title: Changes in childhood diarrhea incidence in nicaragua following 3 years of universal infant rotavirus immunization.
abstract: BACKGROUND
  Although the pentavalent rotavirus vaccine was highly efficacious against rotavirus diarrhea in clinical trials, the effectiveness of vaccine under field conditions in the developing world is unclear. In October 2006, Nicaragua became the first developing nation to implement universal infant immunization with the pentavalent rotavirus vaccine. To assess the effect of the immunization program, we examined the incidence of diarrhea episodes between 2003 and 2009 among children in the state of León, Nicaragua.
  
  
  METHODS
  We extracted data on diarrhea episodes from health ministry records. We used scaled Poisson regression models to estimate diarrhea incidence rate ratios for the period following the program's implementation to the period before implementation.
  
  
  RESULTS
  Following implementation of the immunization program, diarrhea episodes among infants were reduced (incidence rate ratios: 0.85, 95% confidence interval: 0.71-1.02) during the rotavirus season, but appear to have increased during other months.
  
  
  CONCLUSIONS
  Although the immunization program appears effective in reducing diarrhea episodes during the rotavirus season, a large burden of diarrhea still persists during the remainder of the year.
authors.affiliation: Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. sbd@unc.edu
authors.forename: Sylvia
authors.initials: S
authors.lastname: Becker-Dreps
authors.forename: Margarita
authors.initials: M
authors.lastname: Paniagua
authors.forename: Rosalie
authors.initials: R
authors.lastname: Dominik
authors.forename: Hongyuan
authors.initials: H
authors.lastname: Cao
authors.forename: Naman K
authors.initials: NK
authors.lastname: Shah
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Morgan
authors.forename: Gilberto
authors.initials: G
authors.lastname: Moreno
authors.forename: Félix
authors.initials: F
authors.lastname: Espinoza
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated