title: Sustained Effectiveness of Rotavirus Vaccine Against Very Severe Rotavirus Disease Through the Second Year of Life, Bolivia 2013-2014.
abstract: BACKGROUND
  In Bolivia, monovalent rotavirus vaccine was introduced in 2008 and a previous evaluation reported a vaccine effectiveness (VE) of 77% with 2 doses of vaccine in children aged <3 years. This evaluation sought to determine if rotavirus vaccine provided protection through the second year of life against circulating genotypes.
  
  
  METHODS
  A case-control study was performed in 5 hospitals from April 2013 to March 2014. Among enrolled participants who met study criteria and had rotavirus stool testing performed and vaccine status confirmed, we calculated VE using a logistic regression model. Subgroup analyses were performed among children aged <1 year and those aged ≥1 year, among children with severe diarrhea (Vesikari score ≥11) and very severe diarrhea (Vesikari score ≥15), and among G and P strains with at least 40 specimens.
  
  
  RESULTS
  A total of 776 children were enrolled. For children <1 year and ≥1 year of age with severe diarrhea, VE for 2 doses was 75% (95% confidence interval [CI], 46%-88%) and 53% (95% CI, 9%-76%), respectively. For children <1 year and ≥1 year of age with very severe diarrhea, VE for 2 doses was 80% (95% CI, 44%-93%) and 74% (95% CI, 35%-90%), respectively. Genotype-specific analysis demonstrated similar VE for the 4 most common G and P types (G3, G9, P[6] and P[8]).
  
  
  CONCLUSIONS
  A monovalent rotavirus vaccine remains effective against a broad range of circulating strains as part of a routine immunization program >5 years after its introduction in Bolivia. Although VE appears to wane in children aged ≥1 year, it still provides significant protection, and does not wane against severe disease.
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Pringle
authors.affiliation: Programa Ampliado de Inmunización, Ministerio de Salud.
authors.forename: Maritza
authors.initials: M
authors.lastname: Patzi
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.affiliation: Facultad de Ciencias Puras y Naturales, Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés.
authors.forename: Volga
authors.initials: V
authors.lastname: Iniguez Rojas
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.affiliation: Facultad de Ciencias Puras y Naturales, Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés.
authors.forename: Lucia
authors.initials: L
authors.lastname: Inchauste Jordan
authors.affiliation: Pan American Health Organization, La Paz, Bolivia.
authors.forename: Raul
authors.initials: R
authors.lastname: Montesano
authors.affiliation: Programa Ampliado de Inmunización, Ministerio de Salud.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Zarate
authors.affiliation: Pan American Health Organization, Washington D.C.
authors.forename: Lucia
authors.initials: L
authors.lastname: De Oliveira
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases.
authors.forename: Umesh
authors.initials: U
authors.lastname: Parashar
mesh_terms: D001838:Bolivia / Q000453:epidemiology; D016022:Case-Control Studies; D046688:Child Mortality; D002675:Child, Preschool; D003967:Diarrhea / Q000517:prevention & control / Q000821:virology; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000517:prevention & control* / Q000821:virology; D005838:Genotype; D006801:Humans; D007115:Immunization Schedule; D000071497:Immunogenicity, Vaccine; D007223:Infant; D008297:Male; D015233:Models, Statistical; D012400:Rotavirus Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control* / Q000821:virology*; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D014611:Vaccination / Q000706:statistics & numerical data; D064166:Vaccine Potency; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: childhood mortality; diarrhea; gastroenteritis; middle-income country; rotavirus