Elsevier

Vaccine

Volume 25, Issue 20, 16 May 2007, Pages 3962-3970
Vaccine

Evaluating rotavirus vaccination in England and Wales: Part I. Estimating the burden of disease

https://doi.org/10.1016/j.vaccine.2007.02.072Get rights and content

Abstract

Rotavirus is a major cause of gastroenteritis in young children. New vaccines for rotavirus are now available and countries need to establish the health and economic burden of rotavirus disease to assess whether vaccine introduction is advisable. This study assesses the fraction of acute gastroenteritis in children under 5 years that may be attributable to rotavirus using multiple linear regression. Results suggest around 45% of hospitalisations, 25% of GP consultations, 27% of NHS Direct calls and 20% of accident and emergency (A&E) attendances for acute gastroenteritis in this age group may be attributable to rotavirus. The annual incidence is estimated to be 4.5 hospitalisations, 9.3 A&E consultations, and 28–44 GP consultations per 1000 children under five years of age. The cost to the health service is estimated to be £14.2 m per annum. Rotavirus vaccination has the potential to reduce this burden of disease. This study provides a sound basis on which to make this assessment and serves as a baseline against which any reductions that do occur if vaccination is introduced can be measured against.

Section snippets

Background

Rotavirus is a major cause of gastroenteritis in young children [1], [2], [3]. Although in the developed world deaths due to rotavirus infection are rare it remains a considerable cause of illness in young children. With newly available vaccines for rotavirus, countries need to establish the health and economic burden of rotavirus disease using the best available data, to assess whether vaccine introduction is advisable compared with other uses of the same resources. Estimating the burden of

Laboratory reports (LabBase2)

The Health Protection Agency collects voluntary data from laboratories around England and Wales on weekly reports of positive isolates for various organisms [9]. Weekly counts (by date of first specimen) of the number of reports of specimens for the period 1995–2004 was extracted. Causative organisms used in the models were astrovirus, adenovirus, rotavirus, norovirus, salmonellas (excluding typhi and paratyphi), campylobacters, Escherichia coli (non-verocytoxin producing), shigellas, giardia,

Results

Between April 1995 and March 2003 there were 139,728 admissions in children under 5 for infectious intestinal disease and 94,569 admissions for non-infectious intestinal disease in children under 5. Over the same period there were 832,942 positive samples for the specified organisms identified from LabBase2 of which 124,723 were rotavirus. Fig. 1 shows the average seasonal trends of the pathogens from positive samples received on LabBase2 for the time period 1995–2003.

The pathogens exhibited

Discussion

This study suggests that approximately 45% of hospital admissions, 25% of GP consultations and NHS Direct calls and 20% of accident and emergency attendances for gastroenteritis in the under 5s can be attributable to rotavirus. These results were robust to a wide range of different model specifications. The finding that a greater proportion of hospitalisations than GP consultations might be attributable to rotavirus is consistent with other studies [24] and the observation that rotavirus

Acknowledgments

The authors would like to thank Chris Lane, Environmental and Enteric Diseases Department, Centre for Infections, for his work on the GIS section of the paper, and Graeme Hall and Prof. Brent Taylor of University College London Hospitals for providing the data on A&E attendances. We also thank the RCGP and NHS Direct for the use of their data, Mark Chen for advice on classifying drug prescriptions, and Prof. Elizabeth Miller for helpful discussions.

The study benefited from discussions held as

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