title: Impact and Effectiveness of Monovalent Rotavirus Vaccine Against Severe Rotavirus Diarrhea in Ghana.
abstract: BACKGROUND
  Ghana was among the first African nations to introduce monovalent rotavirus vaccine (RV1) into its childhood immunization schedule in April 2012. We aimed to assess the impact of vaccine introduction on rotavirus and acute gastroenteritis (AGE) hospitalizations and to estimate vaccine effectiveness (VE).
  
  
  METHODS
  Using data from 2 teaching hospitals, monthly AGE and rotavirus admissions by age were examined 40 months before and 31 months after RV1 introduction using interrupted time-series analyses. From January 2013, we enrolled children <2 years of age who were eligible for RV1 from a total of 7 sentinel sites across the country. To estimate VE, we fit unconditional logistic regression models to calculate odds ratios of vaccination by rotavirus case-patient status, controlling for potential confounders.
  
  
  RESULTS
  Vaccine coverage ranged from 95% to 100% for dose 1 and 93% to 100% for dose 2. In the first 3 years after vaccine introduction, the percentage of hospital admissions positive for rotavirus fell from 48% in the prevaccine period to 28% (49% adjusted rate reduction; 95% confidence interval [CI], 32%-63%) postvaccination among <5-year-olds. With high vaccine coverage, it was not possible to arrive at robust VE estimates; any-dose VE against rotavirus hospitalization was estimated at 60% (95% CI, -2% to 84%;P= .056).
  
  
  CONCLUSIONS
  Results from the first 3 years following RV1 introduction suggest substantial reductions of pediatric diarrheal disease as a result of vaccination. Our VE estimate is consistent with the observed rotavirus decrease and with efficacy estimates from elsewhere in sub-Saharan Africa.
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra.
authors.forename: George
authors.initials: G
authors.lastname: Armah
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Pringle
authors.affiliation: School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra.
authors.forename: Christabel C
authors.initials: CC
authors.lastname: Enweronu-Laryea
authors.affiliation: Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansong
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: Ghana World Health Organization Country Office, Accra.
authors.forename: Stanley K
authors.initials: SK
authors.lastname: Diamenu
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
authors.forename: Clement
authors.initials: C
authors.lastname: Narh
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana, Accra.
authors.forename: Belinda
authors.initials: B
authors.lastname: Lartey
authors.affiliation: School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
authors.forename: Fred
authors.initials: F
authors.lastname: Binka
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Scott
authors.initials: S
authors.lastname: Grytdal
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Umesh
authors.initials: U
authors.lastname: Parashar
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ben
authors.initials: B
authors.lastname: Lopman
mesh_terms: D000208:Acute Disease / Q000453:epidemiology; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D062665:Epidemiological Monitoring; D005260:Female; D005759:Gastroenteritis / Q000517:prevention & control / Q000821:virology; D005869:Ghana / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D017589:Immunization Programs; D007115:Immunization Schedule; D007223:Infant; D016015:Logistic Models; D008297:Male; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D014611:Vaccination; D064166:Vaccine Potency; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492457:RIX4414 vaccine; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: Ghana; case-control; rotavirus; surveillance; vaccine effectiveness