title: Effect of rotavirus vaccine on childhood diarrhea mortality in five Latin American countries.
abstract: BACKGROUND
  The aim of this study was to estimate the association between rotavirus vaccine (RV) introduction and reduction of all-cause diarrhea death rates among children in five Latin American countries that introduced RV in 2006.
  
  
  METHODS
  Diarrhea mortality data was gathered from 2002 until 2009 from the Pan American Health Organization Mortality Database for five "vaccine adopter" countries (Brazil, El Salvador, Mexico, Nicaragua, and Panama) that introduced RV in 2006 and four "control" countries (Argentina, Chile, Costa Rica, and Paraguay) that did not introduce RV by 2009. Time trend analyses were carried out, and effects and 95% confidence intervals (CI) were estimated.
  
  
  RESULTS
  Each of the five vaccine adopter countries, except Panama, showed a significant trend in declining mortality rates during the post-vaccine period from 2006 to 2009, whereas no decline was seen in control countries during these years. Furthermore, trends of reduction of all-cause diarrhea mortality in both children <1 year of age and <5 years of age were greater in the post-vaccination period compared with the pre-vaccine period in all vaccine adopter countries (except for Nicaragua), whereas in control countries, a reverse pattern was seen with greater reduction in the early years from 2002 to 2005 versus 2006-2009. An estimatedtotal of 1777 of annual under-5 deaths were avoided in Brazil, El Salvador, Mexico, and Nicaragua during the post-vaccination period.
  
  
  CONCLUSIONS
  All vaccine adopter countries, except Panama, showed a significant decrease in all-cause diarrhea-related deaths after RV implementation, even after adjusting for declining trends over time in diarrhea mortality. These data strongly support continuous efforts to increase vaccination coverage of RV vaccines, particularly in countries with high levels of child mortality from diarrhea.
authors.affiliation: Universidad de Cartagena, Cartagena de Indias, Colombia; Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia. Electronic address: angel.paternina@gmail.com.
authors.forename: Angel
authors.initials: A
authors.lastname: Paternina-Caicedo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, United States.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: Universidad de Cartagena, Cartagena de Indias, Colombia; Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia.
authors.forename: Nelson
authors.initials: N
authors.lastname: Alvis-Guzmán
authors.affiliation: Pan American Health Organization/World Health Organization, Washington, DC, United States.
authors.forename: Lucia Helena
authors.initials: LH
authors.lastname: De Oliveira
authors.affiliation: IDEAR - Department of Economics, Universidad Católica del Norte, Antofagasta, Chile.
authors.forename: Andres
authors.initials: A
authors.lastname: Castaño-Zuluaga
authors.affiliation: Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Karol
authors.initials: K
authors.lastname: Cotes-Cantillo
authors.affiliation: Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Oscar
authors.initials: O
authors.lastname: Gamboa-Garay
authors.affiliation: Universidad de Cartagena, Cartagena de Indias, Colombia.
authors.forename: Wilfrido
authors.initials: W
authors.lastname: Coronell-Rodríguez
authors.affiliation: Universidad Nacional de Colombia, Bogotá, Colombia.
authors.forename: Fernando
authors.initials: F
authors.lastname: De la Hoz-Restrepo
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008297:Male; D012400:Rotavirus Infections / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D016019:Survival Analysis
chemical_list: D022243:Rotavirus Vaccines
keywords: Ecological; Effectiveness; Latin America and the Caribbean; Rotavirus vaccines