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Page 1: Dr parashar slides

Burden of Rotavirus Disease &Impact of Rotavirus Vaccination

Umesh D. Parashar, MBBS, MPHLead, Viral Gastroenteritis Epidemiology TeamCenters for Disease Control PreventionAtlanta, GA

TM

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Rotavirus is the Leading Cause Of Severe Gastroenteritis in Children <5 Years

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OtherOther

Bacterial Bacterial

Rotavirus

Developed Countries Developing Countries

Unknown Unknown Rotavirus

A. Kapikian, Fields Virology 2003

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The face of rotavirus

DiarrheaVomiting

DehydrationShock Death

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Burden of Rotavirus in the US in 2006Burden of Rotavirus in the US in 2006

20-60 Deaths

55-70,000 Hospitalizations

500,000 Outpatient visits

3.2 Million episodes

Cost: $300 M medical; >$1 B total CDC, MMWR, 2006

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51 dot = 250 deaths

Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children

Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children

Parashar et al, JID, 2009

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2006 -- Phase 3 Trials of Two Rotavirus Vaccines

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• Trials of 60-70,000 infants• No increased risk of intussusception or other SAE• Efficacy of 85%-98% against severe disease

Vesikari et al and Ruiz-Palacios et al, NEJM 2006

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Countries in the Americas with Rotavirus Vaccine Programs

Rotarix only

No program

Rotateq & Rotarix

Rotateq only

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Rotavirus Vaccines in USA

• Feb 2006 – RotaTeq recommended• June 2008 – Rotarix recommended

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National Rotavirus Laboratory Surveillance

• Network of 67 laboratories reporting since 2000

• Weekly reporting: – # specimens tested for rotavirus– # positive tests

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Total number of rotavirus tests and number of positive test results* from 27 continuously reporting laboratories - National Respiratory and Enteric Virus Surveillance System, United

States, July 2, 2000-February 20, 2010

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Month and year

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Total no. tests

No. positive results

* 3-week moving averages

Vaccine introduced

Total and Positive Rotavirus Tests, July 2000-Mar 2010

Tate et al, Pediatrics 2009 and CDC unpublished data

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Active Rotavirus Surveillance

Payne et al, PAS 2009

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Total AGE and Rotavirus AGE HospitalizationsNVSN, 2006-2008

181 179

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9181

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020406080

100120140160180200

2006 2007 2008

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f cas

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Total AGE Rotavirus

50 %

Rota+

45 %

Rota+

6 % Rota

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National reduction of 45,000-62,000 hospitalizations in 2008

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Age Decline in rotavirus hospitalization rate

(2008 vs. 2006)

Rotavirus vaccine coverage in 2008

(>=1 dose)

< 1 year 66% 56%

1 -< 2 years 95% 44%

2 -< 3 years 85% <1%

This age cohort was ineligible to receive rotavirus vaccine

Age-Specific Rotavirus Hospitalization Rate Reduction and Vaccine Coverage, NVSN

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Reduction in Rotavirus Admissions in Children < 5 Years after Rotarix Introduction, El Salvador

70-80% reduction in rotavirus hospitalizations children < 5 years

1771

1066

863

1092 1117

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342

2274

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Surveillance year

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Total diarrhoea cases

Rotavirus positive cases

Vaccination (October, 2006)

In press, BMJ, 2010

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Richardson et al, NEJM 2010

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Month-Year

Age ≤11 months

Age 12-23 months

Age 24-59 months

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Marked Decline in Childhood Diarrhea Deaths After Rotarix Introduction, Mexico

Vaccine Introduction(May 2007)

2008

2009

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Winter Blunting of Diarrhea Deaths Suggests Effect Against Rotavirus

Age 0-11 months

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2007-2009 observed deaths

2003-2006 maximum

2003-2006 median

2003-2006 minimum

Country-wide vaccine introduction, May, 2007

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191 dot = 250 deaths

Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children

Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children

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Rotarix Trial in Malawi & So. Africa

RegionVaccine

Efficacy 95% CI

No. of rotavirus cases prevented

per 100 vaccinated

Malawi49% 19, 68 6.7

South Africa 77% 40, 88 4.1

Madhi, S et al. NEJM 2010

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2006-2010Incredible years for rotavirus vaccines!....

And great promise for the future!!

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Acknowledgements


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