Jacqueline E Tate

Publications of Jacqueline E Tate

• All Cause Gastroenteritis and Rotavirus-Coded Hospitalizations among US Children from 2000-2009.

  Authors: Rishi Desai, Aaron T Curns, Claudia A Steiner, Jacqueline E Tate, Manish M Patel, Umesh D Parashar

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 04/2012;

  IntroductionRotavirus vaccine was recommended for US infants in 2006. We estimated baseline, pre-vaccine burden and monitored post-vaccine trends in gastroenteritis-coded and rotavirus-codedIntroductionRotavirus vaccine was recommended for US infants in 2006. We estimated baseline, pre-vaccine burden and monitored post-vaccine trends in gastroenteritis-coded and rotavirus-coded hospitalizations among US children.MethodsWe analyzed data from the State Inpatient Databases (SID) for 29-44 US states over a 10-year period (2000-2009) to calculate gastroenteritis and rotavirus-coded hospitalization rates by age group, sex, and region, among children <5 years of age. By extrapolating observed pre- and post-vaccine gastroenteritis hospitalization rates to the US population <5 years and based on the 2009 cost of a diarrhea hospitalization, we estimated national reductions in diarrhea hospitalizations and associated treatment costs.ResultsThe pre-vaccine (2000-2006) annual average gastroenteritis-coded hospitalization rate among children <5 years of age was 74 per 10,000 (annual range: 71-82 per 10,000), and declined to 51 and 50 per 10,000 in 2008 and 2009, respectively (p < 0.001). The pre-vaccine (2000-2006) annual average rotavirus-coded hospitalization rate among children <5 years of age was 15 per 10,000 (annual range: 13-18 per 10,000), and declined to 5 and 6 per 10,000 in 2008 and 2009, respectively (p < 0.001). The decreases in rotavirus-coded hospitalization rates in 2008 and 2009 compared with rates in pre-vaccine years were observed among all age-groups and US regions. Nationally, during 2008 and 2009 combined, we estimated a reduction of ~77,000 diarrhea hospitalizations and approximately $242 million in hospital costs.ConclusionSince implementation of the US rotavirus vaccination program, a marked reduction in diarrhea hospitalizations and related hospital charges has occurred among US children.

• Trends in Intussusception Hospitalizations among US Infants Before and After Implementation of the Rotavirus Vaccination Program, 2000-2009.

  Authors: Catherine Yen, Jacqueline E Tate, Claudia A Steiner, Margaret M Cortese, Manish M Patel, Umesh D Parashar

  The Journal of infectious diseases. 04/2012;

  BackgroundIn 1999, a rotavirus vaccine was withdrawn due to an association with intussusception. While US data have not documented an intussusception risk with current rotavirus vaccines,BackgroundIn 1999, a rotavirus vaccine was withdrawn due to an association with intussusception. While US data have not documented an intussusception risk with current rotavirus vaccines, international data indicate a possible low risk, primarily after the first dose.MethodsAmong infants in 26 US states comprising 75% of the birth cohort, we conducted an ecological analysis to examine age-specific trends in population-level intussusception hospitalization rates before (2000-2005) and after (2007-2009) rotavirus vaccine introduction.ResultsCompared with 2000-2005 (35.3/100,000), the rate was greater in 2007 (39.0/100,000; rate ratio [RR]=1.10;95% confidence interval [CI]: 1.04-1.18), similar in 2008 (33.4/100,000; RR=0.95[0.89-1.01]), and lower in 2009 (32.9/100,000; RR=0.93[0.87-0.99]). Among 8-11 week-olds, compared with 2000-2005 (6.9/100,000), a small, significant increase was observed in each of 2007 (11.4/100,000; RR=1.64[1.08-2.50]), 2008 (12.2/100,000; RR=1.76[1.17-2.65]), and 2009 (11.0/100,000; RR=1.59[1.04-2.44]).ConclusionsFollowing rotavirus vaccine introduction, a small increase in intussusception rates was seen among US 8-11 week-olds who receive most first doses of vaccine; no sustained population-level change in overall rates was observed. While this ecologic analysis alone cannot establish an association between intussusception and rotavirus vaccination, even if a low risk with the first dose exists, it is outweighed by the well-documented benefits of vaccination among US infants.

• Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America.

  Authors: Rishi Desai, Umesh D Parashar, Benjamin Lopman, Lucia Helena de Oliveira, Andrew D Clark, Colin F B Sanderson, Jacqueline E Tate, Cuahtemoc Ruiz Matus, Jon K Andrus, Manish M Patel

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 03/2012;

  Background. With the recent postlicensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must nowBackground. With the recent postlicensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must now weigh the health benefits versus risks to assess whether to continue vaccination. To inform policy considerations, we estimated excess intussusception cases and mortality potentially caused by rotavirus vaccine for each of the 14 countries and compared these estimates to hospitalizations and deaths expected to be averted through vaccination.Methods. We used regional rotavirus disease burden and rotavirus vaccine efficacy data, global natural intussusception and regional rotavirus vaccine-related risk estimates, and country-specific diphtheria, tetanus, and pertussus vaccination coverage rates to estimate rotavirus vaccine coverage rates. We performed a probabilistic sensitivity analysis to account for uncertainty in these parameters.Results. For an aggregate hypothetical birth cohort of 9.5 million infants in these 14 countries, rotavirus vaccine would annually prevent 144 746 (90% confidence interval [CI], 128 821-156 707) hospitalizations and 4124 deaths (90% CI, 3740-4239) due to rotavirus in their first 5 years of life but could cause an additional 172 hospitalizations (90% CI, 126-293) and 10 deaths (90% CI, 6-17) due to intussusception, yielding benefit-risk ratios for hospitalization and death of 841:1 (90% CI, 479:1 to 1142:1) and 395:1 (90% CI, 207:1 to 526:1), respectively. In an uncertainty analysis using 10 000 simulations of our probabilistic parameters, in comparing rotavirus disease averted to intussusception events caused, the hospitalization ratio was never below 100:1, and our death ratio fell below 100:1 only once.Conclusions. The health benefits of vaccination far outweigh the short-term risks and support continued rotavirus vaccination in Latin America.

• Risk Factors for Diarrhea-Associated Infant Mortality in the United States, 2005-2007.

  Authors: Jason M Mehal, Douglas H Esposito, Robert C Holman, Jacqueline E Tate, Laura L Sinden, Umesh D Parashar

  The Pediatric infectious disease journal. 03/2012;

  BACKGROUND:: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improveBACKGROUND:: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improve prevention strategies. METHODS:: Records of singleton infants with diarrhea listed anywhere on the death certificate were selected from the US Linked Birth/Infant Death data for 2005-2007; characteristics of these infants were compared with those of infants who survived their first year. RESULTS:: During 2005-2007, 1087 diarrhea-associated infant deaths were reported; 86% occurred among low birthweight (LBW, <2500 grams) infants. Compared with normal birthweight (NBW, ≥2500 grams) infants, LBW infants had a greater mortality rate (RR: 91.9, 95% CI: 77.4-109.0) and younger median age at death (7 versus 15 weeks, p<0.0001). The most common co-diagnoses for diarrhea-associated death among LBW and NBW infants were sepsis (26%) and volume depletion (20%), respectively. Among LBW infants, 97% of diarrhea-associated deaths occurred in inpatient settings, whereas 27% of NBW infant deaths occurred in outpatient settings and 5.3% in the decedent's home. Male sex, black race, unmarried status, and low 5-minute Apgar score (<7) increased mortality odds among LBW infants while, among NBW infants, low 5-minute Apgar score, black race, young maternal age (<25 years) and high birth order (third or more) increased mortality odds. CONCLUSIONS:: Efforts to reduce diarrhea-associated morality should focus on understanding and improving management of diarrhea in vulnerable LBW infants. For prevention of diarrhea-associated deaths in NBW infants, educating mothers who fit the high risk profile regarding home hydration therapy and timely access to medical treatment is important.

• Remaining issues and challenges for rotavirus vaccine in preventing global childhood diarrheal morbidity and mortality.

  Authors: Jacqueline E Tate, Manish M Patel, Margaret M Cortese, Benjamin A Lopman, Jon R Gentsch, Jessica Fleming, A Duncan Steele, Umesh D Parashar

  Expert review of vaccines. 02/2012; 11(2):211-20.

  Rotavirus vaccines have had a dramatic impact on morbidity and mortality from diarrhea among children in high- and middle-income countries that have introduced the vaccine into their nationalRotavirus vaccines have had a dramatic impact on morbidity and mortality from diarrhea among children in high- and middle-income countries that have introduced the vaccine into their national immunization programs. Widespread introduction of rotavirus vaccine in developing countries is imminent and their full potential in reducing the global burden from severe childhood diarrhea may soon be realized. The objectives of this paper are to describe the remaining issues and challenges in ensuring the success of the global rotavirus vaccination program and to discuss further research needed to help address them.

• 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis.

  Authors: Jacqueline E Tate, Anthony H Burton, Cynthia Boschi-Pinto, A Duncan Steele, Jazmin Duque, Umesh D Parashar

  The Lancet infectious diseases. 02/2012; 12(2):136-41.

  WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirusWHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453,000 deaths (95% CI 420,000-494,000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98,621 deaths). Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

• Reduction in morbidity and mortality from childhood diarrhoeal disease after species A rotavirus vaccine introduction in Latin America - a review.

  Authors: Rishi Desai, Lucia Helena de Oliveira, Umesh D Parashar, Benjamin Lopman, Jacqueline E Tate, Manish M Patel

  Memórias do Instituto Oswaldo Cruz. 12/2011; 106(8):907-11.

  Countries in Latin America were among the first to implement routine vaccination against species A rotavirus (RVA). We evaluate data from Latin America on reductions in gastroenteritis and RVACountries in Latin America were among the first to implement routine vaccination against species A rotavirus (RVA). We evaluate data from Latin America on reductions in gastroenteritis and RVA disease burden following the introduction of RVA vaccine. Published literature was reviewed to identify case-control studies of vaccine effectiveness and population-based studies examining longitudinal trends of diarrhoeal disease reduction after RVA vaccine introduction in Latin American countries. RVA vaccine effectiveness and impact on gastroenteritis mortality and hospitalization rates and RVA hospitalization rates are described. Among middle-income Latin American countries with published data (Mexico, Brazil, El Salvador and Panama), RVA vaccine contributed to a gastroenteritis-associated mortality reduction of 22-41%, a gastroenteritis-associated hospitalization reduction of 17-51% and a RVA hospitalization reduction of 59-81% among children younger than five years of age. In Brazil and El Salvador, case-control studies demonstrated that a full RVA vaccination schedule was 76-85% effective against RVA hospitalization; a lower effectiveness of 46% was seen in Nicaragua, the only low-income country with available data. A growing body of literature offers convincing evidence of "real world" vaccine program successes in Latin American settings, which may be expanded as more countries in the region include RVA vaccine in their immunization programs.

• Rotavirus vaccines: update on global impact and future priorities.

  Authors: Catherine Yen, Jacqueline E Tate, Manish M Patel, Margaret M Cortese, Benjamin Lopman, Jessica Fleming, Kristen Lewis, Baoming Jiang, Jon Gentsch, Duncan Steele, Umesh D Parashar

  Human vaccines. 12/2011; 7(12):1282-90.

  Early rotavirus vaccine adopter countries in the Americas, Europe, and in Australia have documented substantial declines in rotavirus disease burden following the introduction of vaccination.Early rotavirus vaccine adopter countries in the Americas, Europe, and in Australia have documented substantial declines in rotavirus disease burden following the introduction of vaccination. However, the full public health impact of rotavirus vaccines has not been realized as they have not been introduced into routine immunization programs in countries of Africa and Asia with the highest rotavirus disease morbidity and mortality burden. In this article, we review the epidemiology of rotavirus disease, the development and current status of rotavirus vaccines including newly available vaccine impact data from early-introducer countries, and future priorities for implementation and monitoring of rotavirus vaccination programs in developing countries.

• Rotavirus vaccine and health care utilization for diarrhea in U.S. children.

  Authors: Jennifer E Cortes, Aaron T Curns, Jacqueline E Tate, Margaret M Cortese, Manish M Patel, Fangjun Zhou, Umesh D Parashar

  The New England journal of medicine. 09/2011; 365(12):1108-17.

  Routine vaccination of U.S. infants with pentavalent rotavirus vaccine (RV5) began in 2006. Using MarketScan databases, we assessed RV5 coverage and diarrhea-associated health care use from July 2007Routine vaccination of U.S. infants with pentavalent rotavirus vaccine (RV5) began in 2006. Using MarketScan databases, we assessed RV5 coverage and diarrhea-associated health care use from July 2007 through June 2009 versus July 2001 through June 2006 in children under 5 years of age. We compared the rates of diarrhea-associated health care use in unvaccinated children in the period from January through June (when rotavirus is most prevalent) in 2008 and 2009 with the prevaccine rates to estimate indirect benefits. We estimated national reductions in the number of hospitalizations for diarrhea, and associated costs, by extrapolation. By December 31, 2008, at least one dose of RV5 had been administered in 73% of children under 1 year of age, 64% of children 1 year of age, and 8% of children 2 to 4 years of age. Among children under 5 years of age, rates of hospitalization for diarrhea in 2001-2006, 2007-2008, and 2008-2009 were 52, 35, and 39 cases per 10,000 person-years, respectively, for relative reductions from 2001-2006 by 33% (95% confidence interval [CI], 31 to 35) in 2007-2008 and by 25% (95% CI, 23 to 27) in 2008-2009; rates of hospitalization specifically coded for rotavirus infection were 14, 4, and 6 cases per 10,000 person-years, respectively, for relative reductions in the rate from 2001-2006 by 75% (95% CI, 72 to 77) in 2007-2008 and by 60% (95% CI, 58 to 63) in 2008-2009. In the January-June periods of 2008 and 2009, the respective relative rate reductions among vaccinated children as compared with unvaccinated children were as follows: hospitalization for diarrhea, 44% (95% CI, 33 to 53) and 58% (95% CI, 52 to 64); rotavirus-coded hospitalization, 89% (95% CI, 79 to 94) and 89% (95% CI, 84 to 93); emergency department visits for diarrhea, 37% (95% CI, 31 to 43) and 48% (95% CI, 44 to 51); and outpatient visits for diarrhea, 9% (95% CI, 6 to 11) and 12% (95% CI, 10 to 15). Indirect benefits (in unvaccinated children) were seen in 2007-2008 but not in 2008-2009. Nationally, for the 2007-2009 period, there was an estimated reduction of 64,855 hospitalizations, saving approximately $278 million in treatment costs. Since the introduction of rotavirus vaccine, diarrhea-associated health care utilization and medical expenditures for U.S. children have decreased substantially.

• Monovalent rotavirus vaccine provides protection against an emerging fully heterotypic G9P[4] rotavirus strain in Mexico.

  Authors: Catherine Yen, Jesùs Reyna Figueroa, Edgar Sánchez Uribe, Luz Del Carmen-Hernández, Jacqueline E Tate, Umesh D Parashar, Manish M Patel, Vesta Richardson López-Collado

  The Journal of infectious diseases. 09/2011; 204(5):783-6.

  After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In JanuaryAfter the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%-100%) against G9P[4] rotavirus-related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure.

• Monitoring impact and effectiveness of rotavirus vaccination.

  Authors: Jacqueline E Tate, Umesh D Parashar

  Expert review of vaccines. 08/2011; 10(8):1123-5.

  Rotavirus infection is the most common cause of severe gastroenteritis in children <5 years of age globally. Since 2009, the WHO has recommended inclusion of rotavirus vaccine in the nationalRotavirus infection is the most common cause of severe gastroenteritis in children <5 years of age globally. Since 2009, the WHO has recommended inclusion of rotavirus vaccine in the national immunization programs of all countries. Data regarding rotavirus vaccine impact and effectiveness under conditions of routine use are important for encouraging countries to implement vaccination programs. In the absence of a national rotavirus vaccination program in France, the IVANHOE study was initiated to determine the real-world impact and effectiveness of rotavirus vaccine following introduction in a limited geographic area. This study found a twofold reduction in rotavirus hospitalizations among children <2 years of age who were age-eligible to receive rotavirus vaccine and a 98% vaccine effectiveness, highlighting the health benefits of a vaccination program.

• Direct and indirect effects of rotavirus vaccination upon childhood hospitalizations in 3 US Counties, 2006-2009.

  Authors: Daniel C Payne, Mary Allen Staat, Kathryn M Edwards, Peter G Szilagyi, Geoffrey A Weinberg, Caroline B Hall, James Chappell, Aaron T Curns, Mary Wikswo, Jacqueline E Tate, Benjamin A Lopman, Umesh D Parashar

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 06/2011; 53(3):245-53.

  Routine rotavirus vaccination of US infants began in 2006. We conducted active, population-based surveillance for rotavirus gastroenteritis hospitalizations in 3 US counties to assess vaccineRoutine rotavirus vaccination of US infants began in 2006. We conducted active, population-based surveillance for rotavirus gastroenteritis hospitalizations in 3 US counties to assess vaccine impact. Children <36 months old hospitalized with diarrhea and/or vomiting were enrolled from January through June each year during the period 2006-2009 and tested for rotavirus. Age-stratified rates of hospitalization for rotavirus infection were compared with corresponding vaccination coverage among a control group of children with acute respiratory illness. To assess direct and indirect benefits, vaccination coverage rates in the control group were multiplied by vaccine effectiveness estimates to calculate expected reductions in the rate of hospitalization for rotavirus infection. Rotavirus serotypes were compared across years. Compared with 2006, a significant reduction in rates of hospitalization for rotavirus infection (P < .001) was observed in 2008 among all age groups. There was an 87% reduction in the 6-11-month-old age group (coverage, 77%), a 96% reduction in the 12-23-months-old age group (coverage, 46%), and a 92% reduction in the 24-35-month-old age group (coverage, 1%), which exceeded reductions expected on the basis of coverage and vaccine effectiveness estimates. Age-specific rate reductions were nearly equivalent to those expected on the basis of age-specific vaccine coverage in 2009. Predominant strains varied annually: G1P[8] (91%) in 2006; G1P[8] (45%) and G12P[8] (36%) in 2007; G1P[8] (89%) in 2008; and G3P[8] (43%), G2P[4] (34%), and G9P[8] (27%) in 2009. Rotavirus vaccination has dramatically decreased rates of hospitalization for rotavirus infection among children in these US counties. In 2008, reductions were prominent among both vaccine-eligible age groups and older, largely unvaccinated children; the latter likely resulted from indirect protection. Although rates among age groups eligible for vaccination remained low in 2009, indirect benefits disappeared.

• Baseline estimates of diarrhea-associated mortality among United States children before rotavirus vaccine introduction.

  Authors: Douglas H Esposito, Robert C Holman, Dana L Haberling, Jacqueline E Tate, Laura Jean Podewils, Roger I Glass, Umesh Parashar

  The Pediatric infectious disease journal. 06/2011; 30(11):942-7.

  Deaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young USDeaths due to diarrhea among US children declined substantially from the 1960s through the 1980s, but have not been recently assessed. We examined diarrhea-associated mortality among young US children from 1992 to 2006 to establish baseline estimates through which the effect of rotavirus vaccines, introduced in 2006, can be assessed. National Center for Health Statistics multiple cause-of-death mortality data were used to examine diarrhea-associated deaths and death rates among US children 1 to 59 months of age during 1992-2006. The winter residual method was used to indirectly estimate the annual number of diarrhea-associated deaths attributable to rotavirus. An average of 369 diarrhea-associated deaths/year (3320 total deaths) occurred among US children 1 to 59 months of age during 1992-1998 and 2005-2006. The diarrhea-associated death rate increased 40% between the first 3 and last 2 years of the study period, from an average of 1.6 deaths per 100,000 to 2.3 deaths per 100,000. Black children died at almost 4 times the rate of white children. Diarrhea-associated deaths showed a winter seasonal pattern similar to that of rotavirus, particularly among children 4 to 23 months of age. Using indirect methods, we estimated 25 yearly rotavirus-associated deaths during the study period. Rotavirus vaccination could potentially prevent 21 of these deaths annually. Diarrhea-associated mortality among US children stabilized but appears to be increasing in recent years. Rotavirus was associated with a small but significant number of preventable deaths. The national multiple cause-of-death data should prove useful for assessing mortality impact of rotavirus vaccination in the United States.

• Remarkable postvaccination spatiotemporal changes in United States rotavirus activity.

  Authors: Aaron T Curns, Catherine A Panozzo, Jacqueline E Tate, Daniel C Payne, Manish M Patel, Margaret M Cortese, Umesh D Parashar

  The Pediatric infectious disease journal. 01/2011; 30(1 Suppl):S54-5.

  Analyses of US laboratory surveillance data during 1991 to 2004 established annual peak rotavirus activity occurred first in the Southwest and last in the Northeast. We compared spatiotemporalAnalyses of US laboratory surveillance data during 1991 to 2004 established annual peak rotavirus activity occurred first in the Southwest and last in the Northeast. We compared spatiotemporal patterns during the 2 years preceding vaccine introduction in 2006 with the first 2 years following introduction. The postvaccine introduction years failed to demonstrate the typical Southwest to Northeast spread of rotavirus activity.

• Diarrhea-associated hospitalizations among US children over 2 rotavirus seasons after vaccine introduction.

  Authors: Catherine Yen, Jacqueline E Tate, Joshua D Wenk, J Mitchell Harris, Umesh D Parashar

  Pediatrics. 01/2011; 127(1):e9-e15.

  After implementation of rotavirus vaccination in 2006, large decreases in rates of severe diarrhea among US children occurred in 2007-2008. We ascertained whether these decreases were sustained inAfter implementation of rotavirus vaccination in 2006, large decreases in rates of severe diarrhea among US children occurred in 2007-2008. We ascertained whether these decreases were sustained in 2008-2009. We examined hospital discharge data from a national network of pediatric hospitals and compared all-cause diarrhea-related and rotavirus-specific hospitalizations in 3 prevaccine rotavirus seasons (2003-2006) with those in 2 postvaccine seasons (2007-2008 and 2008-2009) among children <5 years of age. We defined rotavirus seasons using data from a national laboratory surveillance network. At 62 consistently reporting hospitals, a median of 15 645 diarrhea-related hospitalizations (range: 14 881-16 884 hospitalizations) occurred each rotavirus season among children <5 years of age in 2003-2006. Compared with this median, all-cause diarrhea-related hospitalizations decreased by 50% (n = 7760) in 2007-2008 and by 29% (n = 11 039) in 2008-2009. In 2007-2008, reductions of 47% to 55% were seen for all age groups, including vaccine-ineligible children ≥2 years of age (48%). In 2008-2009, these reductions decreased in magnitude, especially among children ≥2 years of age (17%). Decreases in 2007-2008 and 2008-2009 were similar in the Northeast and West, but decreases were smaller in 2008-2009, compared with 2007-2008, in the Midwest and South. Compared with prevaccine seasons, decreases in diarrhea- and rotavirus-associated hospitalizations seen in 2007-2008 were sustained in 2008-2009 but were somewhat smaller. Given the variability in diarrhea-related hospitalization trends over the 2 postvaccine seasons according to age group and region, continued surveillance is required for full assessment of the impact of rotavirus vaccination.

• Sustained decline in rotavirus detections in the United States following the introduction of rotavirus vaccine in 2006.

  Authors: Jacqueline E Tate, Jeffry D Mutuc, Catherine A Panozzo, Daniel C Payne, Margaret M Cortese, Jennifer E Cortes, Catherine Yen, Douglas H Esposito, Benjamin A Lopman, Manish M Patel, Umesh D Parashar

  The Pediatric infectious disease journal. 01/2011; 30(1 Suppl):S30-4.

  Following implementation of the rotavirus vaccination program in 2006, rotavirus activity in the United States declined dramatically in 2007-2008 but increased slightly in 2008-2009, despite greaterFollowing implementation of the rotavirus vaccination program in 2006, rotavirus activity in the United States declined dramatically in 2007-2008 but increased slightly in 2008-2009, despite greater vaccine uptake. To further evaluate impact of the vaccine program, we assessed trends in rotavirus testing and detection during 2009-2010. We examined rotavirus testing data from July 2000 to June 2010 from the National Respiratory and Enteric Viruses Surveillance System to compare rotavirus season timing and peak activity in the pre- and postvaccine introduction eras. Rotavirus season onset was defined as the first of 2 consecutive weeks during which the percentage of specimens testing positive for rotavirus was ≥ 10%. To assess trends in rotavirus testing and detection, we restricted the analyses to 25 laboratories that reported for ≥ 26 weeks per season from 2000 to 2010. During 2009-2010, the threshold for the start of the rotavirus season was never achieved nationally or in the North, Midwest, or West. Activity in the South met this threshold but the season duration was substantially shorter and of lower magnitude than in all previous pre- and postvaccine introduction seasons. Nationally and within each region, the peak week was more delayed and the peak proportion of positive tests was substantially lower than all previous seasons. The total number of tests performed declined by 23%, and the number of positive tests declined by 86%. Rotavirus activity was substantially diminished during the 2009-2010 rotavirus season compared with the prevaccine baseline and the 2 previous postvaccine introduction seasons. These sustained declines over 3 rotavirus seasons reaffirm the health benefits of the US rotavirus vaccination program.

• Uptake, impact, and effectiveness of rotavirus vaccination in the United States: review of the first 3 years of postlicensure data.

  Authors: Jacqueline E Tate, Margaret M Cortese, Daniel C Payne, Aaron T Curns, Catherine Yen, Douglas H Esposito, Jennifer E Cortes, Benjamin A Lopman, Manish M Patel, Jon R Gentsch, Umesh D Parashar

  The Pediatric infectious disease journal. 01/2011; 30(1 Suppl):S56-60.

  Rotavirus vaccine was recommended for routine use in US infants in 2006. Before the introduction of vaccine, rotavirus was the most common cause of severe gastroenteritis in children <5 years of ageRotavirus vaccine was recommended for routine use in US infants in 2006. Before the introduction of vaccine, rotavirus was the most common cause of severe gastroenteritis in children <5 years of age in the United States. We reviewed published data to summarize the US experience during the first 3 years of its rotavirus vaccination program. Rotavirus seasons have been delayed and diminished in magnitude during the postvaccine era compared with the prevaccine era. Hospitalizations, emergency department visits, and outpatient visits due to gastroenteritis have declined dramatically in children < 5 years of age including in children age-ineligible to have received vaccine, suggesting indirect benefits of vaccination. Rotavirus vaccine has been widely accepted by pediatricians. Vaccine coverage is steadily increasing but remains lower than coverage levels of other routine infant immunizations. The implementation of routine childhood immunization against rotavirus has rapidly and dramatically reduced the large health burden of rotavirus gastroenteritis in US children. Continued monitoring of rotavirus diarrhea is needed to determine if immunity wanes as vaccinated children get older and to better quantify the indirect benefits of vaccination. Ongoing surveillance will also enable monitoring of the long-term impact of vaccination on rotavirus epidemiology.

• Projected health benefits and costs of pneumococcal and rotavirus vaccination in Uganda.

  Authors: Jacqueline E Tate, Annet Kisakye, Prosper Mugyenyi, Diana Kizza, Amos Odiit, Fiona Braka

  Vaccine. 01/2011; 29(17):3329-34.

  We determined impact and cost-effectiveness of pneumococcal and rotavirus vaccination programs among children<5 years of age in Uganda from the public health system perspective. Disease-specificWe determined impact and cost-effectiveness of pneumococcal and rotavirus vaccination programs among children<5 years of age in Uganda from the public health system perspective. Disease-specific models compared the disease burden and cost with and without a vaccination program. If introduced, pneumococcal and rotavirus vaccine programs will save 10,796 and 5265 lives, respectively, prevent 94,071 Streptococcus pneumoniae and 94,729 rotavirus cases in children<5 years, and save 3886 and 996 million Ugandan shillings ($2.3 and $0.6 million US dollars), respectively, in direct medical costs annually. At the GAVI price ($0.15/dose), pneumococcal vaccine will be cost-saving and rotavirus vaccine highly cost-effective.

• Projected impact and cost-effectiveness of a rotavirus vaccination program in India, 2008.

  Authors: Douglas H Esposito, Jacqueline E Tate, Gagandeep Kang, Umesh D Parashar

  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 01/2011; 52(2):171-7.

  To assess the value of rotavirus vaccination in India, we determined the potential impact and cost-effectiveness of a national rotavirus vaccination program. We compared the national rotavirusTo assess the value of rotavirus vaccination in India, we determined the potential impact and cost-effectiveness of a national rotavirus vaccination program. We compared the national rotavirus disease and cost burden with and without a vaccination program and assessed the cost-effectiveness of vaccination. Model inputs included measures of disease and cost burden, vaccine performance, and vaccination coverage and cost. We measured the annual number of health-related events and treatment costs averted, as well as the cost-effectiveness in US dollars per disability-adjusted life-year (DALY) and cost per death averted. One-way sensitivity analyses were performed by individually varying each model input. With use of a vaccine that has an estimated effectiveness of 50%, a rotavirus vaccination program in India would prevent ~44,000 deaths, ~293,000 hospitalizations, and ~328,000 outpatient visits annually, which would avert $20.6 million in medical treatment costs. Vaccination would be cost-saving at the GAVI Alliance price of $0.15 per dose. At $1.00 per dose, a vaccination program would cost $49.8 million, which would result in an expenditure of $21.41 per DALY averted or $662.94 per life saved. Even at $7.00 per dose, vaccination would be highly cost-effective. In sensitivity analyses, varying efficacy against severe rotavirus disease and vaccine price had the greatest impact on cost-effectiveness. A national rotavirus vaccination program in India would prevent substantial rotavirus morbidity and mortality and would be highly cost-effective at a range of vaccine prices. Public health officials can use this locally derived data to evaluate how this highly cost-effective intervention might fit into India's long-term health care goals.

• Sustained protection from pentavalent rotavirus vaccination during the second year of life at a large, urban United States pediatric hospital.

  Authors: Julie A Boom, Jacqueline E Tate, Leila C Sahni, Marcia A Rench, Osbourne Quaye, Slavica Mijatovic-Rustempasic, Manish M Patel, Carol J Baker, Umesh D Parashar

  The Pediatric infectious disease journal. 12/2010; 29(12):1133-5.

  Fecal specimens from children presenting to Texas Children's Hospital with acute gastroenteritis were tested for the presence of rotavirus. Children were grouped according to vaccination status, andFecal specimens from children presenting to Texas Children's Hospital with acute gastroenteritis were tested for the presence of rotavirus. Children were grouped according to vaccination status, and pentavalent rotavirus vaccine effectiveness was calculated. Pentavalent rotavirus vaccine effectiveness against severe rotavirus gastroenteritis was sustained during the first 2 years of the vaccination program. Overall 3-dose effectiveness was 83% to 86%; it was 92% to 93% among children 6 to 11 months of age and 78% to 84% among children ≥12 months of age.