title: Assessing the Likely Impact of a Rotavirus Vaccination Program in England: The Contribution of Syndromic Surveillance.
abstract: BACKGROUND
  In July 2013, a rotavirus vaccination program for 2- to 3-month-olds was introduced in the United Kingdom. We present an initial impact analysis of this new vaccine program using national syndromic surveillance systems.
  
  
  METHODS
  General practitioner (GP) in-hours, GP out-of-hours, and emergency department (ED) syndromic surveillance systems were used to monitor GP consultations and ED visits for gastroenteritis, diarrhea, and vomiting. Data were stratified by age group and compared between pre- and postvaccine-year rotavirus seasons. Incidence rate ratios (IRRs) and percentage ratios were calculated for GP in-hours consultations and GP out-of-hours and ED data, respectively.
  
  
  RESULTS
  There was a significant reduction in gastroenteritis, diarrhea, and vomiting GP in-hours consultations in children aged 0-4 years when comparing the rotavirus season in the pre- and postvaccine years (P < .001 for all indicators). IRRs illustrated a 26%-33% and 23%-31% decrease in gastroenteritis incidence in the <1 and 1-4 years age groups, respectively, across the syndromic surveillance systems. There was also an 8% decrease recorded in the 5-14 years age group in the GP in-hours and ED systems.
  
  
  CONCLUSIONS
  Syndromic surveillance revealed a marked decline in gastroenteritis, coinciding with the introduction of the new rotavirus vaccine program in England. The largest reduction in disease was observed in infants, although some impact was also demonstrated in children aged 1-4 and 5-14 years, suggesting possible herd protection in older age groups. This study was limited to the first postvaccine year, and further analysis is required to assess the longer-term impact of the vaccine.
authors.affiliation: Real-time Syndromic Surveillance Team, Birmingham.
authors.forename: Zharain
authors.initials: Z
authors.lastname: Bawa
authors.affiliation: Real-time Syndromic Surveillance Team, Birmingham.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Elliot
authors.affiliation: Real-time Syndromic Surveillance Team, Birmingham.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Morbey
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London.
authors.forename: Shamez
authors.initials: S
authors.lastname: Ladhani
authors.affiliation: Clinical Infection, Microbiology and Immunology.
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Cunliffe
authors.affiliation: Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.affiliation: Greater Manchester Centre, Public Health England, United Kingdom.
authors.forename: Martyn
authors.initials: M
authors.lastname: Regan
authors.affiliation: Real-time Syndromic Surveillance Team, Birmingham.
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control; D004739:England / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D022243:Rotavirus Vaccines
keywords: diarrhea; gastroenteritis; rotavirus; rotavirus vaccine; syndromic surveillance