title: Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa.
abstract: BACKGROUND
  The public health impact of rotavirus vaccination in African settings with a high human immunodeficiency virus (HIV) infection prevalence is yet to be established. We evaluated trends in all-cause diarrheal hospitalizations in Soweto, Johannesburg, before and after the introduction of rotavirus vaccine into South Africa's national immunization program in August 2009.
  
  
  METHODS
  Hospitalizations in children <5 years of age with a diagnosis of diarrhea, defined byInternational Classification of Diseases, Tenth Revisioncodes A00-A05, A06.0-A06.3, A06.9, A07.0-A07.2, A07.9, and A08-A09, were identified at the Chris Hani Baragwanath Academic Hospital from 1 January 2006 to 31 December 2014. The median annual prevaccine (2006-2008) hospitalization incidence was compared to that of the vaccine era (2010-2014), and stratified by age group and HIV infection status.
  
  
  RESULTS
  Incidence reductions (per 1000 population) were greatest in children aged <12 months: 54.4 in the prevaccine era vs 30.0, 23.6, 20.0, 18.8, and 18.9 in the postvaccine years 2010-2014, respectively (a 44.9%-65.4% reduction). Lower incidence reductions (39.8%-49.4%) were observed among children aged 12-24 months from the second year post-vaccine introduction onward. Reductions were observed in both HIV-infected and HIV-uninfected children. There was a change in the seasonal pattern of diarrheal hospitalizations post-vaccine introduction, with flattening of the autumn-winter peaks seen in the prevaccine years.
  
  
  CONCLUSIONS
  An accelerated and sustained decline in all-cause diarrheal hospitalizations, temporally associated with rotavirus vaccine introduction, was observed in children <2 years of age. However, the impact of other interventions such as improved sanitation and changes in HIV management cannot be discounted.
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Groome
authors.affiliation: Stat-Epi Associates Inc, West Palm Beach, Florida.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Zell
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.
authors.forename: Fatima
authors.initials: F
authors.lastname: Solomon
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.
authors.forename: Susan
authors.initials: S
authors.lastname: Nzenze
authors.affiliation: Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases.
authors.forename: Alane
authors.initials: A
authors.lastname: Izu
authors.affiliation: Medical Research Council, Respiratory and Meningeal Pathogens Research Unit Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases National Institute for Communicable Diseases, National Health Laboratory Service, Sandringham, South Africa.
authors.forename: Shabir A
authors.initials: SA
authors.lastname: Madhi
mesh_terms: D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006760:Hospitalization / Q000639:trends; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D008297:Male; D012400:Rotavirus Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology; D012621:Seasons; D013019:South Africa / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data* / Q000639:trends; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492457:RIX4414 vaccine; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: HIV; children; diarrhea; rotavirus vaccine