The Burden of Rotavirus Gastroenteritis among Japanese Children during Its Peak Months: an Internet Survey

Article · July 2013with7 Reads
DOI: 10.7883/yoken.66.269 · Source: PubMed
Rotavirus gastroenteritis (RVGE) is one of the most common early childhood diseases; however, little information exists on the frequency of RVGE attacks during peak epidemic months and the subsequent clinical consequences in Japanese children. Therefore, we conducted a nationwide internet survey that targeted mothers whose children recently experienced an episode of RVGE or influenza from January 2011 to April 2011. Data concerning the incidence and clinical consequences of RVGE and influenza among 15,137 children aged <3 years were collected. Of these, 1,286 children who experienced an RVGE episode and 1,487 children who experienced an influenza episode visited a physician or required hospital admission. Data analysis of 867 RVGE episodes and 897 influenza episodes found that 25% of children with RVGE required 8-14 days for recovery, 28% received intravenous rehydration, 7% were hospitalized, 15% visited an emergency department, 70% sought medical interventions ≥2 times, and 32% sought medical intervention ≥3 times. Compared with influenza, RVGE required a longer recovery period, and was associated with more frequent episodes of intravenous rehydration, hospitalization, and emergency department and physician visits. Our results indicate that, like influenza, RVGE occurring during peak epidemic months in children aged <3 years imposes a substantial burden on families and medical institutions in Japan.
  • [Show abstract] [Hide abstract] ABSTRACT: Rotavirus is a major cause of severe gastroenteritis in children <5 years of age worldwide, and two, live attenuated rotavirus vaccines are globally available. As rotavirus vaccines are introduced into national immunization programs, there is an increasing need to monitor circulating wild-type strains. However, few studies have systematically examined their full genotype constellation. This study was therefore undertaken to characterize the whole genotype constellation of circulating rotavirus strains in three widely-separated locations in Japan during the 2012 rotavirus season when rotavirus vaccines became available in the country for the first time. Of 107 rotavirus-positive specimens, 50 (46.7%) strains collected from all three locations possessed an unusual G1-P[8]-I2-R2-C2-M2-A2-N2-T2-E2-H2 constellation in which a typical G2P[4] strain appeared to have acquired its two surface protein genes from the most common G1P[8] strain. These G1P[8] double-reassortant strains were shown to possess the 11 genome segments virtually indistinguishable from each other in their nucleotide sequences and phylogenetic lineages except for two strains that underwent further intra-genotype reassortment. Successful spread to and predominance in broad locations across Japan of novel rotavirus strains possessing a genotype constellation that was previously thought not to be preferred suggests unexpected genomic flexibility of the genotype constellation.
    Article · Aug 2014
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives Rotavirus vaccination has been reimbursed in Belgium since November 2006 with a high uptake (>85%). Economic analyses of the vaccine have been reported, including estimates of indirect cost gain related to the reduction in work absenteeism. The objective of this study was to evaluate the latter parameter using real-life data. Design and setting A simple model estimated the reduction in absent workdays per working mother with a firstborn baby after the introduction of the rotavirus vaccine. Next, data on work absences were retrospectively analysed (from 2003 to 2012) using a database of administrative employees (n=11 600 working women per year) in the City of Antwerp. Observed reductions in absenteeism after the introduction of the vaccine were compared with the results from the model. These reductions would most likely be observed during the epidemic periods of rotavirus (from January to the end of May) for short-duration absences of ≤5 days. We compared data from outside epidemic periods (from June to December), expecting no changes over time prevaccine and postvaccine introduction, as well as with a control group of women aged 30–35 years with no first child. Results Model estimates were 0.73 working days gained per working mother. In the database of the City of Antwerp, we identified a gain of 0.88 working days during the epidemic period, and an accumulated gain of 2.24 days over a 3-year follow-up period. In the control group, no decrease in absenteeism was measured. Giving vaccine access to working mothers resulted in an estimated accumulated net cost gain of €187 per mother. Conclusions Reduction in absenteeism among working mothers was observed during periods of the epidemic after the introduction of the rotavirus vaccine in Belgium. This reduction is in line with estimates of indirect cost gains used in economic evaluations of the rotavirus vaccine. Trial registration number HO-12-12768.
    Full-text · Article · Jun 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Rotavirus is a leading cause of severe acute gastroenteritis in children worldwide, and globally licensed vaccines are available. To expedite the introduction of rotavirus vaccines in the national immunisation programme, a simple, economical method to monitor changes in the burden of rotavirus disease may be of great help. Here, we report an application of a time-series analysis on a publicly-available dataset in Japan on the weekly number of laboratory-confirmed rotavirus-positive samples over the last 5 year period between the 36th week of 2009 and the 35th week of 2014 during which rotavirus vaccines became marketed in Japan and presumed to reach an uptake rate of at least 39% as a national average. Compared with the expected number of rotavirus detection based on the preceding four rotavirus seasons, the number of rotavirus detection during the 2013-2014 season was 43% (95% CI: 38.6, 47.8). This suggests that the use of rotavirus vaccine had a positive impact on reducing the burden of rotavirus diarrhoea in Japan. This method, because of its simplicity and little cost, should be applicable to early detection of the impact of rotavirus vaccine even in resource-poor countries where the World Health Organization funded and implemented the sentinel surveillance programmes of laboratory-confirmed rotavirus cases.
    Article · Sep 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction Rotarix™, GSK’s live attenuated rotavirus vaccine, was introduced in Japan in 2011. A recent trend in reduction of rotavirus gastroenteritis (RVGE) due to this vaccine was described. However, an observed/expected analysis showed a temporal association with intussusception within 7 days post dose 1. Objective In this paper, we compare the benefit and risk of vaccination side-by-side in a benefit–risk analysis. Methods The number of vaccine-preventable RVGE-associated hospitalizations and deaths (benefit) and intussusception-associated hospitalizations and deaths (risk) following two doses of Rotarix™ in Japan was compared using simulations. Source data included peer-reviewed clinical and epidemiological publications, Japanese governmental statistics (Statistics Bureau, Ministry of Internal Affairs and Communications), and market survey data. Results For a birth cohort of 1 million vaccinated Japanese children followed for 5 years, the benefit–risk analysis suggested that the vaccine would prevent ~17,900 hospitalizations and ~6.3 deaths associated with RVGE. At the same time, vaccination would be associated with about ~50 intussusception hospitalizations and ~0.017 intussusception deaths. Therefore, for every intussusception hospitalization caused by vaccination and for one intussusception-associated death, 350 (95 % CI 69–2510) RVGE-associated hospitalizations and 366 (95 % CI 59–3271) RVGE-associated deaths are prevented, respectively, by vaccination. Conclusions The benefit–risk balance for Rotarix™ is favorable in Japan. From a public health perspective, the benefits in terms of prevented RVGE hospitalizations and deaths for the vaccinated population far exceed the estimated risks due to intussusception.
    Full-text · Article · Jan 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Rotavirus is the leading cause of severe acute gastroenteritis in infants and young children. Most children are infected with rotavirus, and the health and economic burdens of rotavirus gastroenteritis on healthcare systems and families are considerable. In 2012 pentavalent rotavirus vaccine (RV5) and diphtheria, tetanus, acellular pertussis and inactivated poliovirus vaccine derived from Sabin strains (DTaP-sIPV) were licensed in Japan. We examined the immunogenicity and safety of DTaP-sIPV when administrated concomitantly with RV5 in Japanese infants. A total of 192 infants 6 to 11 weeks of age randomized to Group 1 (N = 96) received DTaP-sIPV and RV5 concomitantly, and Group 2 (N = 96) received DTaP-sIPV and RV5 separately. Antibody titer to diphtheria toxin, pertussis antigens (PT and FHA), tetanus toxin, and poliovirus type 1, 2, and 3 were measured at 4 to 6 weeks following 3-doses of DTaP-sIPV. Seroprotection rates for all components of DTaP-sIPV were 100% in both groups, and the geometric mean titers for DTaP-sIPV in Group 1 were comparable to Group 2. Incidence of systemic AEs (including diarrhea, vomiting, fever, and nasopharyngitis) were lower in Group 1 than in Group 2. All vaccine-related AEs were mild or moderate in intensity. There were no vaccine-related serious AEs, no deaths, and no cases of intussusception during the study. Concomitant administration of DTaP-sIPV and RV5 induced satisfactory immune responses to DTaP-sIPV and acceptable safety profile. The administration of DTaP-sIPV given concomitantly with RV5 is expected to facilitate compliance with the vaccination schedule and improve vaccine coverage in Japanese infants.
    Article · Jan 2017