title: Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study.
abstract: BACKGROUND
  Almost all diarrhea deaths in young children occur in developing countries. Immunization against rotavirus, the leading cause of childhood severe dehydrating acute diarrhea may reduce the burden of severe diarrhea in developing countries. Ghana introduced rotavirus and pneumococcal vaccination in the national expanded program on immunization in May 2012.
  
  
  METHODS
  Review of all-cause diarrheal hospitalization data for children aged 59 months and younger at 2 pediatric referral hospitals in southern Ghana from 2008 to 2014. The proportion of acute diarrhea (defined as 3 or more watery, non-bloody stools within 24 hours that has lasted for less than 7 days) cases caused by rotavirus was determined. Temporal trend and age group distribution of all-cause diarrhea and rotavirus gastroenteritis before and after introduction of the new vaccines were compared.
  
  
  RESULTS
  Of the 5847 children hospitalized with all-cause diarrhea during the 74 months (January 2008 - February 2014), 3963 (67.8%) children were recruited for rotavirus surveillance and stool specimens were tested for rotavirus in 3160/3963 (79.7%). Median monthly hospitalization for all-cause diarrhea reduced from 84 [interquartile range (IQR) 62 - 105] during the 52 months pre-vaccination introduction to 46 (IQR 42 - 57) in the 22 months after implementation of vaccination. Significant decline in all-cause diarrhea hospitalization occurred in children aged 0 - 11 months: 56.3% (2711/4817) vs. 47.2% 486/1030 [p = 0.0001, 95% confidence interval (CI) 0.77 - 0.88] and there was significant reduction of rotavirus gastroenteritis hospitalization: 49.7% (1246/2505) vs. 27.8% (182/655) [p = 0.0001, 95% CI 0.32 - 0.47] before and after vaccine introduction respectively.
  
  
  CONCLUSIONS
  Implementation of rotavirus vaccination program may have resulted in significant reduction of severe diarrhea hospitalization even though this observational study could not exclude the effect of other confounding factors. Continued surveillance is recommended to monitor the progress of this program.
authors.affiliation: Department of Child Health, University of Ghana Medical School, P O Box 4236, Accra, Ghana. chikalaryea@gmail.com.
authors.forename: Christabel C
authors.initials: CC
authors.lastname: Enweronu-Laryea
authors.forename: Isaac
authors.initials: I
authors.lastname: Boamah
authors.forename: Eric
authors.initials: E
authors.lastname: Sifah
authors.forename: Stanley K
authors.initials: SK
authors.lastname: Diamenu
authors.forename: George
authors.initials: G
authors.lastname: Armah
mesh_terms: D017677:Age Distribution; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy / Q000821:virology; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D012401:Rotavirus / Q000276:immunology* / Q000502:physiology; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D014611:Vaccination
chemical_list: D022243:Rotavirus Vaccines
references.citation: N Engl J Med. 2010 Jan 28;362(4):289-98
references.pmid: 20107214
references.citation: Int J Epidemiol. 2009 Jun;38(3):766-72
references.pmid: 19279073
references.citation: Pediatr Infect Dis J. 2010 Jul;29(7):673-5
references.pmid: 20300045
references.citation: J Infect Dis. 2010 Sep 1;202 Suppl:S5-S11
references.pmid: 20684718
references.citation: J Infect Dis. 2009 Nov 1;200 Suppl 1:S85-91
references.pmid: 19817619
references.citation: Wkly Epidemiol Rec. 2009 Jun 5;84(23):220-36
references.pmid: 19499606
references.citation: Bull World Health Organ. 2008 Sep;86(9):710-7
references.pmid: 18797647
references.citation: J Infect Dis. 2009 Nov 1;200 Suppl 1:S9-S15
references.pmid: 19817620
references.citation: Bull World Health Organ. 2003;81(3):197-204
references.pmid: 12764516
references.citation: Soc Sci Med. 2000 Jul;51(2):185-97
references.pmid: 10832567
references.citation: J Glob Health. 2013 Jun;3(1):010402
references.pmid: 23826506
references.citation: Lancet. 2010 Jun 5;375(9730):1969-87
references.pmid: 20466419
references.citation: Ann Trop Paediatr. 1994;14(3):223-9
references.pmid: 7825996
references.citation: Lancet. 2013 Apr 20;381(9875):1405-1416
references.pmid: 23582727
references.citation: MMWR Recomm Rep. 2006 Aug 11;55(RR-12):1-13
references.pmid: 16902398
references.citation: Lancet. 2003 Jun 28;361(9376):2226-34
references.pmid: 12842379
references.citation: J Infect Dis. 2010 Sep 1;202 Suppl:S126-30
references.pmid: 20684692
references.citation: Acta Paediatr. 2001 Jun;90(6):682-90
references.pmid: 11440104
references.citation: PLoS Med. 2011 Apr;8(4):e1001024
references.pmid: 21526228
references.citation: Expert Rev Vaccines. 2008 Apr;7(3):345-53
references.pmid: 18393604
references.citation: Pediatr Infect Dis J. 2014 Jan;33 Suppl 1:S9-S13
references.pmid: 24343622