title: Impact of rotavirus vaccine on diarrhea-associated disease burden among American Indian and Alaska Native children.
abstract: OBJECTIVE
  Beginning in 2006, the Indian Health Service (IHS) began rotavirus vaccination of American Indian and Alaska Native (AI/AN) infants. To assess vaccine impact, we examined trends in IHS diarrhea-associated hospitalization and outpatient visits among AI/AN children in the pre- and postrotavirus vaccine era.
  
  
  METHODS
  Diarrhea-associated hospitalizations and outpatient visits among AI/AN children <5 years of age during 2001 through 2010 were examined by gender, age group, and region for prevaccine years 2001-2006 and postvaccine years 2008, 2009, and 2010. To account for secular declining trends observed in prevaccine years, expected diarrhea-associated hospitalization and outpatient rates for postvaccine years were generated by using Poisson regression analysis of the 2001-2006 annual rates.
  
  
  RESULTS
  Coverage with at least 1 dose of rotavirus vaccine among AI/AN infants aged 3 to 5 months in the first half of 2008, 2009, and 2010 ranged from 48% to 80% in various IHS regions. The prevaccine average annual diarrhea-associated hospitalization rates among AI/AN children <5 years of age was 63 per 10 000 persons (range: 57-75 per 10 000), and declined to 39, 31, and 27 per 10 000 in 2008, 2009, and 2010, respectively. Observed 2008, 2009, and 2010 rates were 24%, 37%, and 44% lower than expected rates, respectively. Decreases in diarrhea-associated hospitalizations and outpatient visits were observed in all IHS regions.
  
  
  CONCLUSIONS
  Diarrhea-associated hospitalization and outpatient visit rates among AI/AN children have declined after implementation of rotavirus vaccination in AI/AN populations.
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. rdesai1@cdc.gov
authors.forename: Rishi
authors.initials: R
authors.lastname: Desai
authors.forename: Dana
authors.initials: D
authors.lastname: Haberling
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
authors.forename: Amy V
authors.initials: AV
authors.lastname: Groom
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Steiner
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000208:ethnology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D007223:Infant; D004930:Inuit; D008297:Male; D008913:Minority Groups; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D012401:Rotavirus / Q000276:immunology*; D022243:Rotavirus Vaccines / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D022243:Rotavirus Vaccines