title: Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis.
abstract: BACKGROUND
  In May, 2012, Rwanda became the first low-income African country to introduce pentavalent rotavirus vaccine into its routine national immunisation programme. Although the potential health benefits of rotavirus vaccination are huge in low-income African countries that account for more than half the global deaths from rotavirus, concerns remain about the performance of oral rotavirus vaccines in these challenging settings.
  
  
  METHODS
  We conducted a time-series analysis to examine trends in admissions to hospital for non-bloody diarrhoea in children younger than 5 years in Rwanda between Jan 1, 2009, and Dec 31, 2014, using monthly discharge data from the Health Management Information System. Additionally, we reviewed the registries in the paediatric wards at six hospitals from 2009 to 2014 and abstracted the number of total admissions and admissions for diarrhoea in children younger than 5 years by admission month and age group. We studied trends in admissions specific to rotavirus at one hospital that had undertaken active rotavirus surveillance from 2011 to 2014. We assessed changes in rotavirus epidemiology by use of data from eight active surveillance hospitals.
  
  
  RESULTS
  Compared with the 2009-11 prevaccine baseline, hospital admissions for non-bloody diarrhoea captured by the Health Management Information System fell by 17-29% from a pre-vaccine median of 4051 to 2881 in 2013 and 3371 in 2014, admissions for acute gastroenteritis captured in paediatric ward registries decreased by 48-49%, and admissions specific to rotavirus captured by active surveillance fell by 61-70%. The greatest effect was recorded in children age-eligible to be vaccinated, but we noted a decrease in the proportion of children with diarrhoea testing positive for rotavirus in almost every age group.
  
  
  CONCLUSIONS
  The number of admissions to hospital for diarrhoea and rotavirus in Rwanda fell substantially after rotavirus vaccine implementation, including among older children age-ineligible for vaccination, suggesting indirect protection through reduced transmission of rotavirus. These data highlight the benefits of routine vaccination against rotavirus in low-income settings.
  
  
  BACKGROUND
  Gavi, the Vaccine Alliance and the Government of Rwanda.
authors.affiliation: Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium. Electronic address: ngabog@yahoo.fr.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.affiliation: Rwanda Biomedical Centre, Kigali, Rwanda.
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: World Health Organization, Rwanda Office, Kigali, Rwanda.
authors.forename: Celse
authors.initials: C
authors.lastname: Rugambwa
authors.affiliation: Université Libre de Bruxelles, Ecole de Santé Publique, Centre de Recherche Politiques et Systèmes de Santé-Santé Internationale, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
authors.affiliation: Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepage
authors.affiliation: World Health Organization, African Regional Office, Brazzaville, Congo.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mwenda
authors.affiliation: Ministry of Health, Kigali, Rwanda; Harvard Medical School, Boston, MA, USA; Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D002675:Child, Preschool; D003906:Developing Countries; D003967:Diarrhea / Q000209:etiology / Q000821:virology*; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D012401:Rotavirus; D012400:Rotavirus Infections / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines; D012432:Rwanda; D014611:Vaccination
chemical_list: D022243:Rotavirus Vaccines
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