Abstract:
Background: Dehydration secondary to diarrhoea is a major cause of
hospitalization and mortality in children aged less than five years.
Most diarrhoea cases in childhood are caused by rotavirus, and
routine introduction of rotavirus vaccine is expected to reduce the
incidence and severity of dehydration secondary to diarrhoea in
vaccinated infants. Previously, studies have examined changes in
admissions with stools positive for rotavirus but this study reports on
all admissions with dehydration secondary to diarrhoea regardless of
stool rotavirus results. We aimed to assess the changes in all-cause
severe diarrhoea and dehydration (DAD) admissions following the
vaccine’s introduction.
Methods: We examined changes in admissions of all clinical cases of
DAD before and after introduction of routine vaccination with
rotavirus vaccine in July 2014 in Kenya. We use data from 13 public
hospitals currently involved in a clinical network, the Clinical
Information Network (CIN). Routinely collected data for children aged
2-36 months were examined. We used a segmented mixed effects
model to assess changes in the burden of diarrhoea and dehydration
after introduction of rotavirus vaccine. For sensitivity analysis, we
examined trends for non-febrile admissions (surgical or burns).
Results: There were 17,708 patients classified as having both
diarrhoea and dehydration. Average monthly admissions due to DAD
for each hospital before vaccine introduction (July 2014) was 35
(standard deviation: ±22) and 17 (standard deviation: ±12) after
vaccine introduction. Segmented mixed effects regression model
showed there was a 33% (95% CI, 30% to 38%) decrease in DAD
admissions immediately after the vaccine was introduced to the Kenya
immunization program in July 2014. There was no change in
admissions due to non-febrile admissions pre-and post-vaccine
introduction.
Conclusion: The rotavirus vaccine, after introduction into the Kenya
routine immunization program resulted in reduction of all-cause
admissions of diarrhoea and dehydration in children to public
hospitals.
