title: Potential intussusception risk versus health benefits from rotavirus vaccination in Latin America.
abstract: BACKGROUND
  With the recent postlicensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must now weigh the health benefits versus risks to assess whether to continue vaccination. To inform policy considerations, we estimated excess intussusception cases and mortality potentially caused by rotavirus vaccine for each of the 14 countries and compared these estimates to hospitalizations and deaths expected to be averted through vaccination.
  
  
  METHODS
  We used regional rotavirus disease burden and rotavirus vaccine efficacy data, global natural intussusception and regional rotavirus vaccine-related risk estimates, and country-specific diphtheria, tetanus, and pertussus vaccination coverage rates to estimate rotavirus vaccine coverage rates. We performed a probabilistic sensitivity analysis to account for uncertainty in these parameters.
  
  
  RESULTS
  For an aggregate hypothetical birth cohort of 9.5 million infants in these 14 countries, rotavirus vaccine would annually prevent 144 746 (90% confidence interval [CI], 128 821-156 707) hospitalizations and 4124 deaths (90% CI, 3740-4239) due to rotavirus in their first 5 years of life but could cause an additional 172 hospitalizations (90% CI, 126-293) and 10 deaths (90% CI, 6-17) due to intussusception, yielding benefit-risk ratios for hospitalization and death of 841:1 (90% CI, 479:1 to 1142:1) and 395:1 (90% CI, 207:1 to 526:1), respectively. In an uncertainty analysis using 10 000 simulations of our probabilistic parameters, in comparing rotavirus disease averted to intussusception events caused, the hospitalization ratio was never below 100:1, and our death ratio fell below 100:1 only once.
  
  
  CONCLUSIONS
  The health benefits of vaccination far outweigh the short-term risks and support continued rotavirus vaccination in Latin America.
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: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lopman
authors.forename: Lucia Helena
authors.initials: LH
authors.lastname: de Oliveira
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Clark
authors.forename: Colin F B
authors.initials: CF
authors.lastname: Sanderson
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Cuahtemoc Ruiz
authors.initials: CR
authors.lastname: Matus
authors.forename: Jon K
authors.initials: JK
authors.lastname: Andrus
authors.forename: Manish M
authors.initials: MM
authors.lastname: Patel
mesh_terms: D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007342:Insurance Benefits / Q000706:statistics & numerical data; D007443:Intussusception / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D007843:Latin America / Q000453:epidemiology; D008297:Male; D018570:Risk Assessment; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology*; D016019:Survival Analysis; D014611:Vaccination / Q000009:adverse effects*
chemical_list: D022243:Rotavirus Vaccines