Centers for Disease Control and Prevention, Atlanta, Georgia.
World Health Organization, Geneva, Switzerland.
Clin Infect Dis. 2016 May 1;62 Suppl 2(Suppl 2):S96-S105. doi: 10.1093/cid/civ1013.
Rotavirus vaccine is recommended for routine use in all countries globally. To facilitate decision making on rotavirus vaccine adoption by countries, help donors prioritize investments in health interventions, and monitor vaccine impact, we estimated rotavirus mortality for children <5 years of age from 2000 to 2013.
We searched PubMed using the keyword "rotavirus" to identify studies that met each of the following criteria: data collection midpoint in year 1998 or later, study period of a 12-month increment, and detection of rotavirus infection by enzyme immunoassay in at least 100 children <5 years of age who were hospitalized with diarrhea and systematically enrolled through active surveillance. We also included data from countries that participated in the World Health Organization (WHO)-coordinated rotavirus surveillance network between 2008 and 2013 that met these criteria. To predict the proportion of diarrhea due to rotavirus, we constructed a multiple linear regression model. To determine the number of rotavirus deaths in children <5 years of age from 2000 to 2013, we multiplied annual, country-specific estimates of the proportion of diarrhea due to rotavirus from the regression model by the annual number of WHO-estimated child deaths caused by diarrhea in each country.
Globally, we estimated that the number of rotavirus deaths in children <5 years of age declined from 528 000 (range, 465 000-591 000) in 2000 to 215 000 (range, 197 000-233 000) in 2013. The predicted annual rotavirus detection rate from these studies declined slightly over time from 42.5% (95% confidence interval [CI], 37.4%-47.5%) in 2000 to 37.3% (95% CI, 34.2%-40.5%) in 2013 globally. In 2013, an estimated 47 100 rotavirus deaths occurred in India, 22% of all rotavirus deaths that occurred globally. Four countries (India, Nigeria, Pakistan, and Democratic Republic of Congo) accounted for approximately half (49%) of all estimated rotavirus deaths in 2013.
While rotavirus vaccine had been introduced in >60 countries worldwide by the end of 2013, the majority of countries using rotavirus vaccine during the review period were low-mortality countries and the impact of rotavirus vaccine on global estimates of rotavirus mortality has been limited. Continued monitoring of rotavirus mortality rates and deaths through rotavirus surveillance will aid in monitoring the impact of vaccination.
轮状病毒疫苗在全球所有国家均被推荐用于常规使用。为了便于各国就采用轮状病毒疫苗做出决策，帮助捐助者确定卫生干预措施的投资重点，并监测疫苗的效果，我们估算了 2000 年至 2013 年期间 5 岁以下儿童的轮状病毒死亡率。
我们使用“轮状病毒”这一关键词在 PubMed 上进行检索，以确定符合以下所有标准的研究：数据收集时间为 1998 年或之后；研究时间段为 12 个月的增量；至少有 100 名 5 岁以下因腹泻住院且通过主动监测系统纳入的儿童，其轮状病毒感染通过酶免疫测定法检测。我们还纳入了 2008 年至 2013 年期间参加世界卫生组织（WHO）协调的轮状病毒监测网络且符合这些标准的国家的数据。为了预测轮状病毒引起的腹泻比例，我们构建了一个多元线性回归模型。为了确定 2000 年至 2013 年期间 5 岁以下儿童的轮状病毒死亡人数，我们将回归模型中每年国家特定的轮状病毒引起的腹泻比例与每年 WHO 估计的每个国家因腹泻导致的儿童死亡人数相乘。
全球范围内，我们估计 5 岁以下儿童的轮状病毒死亡人数从 2000 年的 528000 人（范围为 465000 人至 591000 人）下降至 2013 年的 215000 人（范围为 197000 人至 233000 人）。这些研究的预测年度轮状病毒检出率随着时间的推移略有下降，从 2000 年的 42.5%（95%置信区间 [CI]，37.4%-47.5%）下降到 2013 年的 37.3%（95% CI，34.2%-40.5%）。2013 年，印度有估计 47100 例轮状病毒死亡，占全球所有轮状病毒死亡人数的 22%。有 4 个国家（印度、尼日利亚、巴基斯坦和刚果民主共和国）占 2013 年所有估计轮状病毒死亡人数的近一半（49%）。
到 2013 年底，全球已有超过 60 个国家引入了轮状病毒疫苗，但在审查期间使用轮状病毒疫苗的大多数国家都是死亡率较低的国家，轮状病毒疫苗对全球轮状病毒死亡率的影响有限。通过轮状病毒监测继续监测轮状病毒死亡率和死亡人数，将有助于监测疫苗的效果。
