坦桑尼亚三家医院在引入轮状病毒疫苗前后婴儿腹泻住院趋势。
Trends in diarrhea hospitalizations among infants at three hospitals in Tanzania before and after rotavirus vaccine introduction.
机构信息
Dodoma Regional Referral Hospital, Dodoma, Tanzania.
Mbeya Zonal Referral Hospital, Mbeya, Tanzania.
出版信息
Vaccine. 2018 Nov 12;36(47):7157-7164. doi: 10.1016/j.vaccine.2017.11.051. Epub 2018 Apr 11.
BACKGROUND
The Tanzania Ministry of Health introduced monovalent human rotavirus vaccine in January 2013, to be administered at ages 6 and 10 weeks. Data suggest there was high vaccine uptake. We used hospital ward registers from 3 hospitals to examine trends in diarrhea hospitalizations among infants before and after vaccine introduction.
METHODS
Ward registers from Dodoma Regional Referral Hospital (Central Tanzania), and two hospitals in Mbeya (Southwest area), Mbeya Zonal Referral Hospital and Mbalizi Hospital, were used to tally admissions for diarrhea among children by age group, month and year. Rotavirus surveillance had started at these hospitals in early 2013; the proportion of infants enrolled and rotavirus-EIA positive were examined by month to determine peak periods of rotavirus disease post-vaccine introduction.
RESULTS
Registers were available for 2-4 prevaccine years and 2-3 post introduction years. At Dodoma Regional Referral Hospital, compared with the mean of 2011 and 2012, diarrhea hospitalizations among infants were 26% lower in 2015 and 58% lower in 2016. The diarrhea peak shifted later in the year first by 1 and then by 2-3 months from prevaccine. At the Mbeya hospitals, the number of diarrhea admissions in prevaccine period varied substantially by year. At Mbeya Referral Hospital, diarrhea hospitalizations among infants were lower by 25-37% in 2014 and 11-26% in 2015, while at Mbalizi Hospital, these hospitalizations were 4% lower in 2014 and 14% higher in 2015. Rotavirus testing data demonstrated a lowering of the prevaccine peak, a shift in timing of the peak months and indicated that other diarrheal peaks in post-introduction years were not due to rotavirus.
CONCLUSIONS
In this ecological evaluation, total diarrhea hospitalizations among infants were lower (≥25% lower in ≥1 year) following introduction in 2 of 3 hospitals. There are challenges in using ward registers to ascertain possible impact of rotavirus vaccine introduction on trends in hospitalizations for treatment of all diarrheal illness.
背景
坦桑尼亚卫生部于 2013 年 1 月引入单价人轮状病毒疫苗，在婴儿 6 周和 10 周龄时接种。数据表明疫苗接种率很高。我们使用三家医院的病房登记册，检查疫苗引入前后婴儿腹泻住院的趋势。
方法
使用多多马地区转诊医院（坦桑尼亚中部）和姆贝亚的两家医院（姆贝亚地区转诊医院和姆巴利齐医院）的病房登记册，按年龄组、月份和年份计算儿童腹泻入院人数。这些医院于 2013 年初开始进行轮状病毒监测；根据月份检查入组婴儿的比例和轮状病毒-EIA 阳性，以确定疫苗引入后轮状病毒疾病的高峰期。
结果
登记册可用于疫苗引入前 2-4 年和引入后 2-3 年。与 2011 年和 2012 年的平均值相比，多多马地区转诊医院 2015 年婴儿腹泻住院率降低了 26%，2016 年降低了 58%。腹泻高峰期在年初推迟了 1 个月，然后推迟了 2-3 个月。姆贝亚医院在疫苗引入前的几年中，腹泻入院人数每年变化很大。在姆贝亚地区转诊医院，2014 年和 2015 年婴儿腹泻住院率分别降低了 25-37%和 11-26%，而在姆巴利齐医院，2014 年住院率降低了 4%，2015 年则增加了 14%。轮状病毒检测数据表明，疫苗引入前的高峰期降低，高峰期月份的时间发生变化，并表明引入后年份中其他腹泻高峰期不是由轮状病毒引起的。
结论
在这项生态评估中，3 家医院中有 2 家在引入疫苗后，婴儿总腹泻住院率（≥1 年降低≥25%）降低。使用病房登记册来确定轮状病毒疫苗引入对所有腹泻病治疗住院趋势的可能影响存在挑战。
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