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Dr parashar slides

  1. 1. Burden of Rotavirus Disease &Impact of Rotavirus Vaccination TM Umesh D. Parashar, MBBS, MPH Lead, Viral Gastroenteritis Epidemiology Team Centers for Disease Control Prevention Atlanta, GA 1
  2. 2. Rotavirus is the Leading Cause Of Severe Gastroenteritis in Children <5 Years Developed Countries Developing Countries Unknown Unknown Rotavirus Rotavirus OtherBacterial Other Bacterial A. Kapikian, Fields Virology 2003 2
  3. 3. The face of rotavirus Diarrhea Vomiting Dehydration Shock Death
  4. 4. Burden of Rotavirus in the US in 2006 20-60 Deaths 55-70,000 Hospitalizations 500,000 Outpatient visits 3.2 Million episodes Cost: $300 M medical; >$1 B total 4CDC, MMWR, 2006
  5. 5. Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children 1 dot = 250 deaths 5Parashar et al, JID, 2009
  6. 6. 2006 -- Phase 3 Trials of Two Rotavirus Vaccines •Trials of 60-70,000 infants •No increased risk of intussusception or other SAE •Efficacy of 85%-98% against severe disease 6Vesikari et al and Ruiz-Palacios et al, NEJM 2006
  7. 7. Countries in the Americas with Rotavirus Vaccine Programs Rotateq & Rotarix Rotarix only Rotateq only No program
  8. 8. Rotavirus Vaccines in USA• Feb 2006 – RotaTeq recommended• June 2008 – Rotarix recommended 8
  9. 9. National Rotavirus Laboratory Surveillance • Network of 67 laboratories reporting since 2000 • Weekly reporting: – # specimens tested for rotavirus – # positive tests
  10. 10. Total and Positive RotavirusofTests, July 2000-Mar 2010 Total number of rotavirus tests and number positive test results* from 27 continuously reporting laboratories - National Respiratory and Enteric Virus Surveillance System, United States, July 2, 2000-February 20, 2010 800 Vaccine introduced Total no. tests 700 No. positive results 600 500Number 400 300 200 100 0 00 01 02 03 04 05 06 07 08 09 10 20 20 20 20 20 20 20 20 20 20 20 Month and year * 3-week moving averages Tate et al, Pediatrics 2009 and CDC unpublished data
  11. 11. Active Rotavirus SurveillancePayne et al, PAS 2009 11
  12. 12. Total AGE and Rotavirus AGE Hospitalizations NVSN, 2006-2008 Total AGE Rotavirus 200 181 179 180 160 139Number of cases 140 120 91 6% 100 81 Rota 80 50 % + 45 % Rota 60 + Rota + 40 20 9 0 2006 2007 2008 National reduction of 45,000-62,000 hospitalizations in 2008 12
  13. 13. Age-Specific Rotavirus Hospitalization Rate Reduction and Vaccine Coverage, NVSN Age Decline in rotavirus Rotavirus vaccine hospitalization rate coverage in 2008 (2008 vs. 2006) (>=1 dose) < 1 year 66% 56%1 -< 2 years 95% 44%2 -< 3 years 85% <1% This age cohort was ineligible to receive rotavirus vaccine 13
  14. 14. Rotavirus Vaccination in El Salvador• October 2006 – Rotarix recommended 14
  15. 15. Reduction in Rotavirus Admissions in Children < 5 Years after Rotarix Introduction, El Salvador Vaccination (October, 2006) 2500 Total diarrhoea cases 2274 Rotavirus positive casesNumber of hospitalizations 2000 1771 1500 1092 1117 1066 1000 863 500 342 171 0 2006 2007 2008 2009 Surveillance year70-80% reduction in rotavirus hospitalizations children < 5 years 15In press, BMJ, 2010
  16. 16. 16Richardson et al, NEJM 2010
  17. 17. Marked Decline in Childhood DiarrheaDeaths After Rotarix Introduction, Mexico Vaccine Introduction 250 Age ≤11 months (May 2007) Age 12-23 months Age 24-59 months 200 2008Number of diarrhea deaths 2009 150 100 50 0 Month-Year 17
  18. 18. Winter Blunting of Diarrhea Deaths Suggests Effect Against Rotavirus 2007-2009 observed deaths Age 0-11 months 2003-2006 maximum Country-wide vaccine introduction, May, 2007 2003-2006 median 2003-2006 minimum 200 180 160No. diarrhea deaths 140 120 100 80 60 40 20 0 Jan-2007 Jan-2008 Jan-2009 Jul Jul Mar Mar Mar Dec Dec Oct Oct Feb Jun Sep Feb Jun Sep Feb Nov Nov May May May Apr Apr Apr Aug Aug 18
  19. 19. Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children 1 dot = 250 deaths 19
  20. 20. Rotarix Trial in Malawi & So. Africa No. of rotavirus Vaccine cases prevented Region 95% CI Efficacy per 100 vaccinated 49% 19, 68 6.7 Malawi South Africa 77% 40, 88 4.1 20Madhi, S et al. NEJM 2010
  21. 21. 2006-2010Incredible years for rotavirus vaccines!.... And great promise for the future!! 21
  22. 22. Acknowledgements 22

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