The success of publicly funded rotavirus vaccine programs for preventing community- and hospital-acquired rotavirus infections in Canadian pediatric hospitals: an observational study.

CMAJ open Pub Date : 2023-12-19 Print Date: 2023-11-01 DOI:10.9778/cmajo.20220245
Nicole Le Saux, Julie Bettinger, Hennady P Shulha, Manish Sadarangani, Doug Coyle, Timothy F Booth, Taj Jadavji, Scott A Halperin
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Abstract

Background: Canadian immunization programs for rotavirus started in 2011. We sought to determine their effect on the burden of community-acquired admissions and hospital-acquired rotavirus at pediatric hospitals.

Methods: The Canadian Immunization Monitoring Program Active (IMPACT) network conducted active surveillance for rotavirus-positive hospital admissions between 2005 and 2020 at 12 pediatric hospitals. We used yearly rates of community-acquired rotavirus per 10 000 admissions and hospital-acquired rotavirus infections per 1000 patient-days to determine changes in the pre- and post-vaccine program periods.

Results: During the 15-year study period, 5691 rotavirus hospital admissions and hospital-acquired infections were detected, including 4323 (76%) community-acquired infections and 1368 (24%) hospital-acquired infections. The average community-acquired rate in the pre-vaccine period was 60.3 (95% confidence interval [CI] 53.7-68.3) per 10 000 admissions, with a decline to 11.0 (95% CI 7.5-15.1) per 10 000 admissions in the post-vaccine period, resulting in an average reduction of 81.7% (95% CI 74.4%-87.8%). The rate of hospital-acquired rotavirus declined from 0.35 (95% CI 0.29-0.41) per 1000 patient-days in the pre-vaccine period to 0.05 (95% CI 0.03-0.07) per 1000 patient-days in the post-vaccine period, resulting in an 85.3% (95% CI 77.7%-91.9%) average decline. Herd protection was present among children aged 2-16 years.

Interpretation: Although start dates of rotavirus vaccine programs across provinces varied, there was around an 80% average decrease in both community-acquired and hospital-acquired rotavirus infections at pediatric hospitals in Canada in the 1- to 9-year interval after implementation of rotavirus vaccine programs. Herd protection is an important aspect of rotavirus vaccines for other children who are not vaccine eligible, and rotavirus vaccines continue to provide important benefits both for children and health care systems.

加拿大儿科医院预防社区和医院获得性轮状病毒感染的公共资助轮状病毒疫苗计划的成功:一项观察性研究。
背景:加拿大轮状病毒免疫计划始于2011年。我们试图确定这些计划对儿科医院社区获得性入院和医院获得性轮状病毒负担的影响:加拿大主动免疫监测计划(IMPACT)网络在 2005 年至 2020 年期间对 12 家儿科医院的轮状病毒阳性入院病例进行了主动监测。我们使用每 10,000 例入院患者中社区获得性轮状病毒感染率和每 1000 个患者日中医院获得性轮状病毒感染率来确定疫苗接种计划前后的变化:在 15 年的研究期间,共发现 5691 例轮状病毒入院和医院感染病例,其中包括 4323 例(76%)社区感染病例和 1368 例(24%)医院感染病例。疫苗接种前的平均社区感染率为每 10,000 例住院中 60.3 例(95% 置信区间 [CI]:53.7-68.3),疫苗接种后降至每 10,000 例住院中 11.0 例(95% 置信区间 [CI]:7.5-15.1),平均降幅为 81.7%(95% 置信区间 [CI]:74.4%-87.8%)。医院获得性轮状病毒感染率从接种疫苗前的每 1000 个患者日 0.35 例(95% CI 0.29-0.41)下降到接种疫苗后的每 1000 个患者日 0.05 例(95% CI 0.03-0.07),平均降幅为 85.3%(95% CI 77.7%-91.9%)。2-16岁儿童中存在群体保护:尽管各省轮状病毒疫苗接种计划的启动日期不同,但在轮状病毒疫苗接种计划实施后的 1 到 9 年间,加拿大儿科医院的社区获得性和医院获得性轮状病毒感染率平均下降了约 80%。轮状病毒疫苗的一个重要方面是为其他不符合接种条件的儿童提供群体保护,轮状病毒疫苗将继续为儿童和医疗保健系统带来重要益处。
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