Fischer Thea Kølsen, Viboud Cécile, Parashar Umesh, Malek Mark, Steiner Claudia, Glass Roger, Simonsen Lone
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA.
J Infect Dis. 2007 Apr 15;195(8):1117-25. doi: 10.1086/512863. Epub 2007 Mar 6.
Recently a new rotavirus vaccine was licensed in the United States and recommended for universal immunization of American children. The impact of the vaccine on a decrease in hospitalizations will take several years to assess and will be based on the availability of good baseline data on the disease. We used the largest US hospital discharge database available, the Healthcare Cost and Utilization Project (HCUP), to study national rates, trends, and risk factors for diarrhea- and rotavirus-associated hospitalizations and deaths among children <5 years of age, to establish a baseline against which vaccine implementation can be measured. Rotavirus remained the most important cause of pediatric diarrhea throughout the study period (1993-2003). When the data were extrapolated to the US population, rotavirus was estimated to be the cause of approximately 60,000 hospitalizations and 37 deaths annually. Black infants had a significantly higher risk of being hospitalized with and dying from rotavirus disease early in life, compared with white infants (risk ratio [RR] for hospitalization by 12 months of age was 2.4, with a 95% confidence interval [CI] of 1.2-4.7; RR for death was 2.0, with a 95% CI of 1.7-2.5). Such racial differences in age and risk of rotavirus-associated hospitalization and death highlight the importance of timely and early rotavirus immunization of minority children. The HCUP database serves as a sensitive and robust data source for monitoring the impact of a rotavirus-immunization program in the United States.
最近，一种新型轮状病毒疫苗在美国获得许可，并被推荐用于美国儿童的普遍免疫接种。该疫苗对减少住院率的影响需要数年时间来评估，且将基于该疾病良好基线数据的可得性。我们使用了美国现有的最大的医院出院数据库——医疗成本和利用项目（HCUP），来研究5岁以下儿童因腹泻和轮状病毒相关的住院率、趋势及危险因素，并确定一个可用于衡量疫苗实施效果的基线。在整个研究期间（1993 - 2003年），轮状病毒仍然是小儿腹泻的最重要病因。当将数据外推至美国人口时，估计轮状病毒每年导致约60000例住院和37例死亡。与白人婴儿相比，黑人婴儿在生命早期因轮状病毒疾病住院和死亡的风险显著更高（12个月龄时住院的风险比[RR]为2.4，95%置信区间[CI]为1.2 - 4.7；死亡的RR为2.0，95%CI为1.7 - 2.5）。轮状病毒相关住院和死亡在年龄及风险方面的这种种族差异凸显了对少数族裔儿童及时进行轮状病毒免疫接种的重要性。HCUP数据库是监测美国轮状病毒免疫计划影响的一个敏感且可靠的数据源。
