title: A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel.
abstract: Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008-2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011-2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0-23 months (60-61%) than in toddlers aged 24-59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.
authors.affiliation: a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel.
authors.forename: Khitam
authors.initials: K
authors.lastname: Muhsen
authors.affiliation: b Department of Pediatrics ; Laniado Medical Center ; Netanya , Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Rubenstein
authors.affiliation: c Department of Pediatrics ; Hillel Yaffe Medical Center ; Hadera , Israel.
authors.forename: Eias
authors.initials: E
authors.lastname: Kassem
authors.affiliation: a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel.
authors.forename: Sophy
authors.initials: S
authors.lastname: Goren
authors.affiliation: b Department of Pediatrics ; Laniado Medical Center ; Netanya , Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Schachter
authors.affiliation: c Department of Pediatrics ; Hillel Yaffe Medical Center ; Hadera , Israel.
authors.forename: Adi
authors.initials: A
authors.lastname: Kremer
authors.affiliation: a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel.|d Central Virology Laboratory; Ministry of Health ; Tel Hashomer , Israel.
authors.forename: Lester M
authors.initials: LM
authors.lastname: Shulman
authors.affiliation: e Department of Pediatrics ; Carmel Medical Center ; Haifa , Israel.|f Faculty of Medicine; Technion-Israel Institute of Technology ; Haifa , Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Ephros
authors.affiliation: a Department of Epidemiology and Preventive Medicine ; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University Ramat Aviv ; Tel Aviv , Israel.
authors.forename: Dani
authors.initials: D
authors.lastname: Cohen
mesh_terms: D002675:Child, Preschool; D002846:Chromatography, Affinity; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: Israel; RotaTeq; children; impact; rotavirus; universal vaccination