title: Effectiveness of Pentavalent Rotavirus Vaccine Under Conditions of Routine Use in Rwanda.
abstract: BACKGROUND
  Rotavirus vaccine efficacy is lower in low-income countries than in high-income countries. Rwanda was one of the first low-income countries in sub-Saharan Africa to introduce rotavirus vaccine into its national immunization program. We sought to evaluate rotavirus vaccine effectiveness (VE) in this setting.
  
  
  METHODS
  VE was assessed using a case-control design. Cases and test-negative controls were children who presented with a diarrheal illness to 1 of 8 sentinel district hospitals and 10 associated health centers and had a stool specimen that tested positive (cases) or negative (controls) for rotavirus by enzyme immunoassay. Due to high vaccine coverage almost immediately after vaccine introduction, the analysis was restricted to children 7-18 weeks of age at time of rotavirus vaccine introduction. VE was calculated as (1 - odds ratio) × 100, where the odds ratio was the adjusted odds ratio for the rotavirus vaccination rate among case-patients compared with controls.
  
  
  RESULTS
  Forty-eight rotavirus-positive and 152 rotavirus-negative children were enrolled. Rotavirus-positive children were significantly less likely to have received rotavirus vaccine (33/44 [73%] unvaccinated) compared with rotavirus-negative children (81/136 [59%] unvaccinated) (P= .002). A full 3-dose series was 75% (95% confidence interval [CI], 31%-91%) effective against rotavirus gastroenteritis requiring hospitalization or a health center visit and was 65% (95% CI, -80% to 93%) in children 6-11 months of age and 81% (95% CI, 25%-95%) in children ≥12 months of age.
  
  
  CONCLUSIONS
  Rotavirus vaccine is effective in preventing rotavirus disease in Rwandan children who began their rotavirus vaccine series from 7 to 18 weeks of age. Protection from vaccination was sustained after the first year of life.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.affiliation: Universite Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
authors.forename: Fidele
authors.initials: F
authors.lastname: Ngabo
authors.affiliation: Universite Libre de Bruxelles, Ecole de Santé Publique, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Donnen
authors.affiliation: Rwanda Biomedical Center.
authors.forename: Maurice
authors.initials: M
authors.lastname: Gatera
authors.affiliation: University Teaching Hospital.
authors.forename: Jeannine
authors.initials: J
authors.lastname: Uwimana
authors.affiliation: World Health Organization, Rwanda Office, Kigali.
authors.forename: Celse
authors.initials: C
authors.lastname: Rugambwa
authors.affiliation: World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mwenda
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D016022:Case-Control Studies; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D016017:Odds Ratio; D012401:Rotavirus / Q000276:immunology; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D012432:Rwanda; D014611:Vaccination / Q000706:statistics & numerical data / Q000639:trends; D064166:Vaccine Potency; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: rotavirus; rotavirus vaccine; vaccine effectiveness