title: Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis.
abstract: BACKGROUND
  In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. We evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators.
  
  
  RESULTS
  National data were analyzed with an interrupted time-series analysis that used diarrhea-related mortality or hospitalization rates as the main outcomes. Monthly mortality and admission rates estimated for the years after rotavirus vaccination (2007-2009) were compared with expected rates calculated from pre-vaccine years (2002-2005), adjusting for secular and seasonal trends. During the three years following rotavirus vaccination in Brazil, rates for diarrhea-related mortality and admissions among children <5 y of age were 22% (95% confidence interval 6%-44%) and 17% (95% confidence interval 5%-27%) lower than expected, respectively. A cumulative total of ~1,500 fewer diarrhea deaths and 130,000 fewer admissions were observed among children <5 y during the three years after rotavirus vaccination. The largest reductions in deaths (22%-28%) and admissions (21%-25%) were among children younger than 2 y, who had the highest rates of vaccination. In contrast, lower reductions in deaths (4%) and admissions (7%) were noted among children two years of age and older, who were not age-eligible for vaccination during the study period.
  
  
  CONCLUSIONS
  After the introduction of rotavirus vaccination for infants, significant declines for three full years were observed in under-5-y diarrhea-related mortality and hospital admissions for diarrhea in Brazil. The largest reductions in diarrhea-related mortality and hospital admissions for diarrhea were among children younger than 2 y, who were eligible for vaccination as infants, which suggests that the reduced diarrhea burden in this age group was associated with introduction of the rotavirus vaccine. These real-world data are consistent with evidence obtained from clinical trials and strengthen the evidence base for the introduction of rotavirus vaccination as an effective measure for controlling severe and fatal childhood diarrhea.
authors.affiliation: Secretariat for Health Surveillance (Secretaria de Vigilância em Saúde), Ministry of Health, Brasilia, Brazil.
authors.forename: Greice Madeleine Ikeda
authors.initials: GM
authors.lastname: do Carmo
authors.forename: Catherine
authors.initials: C
authors.lastname: Yen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cortes
authors.forename: Alessandra Araújo
authors.initials: AA
authors.lastname: Siqueira
authors.forename: Wanderson Kleber
authors.initials: WK
authors.lastname: de Oliveira
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Cortez-Escalante
authors.forename: Ben
authors.initials: B
authors.lastname: Lopman
authors.forename: Brendan
authors.initials: B
authors.lastname: Flannery
authors.forename: Lucia Helena
authors.initials: LH
authors.lastname: de Oliveira
authors.forename: Eduardo Hage
authors.initials: EH
authors.lastname: Carmo
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003710:Demography; D003967:Diarrhea / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control*; D005843:Geography; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data*; D007223:Infant; D022243:Rotavirus Vaccines / Q000276:immunology*; D013997:Time Factors
chemical_list: D022243:Rotavirus Vaccines