title: Rotavirus-specific and Overall Diarrhea Mortality in Chinese Children Younger than 5 Years: 2003 to 2012.
abstract: BACKGROUND
  During the past decade, substantial declines in overall childhood mortality from diarrhea have been documented among Chinese children, but the last detailed assessment of rotavirus-specific mortality in China was conducted in 2002. To provide policy makers with up-to-date information, we examined rotavirus-related mortality in children <5 years of age in China during 2003-2012.
  
  
  METHODS
  We obtained mortality rates for children <5 years of age from the Chinese Health Statistic Yearbook; these figures were multiplied by the proportion of deaths in this age group attributable to diarrhea from the Chinese Maternal and Child Mortality Surveillance to obtain estimates of diarrhea deaths in children <5 years of age. To estimate rotavirus deaths, diarrhea death estimates were multiplied by the detection rate of rotavirus in children hospitalized with diarrhea from the Viral Diarrhea Surveillance System in China and from peer-reviewed literature.
  
  
  RESULTS
  From 2003 to 2012, a total of 127,539 deaths from diarrhea were reported among Chinese children <5 years of age, of which an estimated 53,559 (42%) had illness attributable to rotavirus. Comparing 2003 to 2012, the annual number of deaths from rotavirus diarrhea decreased by 74% (from 10,531 to 2,791, respectively) and the mortality rate fell 74% (from 0.66 to 0.17 deaths per 1000 live births, respectively). Ninety-three percent of all rotavirus deaths occurred in rural areas, where mortality rates (0.33 deaths per 1000 live births in 2012) were 11 times greater than in urban areas (0.03 deaths per 1000 live births in 2012).
  
  
  CONCLUSIONS
  Rotavirus diarrhea mortality has substantially declined in the past decade in Chinese children. The vast majority of rotavirus deaths occurred in rural areas. There is potential value in using rotavirus vaccine interventions in rural areas to further reduce mortality from this disease.
authors.affiliation: From the *Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; †National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‡Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia; and §National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.forename: Zhaojun
authors.initials: Z
authors.lastname: Duan
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Payne
authors.forename: Catherine
authors.initials: C
authors.lastname: Yen
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Pan
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Chang
authors.forename: Na
authors.initials: N
authors.lastname: Liu
authors.forename: Jianli
authors.initials: J
authors.lastname: Ye
authors.forename: Xiang
authors.initials: X
authors.lastname: Ren
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Baoming
authors.initials: B
authors.lastname: Jiang
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D012400:Rotavirus Infections / Q000453:epidemiology / Q000401:mortality*