healthy controls matched for age and neighbourhood.


METHODS
Effectiveness of rotavirus vaccination ((1-adjusted odds ratio of vaccination)x100) against rotavirus diarrhoea requiring hospital admission.


RESULTS
Cases and controls were similar for breast feeding, premature birth, maternal education, and socioeconomic variables. G1P[8] strains were identified in 92% of rotavirus cases. Effectiveness of two doses of vaccination against diarrhoea requiring hospital admission was 76% (95% confidence interval 64% to 84%). Protection was significantly lower (P=0.046) among children aged 12 months or more (59%, 27% to 77%) compared with children aged 6-11 months (83%, 68% to 91%). One dose of vaccine was 51% (26% to 67%) effective. At the sentinel hospitals, all admissions for diarrhoea among children under 5 declined by 40% in 2008 and by 51% in 2009 from the prevaccine year 2006.


CONCLUSIONS
A monovalent rotavirus vaccine was highly effective against admissions for rotavirus diarrhoea in children aged less than 2 years in El Salvador and substantially reduced the number of such admissions in this low-middle income setting. The impact on disease epidemiology after vaccination, particularly among older children, warrants future attention.
de Palma
Orbelina
O
Ministerio de Salud, San Salvador, El Salvador.
Cruz
Lilian
L
Ramos
Hector
H
de Baires
Amada
A
Villatoro
Nora
N
Pastor
Desiree
D
de Oliveira
Lucia Helena
LH
Kerin
Tara
T
Bowen
Michael
M
Gentsch
Jon
J
Esposito
Douglas H
DH
Parashar
Umesh
U
Tate
Jacqueline
J
Patel
Manish
M
D016022:Case-Control Studies; D003967:Diarrhea / Q000517:prevention & control* / Q000821:virology; D004544:El Salvador; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012400:Rotavirus Infections / Q000517:prevention & control*; D022243:Rotavirus Vaccines; D016896:Treatment Outcome
D022243:Rotavirus Vaccines