Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu.
Centre for Geographic Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, and.
Clin Infect Dis. 2020 May 23;70(11):2298-2305. doi: 10.1093/cid/ciz664.
Rotavirus remains a leading cause of pediatric diarrheal illness and death worldwide. Data on rotavirus vaccine effectiveness in sub-Saharan Africa are limited. Kenya introduced monovalent rotavirus vaccine (RV1) in July 2014. We assessed RV1 effectiveness against rotavirus-associated hospitalization in Kenyan children.
Between July 2014 and December 2017, we conducted surveillance for acute gastroenteritis (AGE) in 3 Kenyan hospitals. From children age-eligible for ≥1 RV1 dose, with stool tested for rotavirus and confirmed vaccination history we compared RV1 coverage among rotavirus positive (cases) vs rotavirus negative (controls) using multivariable logistic regression and calculated effectiveness based on adjusted odds ratio.
Among 677 eligible children, 110 (16%) were rotavirus positive. Vaccination data were available for 91 (83%) cases; 51 (56%) had 2 RV1 doses and 33 (36%) 0 doses. Among 567 controls, 418 (74%) had vaccination data; 308 (74%) had 2 doses and 69 (16%) 0 doses. Overall 2-dose effectiveness was 64% (95% confidence interval [CI], 35%-80%); effectiveness was 67% (95% CI, 30%-84%) for children aged <12 months and 72% (95% CI, 10%-91%) for children aged ≥12 months. Significant effectiveness was seen in children with normal weight for age, length/height for age and weight for length/height; however, no protection was found among underweight, stunted, or wasted children.
RV1 in the Kenyan immunization program provides significant protection against rotavirus-associated hospitalization which persisted beyond infancy. Malnutrition appears to diminish vaccine effectiveness. Efforts to improve rotavirus uptake and nutritional status are important to maximize vaccine benefit.
轮状病毒仍然是全球导致小儿腹泻病和死亡的主要原因。关于轮状病毒疫苗在撒哈拉以南非洲的有效性的数据有限。肯尼亚于 2014 年 7 月推出单价轮状病毒疫苗（RV1）。我们评估了 RV1 对肯尼亚儿童轮状病毒相关住院的有效性。
2014 年 7 月至 2017 年 12 月，我们在肯尼亚的 3 家医院开展了急性胃肠炎（AGE）监测。从有资格接受≥1 剂 RV1 的儿童中，我们比较了轮状病毒阳性（病例）和轮状病毒阴性（对照）儿童的 RV1 覆盖率，使用多变量逻辑回归，并根据调整后的比值比计算有效性。
在 677 名合格儿童中，有 110 名（16%）为轮状病毒阳性。91 名（83%）病例有疫苗接种数据；51 名（56%）有 2 剂 RV1，33 名（36%）没有 0 剂。在 567 名对照中，有 418 名（74%）有疫苗接种数据；308 名（74%）有 2 剂，69 名（16%）没有 0 剂。总体而言，2 剂疫苗的有效性为 64%（95%置信区间 [CI]，35%-80%）；对于年龄<12 个月的儿童，有效性为 67%（95%CI，30%-84%），对于年龄≥12 个月的儿童，有效性为 72%（95%CI，10%-91%）。在体重正常、身高/年龄正常和体重/身高正常的儿童中，观察到了显著的有效性；然而，在体重不足、发育迟缓或消瘦的儿童中，没有发现保护作用。
肯尼亚免疫规划中的 RV1 对轮状病毒相关住院提供了显著保护，这种保护作用持续到婴儿期之后。营养不良似乎降低了疫苗的有效性。努力提高轮状病毒的接种率和改善营养状况对于最大限度地发挥疫苗的效益非常重要。
