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Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years

Educational Objective
To examine the global extent of rotavirus infection among children younger than 5 years and the number of deaths averted because of the rotavirus vaccine.
1 Credit CME
Key Points

Questions  What is the extent of rotavirus infection among children younger than 5 years, and how has the rotavirus vaccine reduced this global burden?

Findings  This report of the Global Burden of Disease and several extended analyses on rotavirus and results of rotavirus vaccination found that rotavirus infection caused 128 500 deaths and 258 173 300 episodes of diarrhea among children younger than 5 years in 2016. The rotavirus vaccine is estimated to have averted approximately 28 000 deaths in 2016, and approximately 83 200 additional children could have been saved had full vaccine coverage been achieved that year.

Meaning  Prioritizing the introduction of the rotavirus vaccine and interventions to reduce diarrhea-associated morbidity and mortality are necessary in the continued reduction of the global rotavirus burden.

Abstract

Importance  Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years.

Objectives  To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine.

Design, Setting, and Participants  This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations.

Exposure  Diarrhea due to rotavirus infection.

Main Outcomes and Measures  Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country.

Results  Rotavirus infection was responsible for an estimated 128 500 deaths (95% uncertainty interval [UI], 104 500-155 600) among children younger than 5 years throughout the world in 2016, with 104 733 deaths occurring in sub-Saharan Africa (95% UI, 83 406-128 842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28 000 deaths (95% UI, 14 600-46 700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years.

Conclusions and Relevance  Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.

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Article Information

Accepted for Publication: April 18, 2018.

Corresponding Author: Robert C. Reiner Jr, PhD, Institute for Health Metrics and Evaluation, 2301 Fifth Ave, Ste 600, Seattle, WA 98121 (bcreiner@uw.edu).

Published Online: August 13, 2018. doi:10.1001/jamapediatrics.2018.1960

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Troeger C et al. JAMA Pediatrics.

Author Contributions: Drs Reiner and Hay had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Troeger, Khalil, Rao, Ahmed, Brewer, Mwenda, Parashar, Steele, Murray, Hay, Reiner.

Acquisition, analysis, or interpretation of data: Troeger, Khalil, Cao, Blacker, Ahmed, Armah, Bines, Colombara, Kang, Kirkpatrick, Kirkwood, Petri, Riddle, Steele, Thompson, Walson, Sanders, Mokdad, Reiner.

Drafting of the manuscript: Troeger, Khalil, Rao, Cao, Blacker, Steele, Walson, Reiner.

Critical revision of the manuscript for important intellectual content: Troeger, Blacker, Ahmed, Armah, Bines, Brewer, Colombara, Kang, Kirkpatrick, Kirkwood, Mwenda, Parashar, Petri, Riddle, Steele, Thompson, Walson, Sanders, Mokdad, Murray, Hay, Reiner.

Statistical analysis: Troeger, Cao, Hay, Reiner.

Obtained funding: Ahmed, Murray.

Administrative, technical, or material support: Rao, Blacker, Ahmed, Kang, Mwenda, Riddle, Hay.

Supervision: Khalil, Rao, Ahmed, Thompson, Mokdad, Murray, Hay, Reiner.

Conflict of Interest Disclosures: None reported.

Funding/Support: This analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study was supported by grant OPP1132415 from the Bill & Melinda Gates Foundation.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Disclaimer: The opinions and assertions expressed herein by Dr Riddle do not necessarily reflect the official policy or position of the Uniformed Services University or the US Department of Defense.

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