Rotavirus vaccination within the South African Expanded Programme on Immunisation.
ABSTRACT Diarrhoeal diseases are ranked the third major cause of childhood mortality in South African children less than 5years, where the majority of deaths are among black children. Acute severe dehydrating rotavirus diarrhoea remains an important contributor towards childhood mortality and morbidity and has been well documented in South Africa. As the preventive strategy to control rotavirus diarrhoea, South Africa became the first country in the WHO African Region to adopt the rotavirus vaccine in the national childhood immunisation programme in August 2009. The rotavirus vaccine in use, Rotarix(®), GSK Biologicals, is given at 6 and 14weeks of age, along with other vaccines as part of Expanded Programme on Immunisation (EPI). Studies which facilitated the introduction of rotavirus vaccine in South Africa included the burden of rotavirus disease and strain surveillance, economic burden of rotavirus infection and clinical trials to assess the safety and efficacy of vaccine candidates. This paper reviews the epidemiology of rotavirus in South Africa, outlines some of the steps followed to introduce rotavirus vaccine in the EPI, and highlights the early positive impact of vaccination in reducing the rotavirus burden of disease based on the post-marketing surveillance studies at Dr George Mukhari hospital, a sentinel site at University of Limpopo teaching hospital in Pretoria, South Africa, which has conducted rotavirus surveillance for >20years.
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ABSTRACT: Oral rotavirus vaccine was introduced into the South African routine immunization program in August 2009 administered at 6 and 14 weeks with no catch up. We described the change in rotavirus-associated diarrheal hospitalizations among children <5 years at 3 sentinel sites from 2009 through 2011. During 2009-2011, we compared the proportion of enrolled children aged <5 years hospitalized with acute gastroenteritis and testing rotavirus positive. We used hospital data to determine the change in diarrhea hospitalizations, and estimated total numbers of rotavirus hospitalizations by adjusting for non-enrolled patients. Stool samples were tested for rotavirus using EIA. In 2009 (May- December), 46% (404/883) of samples amongst children <5 years tested rotavirus positive, decreasing to 33% (192/580) (p<0.001) in 2010 and 29% (113/396) (p<0.001) in 2011. Compared to May- December 2009, total diarrhea hospitalizations among children aged <5 years was one-third lower in May-December of 2010 and 2011. Among infants, adjusted rotavirus hospitalizations were 61% (n=267) and 69% (n=214) lower respectively in 2010 and 2011 when compared to 2009 (n=689), and 45 and 50 percentage points greater than the reduction in rotavirus-negative cases. Among children <5 years rotavirus hospitalizations were 54% and 58% lower in 2010 and 2011, compared to 2009 (40 and 44 percentage points greater than reduction in rotavirus-negative cases). Rotavirus reductions occurred in rural and urban settings. Using published estimates of rotavirus hospitalization burden, we estimate that at least 13,000 to 20,000 hospitalizations in children <2 years were prevented in the two years following rotavirus vaccine introduction.The Pediatric Infectious Disease Journal 08/2013; · 3.14 Impact Factor
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ABSTRACT: Group A rotaviruses (RVAs) are the leading cause of severe gastroenteritis and eventually death among infants and young children worldwide, and disease prevention and management through vaccination is a public health priority. In August 2009, Rotarix™ was introduced in the South African Expanded Programme on Immunisation. As a result, substantial reductions in RVA disease burden have been reported among children younger than 5 years old. Rotavirus strain surveillance post-vaccination is crucial to, inter alia, monitor and study the evolution of vaccine escape strains. Here, full-genome sequence data for the 11 gene segments from 11 South African G1P rotavirus strains were generated, including 5 strains collected from non-vaccinated children during the 2004-2009 rotavirus seasons and 6 strains collected from vaccinated children during the 2010 rotavirus season. These data were analyzed to gain insights into the overall genetic makeup and evolution of South African G1P rotavirus strains and to compare their genetic backbones with those of common human Wa-like RVAs from other countries, as well as with the Rotarix™ and RotaTeq™ G1P vaccine components. All 11 South African G1P strains revealed a complete Wa-like genotype constellation of G1-P-I1-R1-C1-M1-A1-N1-T1-E1-H1. On the basis of sequence similarities, the South African G1P strains (with the exception of strain RVA/Human-wt/ZAF/1262/2004/G1P) were closely related to each other (96-100% identity in all gene segments). Comparison to the Rotarix™ and RotaTeq™ G1P vaccine components revealed a moderate nucleotide identity of 89-96% and 93-95%, respectively. The results indicated that none of the gene segments of these 11 South African G1P strains were vaccine-derived. This study illustrates that large-scale next generation sequencing will provide crucial information on the influence of the vaccination program on evolution of rotavirus strains. This is the first report to describe full genomic analyses of G1P RVA strains collected from both non-vaccinated and vaccinated children in South Africa. J. Med. Virol. 9999: XX-XX, 2014. © 2014 Wiley Periodicals, Inc.Journal of Medical Virology 05/2014; · 2.22 Impact Factor
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ABSTRACT: This case report describes diagnosis and management of intussusception in an 8-month-old baby girl seen at the Ventersdorp District Hospital, South Africa. According to the vaccination card, the child had been immunized with rotavirus vaccine with the last dose given 6 months and 2 weeks before presentation to Ventersdorp Hospital. This case of intussusception was unlikely associated with rotavirus vaccination.The Pediatric Infectious Disease Journal 01/2014; 33 Suppl 1:S104-6. · 3.14 Impact Factor