Fernandes Eder Gatti, Sato Helena Keico, Leshem Eyal, Flannery Brendan, Konstantyner Thais Claudia Roma de Oliveira, Veras Maria Amélia de Sousa Mascena, Patel Manish M
Field Epidemiology Training Program/São Paulo State (EPISUS-SP), Secretaria de Estado da Saúde de São Paulo, Avenida Dr Arnaldo, 35, 6th floor, São Paulo, SP 01246-000, Brazil.
Division of Immunization, São Paulo State Health Department, Avenida Dr Arnaldo, 35, 6th floor, São Paulo, SP 01246-000, Brazil.
Vaccine. 2014 Jun 5;32(27):3402-8. doi: 10.1016/j.vaccine.2014.04.015. Epub 2014 Apr 13.
Following introduction of routine infant rotavirus vaccination, severe diarrhea hospitalization rates declined among children aged <5 years throughout Brazil. Ensuring equity of rotavirus vaccine impact is important in countries that self-finance immunization programs. The objective of this study was to examine rotavirus vaccine impact on diarrhea admission rates among children aged <5 years in Brazil's public health system, according to area-based measures of human development in the state of São Paulo, Brazil.
Ecological analysis of public health system hospitalization rates for acute gastroenteritis among children aged <5 years in the state of São Paulo, Brazil, according to five categories of municipal development based on a modified Human Development Index for municipalities. Acute gastroenteritis hospitalization rates among children aged <5 years after national rotavirus vaccine introduction (2008-2011) were compared to rates in pre-vaccine years (2000-2005) to calculate percent decline in rates (1-rate ratio) and 95% confidence intervals (CI) for each municipal development category. Direct hospitalization costs during the two periods were compared.
Annual rates declined by 40% (95% CI, 39-42%) from 631 diarrhea hospitalizations per 100,000 person years pre-rotavirus vaccination to 377 per 100,000 post-vaccination among children aged <5 years and 50% (95% CI, 48-52%) from 1009 to 505 per 100,000 among infants. Highest rates were observed in least developed municipalities. Significant declines of 26-52% among children <5 years and 41-63% among infants were observed in all categories of municipal development. Lower diarrhea hospitalization rates resulted in annual savings of approximately 2 million USD for the state of São Paulo. Savings in direct hospitalization costs benefitted municipalities in all five categories.
The introduction of rotavirus vaccination was associated with substantial reductions of diarrhea-related admissions at all levels of municipal development in São Paulo State, Brazil.
在巴西全国推行婴幼儿轮状病毒疫苗接种后，5岁以下儿童因严重腹泻住院的比率有所下降。对于自行承担免疫计划费用的国家而言，确保轮状病毒疫苗影响的公平性至关重要。本研究的目的是根据巴西圣保罗州基于地区的人类发展指标，考察轮状病毒疫苗对该州公共卫生系统中5岁以下儿童腹泻住院率的影响。
根据基于城市改良人类发展指数划分的五个城市发展类别，对巴西圣保罗州5岁以下儿童急性肠胃炎的公共卫生系统住院率进行生态分析。将全国引入轮状病毒疫苗后（2008 - 2011年）5岁以下儿童的急性肠胃炎住院率与疫苗接种前几年（2000 - 2005年）的住院率进行比较，以计算每个城市发展类别的住院率下降百分比（1 - 率比）和95%置信区间（CI）。对两个时期的直接住院费用进行比较。
5岁以下儿童的年住院率从轮状病毒疫苗接种前每10万人年631例腹泻住院下降了40%（95%CI，39 - 42%），至接种后每10万人年377例；婴儿的年住院率从每10万人年1009例下降了50%（95%CI，48 - 52%），至每10万人年505例。最不发达的城市住院率最高。在所有城市发展类别中，5岁以下儿童的住院率显著下降了26 - 52%，婴儿的住院率显著下降了41 - 63%。较低的腹泻住院率为圣保罗州每年节省了约200万美元。直接住院费用的节省使所有五个类别的城市都受益。
在巴西圣保罗州，引入轮状病毒疫苗与所有城市发展水平上腹泻相关住院率的大幅降低相关。
