Inchauste Lucia, Patzi Maritza, Halvorsen Kjetil, Solano Susana, Montesano Raul, Iñiguez Volga
Instituto de Biología Molecular y Biotecnología, Carrera de Biología, Facultad de Ciencias Puras y Naturales, Universidad Mayor de San Andrés, Campus Universitario de Cota Cota, Calle 27, La Paz, Bolivia.
Programa Ampliado de Inmunización, Ministerio de Salud, Avenida Capitán Ravelo No. 2199, La Paz, Bolivia.
Int J Infect Dis. 2017 Aug;61:79-88. doi: 10.1016/j.ijid.2017.06.006. Epub 2017 Jun 13.
The public health impact of rotavirus vaccination in countries with high child mortality rates remains to be established. The RV1 rotavirus vaccine was introduced in Bolivia in August 2008. This study describes the trends in deaths, hospitalizations, and healthcare visits due to acute gastroenteritis (AGE) and in rotavirus-related hospitalizations, among children <5 years of age, during the pre- and post-vaccination periods.
Data were obtained from the National Health Information System to calculate vaccine coverage and AGE-related health indicators. Trend reductions in the main health indicators were examined using the pre-vaccine period as baseline. The effect of vaccination on the epidemiology of rotavirus-related AGE was assessed using data from the active surveillance hospitals.
Compared with the 2001-2008 pre-vaccine baseline, the mean number of rotavirus-related hospitalizations was reduced by 40.8% (95% confidence interval (CI) 21.7-66.4%) among children <5years of age in the post-vaccine period (2009-2013). Reductions were most pronounced in children <1year of age, eligible for vaccination. The mean proportions of AGE-related deaths, AGE-related hospitalizations, and AGE-related healthcare visits during 2009-2014 were reduced by 52.5% (95% CI 47.4-56.3), 30.2% (95% CI 23.5-36.1), and 12.9% (95% CI 12.0-13.2), respectively. The greatest effect in reduction of AGE-related deaths was found during the months with seasonal peaks of rotavirus disease. Over the post-vaccine period, changes in rotavirus epidemiology were observed, manifested by variations in seasonality and by a shift in the mean age of those with rotavirus infection.
The significant decrease in main AGE-related health indicators in children <5years of age after the introduction of rotavirus vaccine provides evidence of a substantial public health impact of rotavirus vaccination in Bolivia, as a measure for protecting children against AGE.
轮状病毒疫苗在儿童死亡率高的国家对公共卫生的影响尚待确定。RV1轮状病毒疫苗于2008年8月在玻利维亚引进。本研究描述了接种疫苗前后5岁以下儿童因急性胃肠炎（AGE）导致的死亡、住院和医疗就诊情况以及与轮状病毒相关的住院情况的变化趋势。
从国家卫生信息系统获取数据以计算疫苗覆盖率和与AGE相关的健康指标。以疫苗接种前时期为基线，检查主要健康指标的趋势下降情况。使用来自主动监测医院的数据评估疫苗接种对轮状病毒相关AGE流行病学的影响。
与2001 - 2008年疫苗接种前基线相比，疫苗接种后时期（2009 - 2013年）5岁以下儿童中与轮状病毒相关的住院平均数量减少了40.8%（95%置信区间（CI）21.7 - 66.4%）。在符合接种条件的1岁以下儿童中减少最为明显。2009 - 2014年期间与AGE相关的死亡、与AGE相关的住院和与AGE相关的医疗就诊的平均比例分别降低了52.5%（95%CI 47.4 - 56.3）、30.2%（95%CI 23.5 - 36.1）和12.9%（95%CI 12.0 - 13.2）。在轮状病毒疾病季节性高峰月份，发现降低与AGE相关死亡的效果最为显著。在疫苗接种后时期，观察到轮状病毒流行病学的变化，表现为季节性变化以及轮状病毒感染患者平均年龄的转变。
引进轮状病毒疫苗后，5岁以下儿童中主要的与AGE相关健康指标显著下降，这为轮状病毒疫苗在玻利维亚对公共卫生产生重大影响提供了证据，证明其作为保护儿童预防AGE的一项措施的有效性。
