title: Baseline estimates of diarrhea-associated mortality among United States children before rotavirus vaccine introduction.
abstract: OBJECTIVE
  Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed.
  
  
  METHODS
  National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992-2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus.
  
  
  RESULTS
  An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992-1998 and 2005-2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually.
  
  
  CONCLUSIONS
  Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States.
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. hgj4@cdc.gov
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Dana L
authors.initials: DL
authors.lastname: Haberling
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Laura Jean
authors.initials: LJ
authors.lastname: Podewils
authors.forename: Roger I
authors.initials: RI
authors.lastname: Glass
authors.forename: Umesh
authors.initials: U
authors.lastname: Parashar
mesh_terms: D044383:Black People / Q000208:ethnology; D002675:Child, Preschool; D003967:Diarrhea / Q000208:ethnology / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009309:National Center for Health Statistics, U.S.; D012189:Retrospective Studies; D012401:Rotavirus / Q000187:drug effects / Q000276:immunology; D012400:Rotavirus Infections / Q000208:ethnology / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control / Q000821:virology; D022243:Rotavirus Vaccines / Q000276:immunology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology; D001741:Black or African American
chemical_list: D022243:Rotavirus Vaccines