title: Impact of Rotavirus Vaccine Introduction and Vaccine Effectiveness in the Republic of Moldova.
abstract: BACKGROUND
  The Republic of Moldova was the first low- to middle-income country in the World Health Organization European Region to introduce rotavirus vaccine (July 2012). We aimed to assess the impact of the rotavirus vaccine program and estimate vaccine effectiveness (VE).
  
  
  METHODS
  Surveillance for rotavirus gastroenteritis was conducted in 2 hospitals in the capital city of Chisinau starting in September 2009. Monthly rotavirus admissions by age were examined before and after introduction of rotavirus vaccination using interrupted time-series analyses. We performed a case-control study of VE by comparing rotavirus case patients with test-negative controls.
  
  
  RESULTS
  Coverage with at least 1 dose of vaccine increased from 35% in year 1 to 55% in year 2 for children <1 year of age. The percentage of hospital admissions positive for rotavirus fell from 45% in the prevaccine period to 25% (rate reduction, 36%; 95% confidence interval [CI], 26%-44%) and 14% (rate reduction, 67%; 95% CI, 48%-88%) in the first and second years after vaccine introduction, respectively, among children aged <5 years. Reductions were most pronounced among those aged <1 year. Significant reductions among cohorts too old to be vaccinated suggest indirect benefits. Two-dose VE was 79% (95% CI, 62%-88%) against rotavirus hospitalization and 84% (95% CI, 64%-93%) against moderate to severe rotavirus.
  
  
  CONCLUSIONS
  These results consistently point to profound direct and herd immunity impacts of the rotavirus vaccine program in young children in the Republic of Moldova. Vaccine coverage was modest in these early years following introduction, so there remains potential for further disease reductions.
authors.affiliation: National Center for Public Health.
authors.forename: Stela
authors.initials: S
authors.lastname: Gheorghita
authors.affiliation: Chisinau City Infectious Diseases Hospital for Children.
authors.forename: Ludmila
authors.initials: L
authors.lastname: Birca
authors.affiliation: Chisinau Municipal Hospital for Children, Republic of Moldova.
authors.forename: Ala
authors.initials: A
authors.lastname: Donos
authors.affiliation: Vaccine-Preventable Diseases and Immunization, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Wasley
authors.affiliation: National Center for Public Health.
authors.forename: Ion
authors.initials: I
authors.lastname: Birca
authors.affiliation: National Center for Public Health.
authors.forename: Radu
authors.initials: R
authors.lastname: Cojocaru
authors.affiliation: National Center for Public Health.
authors.forename: Anatol
authors.initials: A
authors.lastname: Melnick
authors.affiliation: World Health Organization Regional Office for Moldova, Chisinau.
authors.forename: Silviu
authors.initials: S
authors.lastname: Ciobanu
authors.affiliation: Vaccine-Preventable Diseases and Immunization, World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Liudmila
authors.initials: L
authors.lastname: Mosina
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Cortese
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ben
authors.initials: B
authors.lastname: Lopman
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000821:virology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D032521:Immunity, Herd; D017589:Immunization Programs; D000071497:Immunogenicity, Vaccine; D007223:Infant; D008297:Male; D008966:Moldova / Q000453:epidemiology; D012401:Rotavirus / Q000276:immunology; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D064166:Vaccine Potency
chemical_list: D022243:Rotavirus Vaccines
keywords: Moldova; case-control; rotavirus; surveillance; vaccine effectiveness