The success of publicly funded rotavirus vaccine programs for preventing community- and hospital-acquired rotavirus infections in Canadian pediatric hospitals: an observational study

Nicole Le Saux; Julie Bettinger; Hennady P Shulha; Manish Sadarangani; Doug Coyle; Timothy F Booth; Taj Jadavji; Scott A Halperin; For members of Immunization Monitoring Program Active

doi:10.9778/cmajo.20220245

The success of publicly funded rotavirus vaccine programs for preventing community- and hospital-acquired rotavirus infections in Canadian pediatric hospitals: an observational study

CMAJ Open. 2023 Dec 19;11(6):E1156-E1163. doi: 10.9778/cmajo.20220245. Print 2023 Nov-Dec.

Authors

Nicole Le Saux¹, Julie Bettinger², Hennady P Shulha², Manish Sadarangani², Doug Coyle², Timothy F Booth², Taj Jadavji², Scott A Halperin²; For members of Immunization Monitoring Program Active

Affiliations

¹ Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS lesaux@cheo.on.ca.
² Children's Hospital of Eastern Ontario (CHEO) (Le Saux), University of Ottawa, Ottawa, Ont.; Vaccine Evaluation Center, BC Children's Hospital Research Institute (Bettinger, Shulha, Sadarangani), University of British Columbia, Vancouver, BC; School of Epidemiology and Public Health (Coyle), University of Ottawa, Ottawa, Ont.; Viral Diseases Division, National Microbiology Laboratory (Booth), Public Health Agency of Canada, Winnipeg, Man.; Alberta Children's Hospital (Jadavji), University of Calgary, Alta.; Dalhousie University and Canadian Center for Vaccinology (Halperin), IWK Health Centre, Halifax, NS.

Abstract

Background: Canadian immunization programs for rotavirus started in 2011. We sought to determine their effect on the burden of community-acquired admissions and hospital-acquired rotavirus at pediatric hospitals.

Methods: The Canadian Immunization Monitoring Program Active (IMPACT) network conducted active surveillance for rotavirus-positive hospital admissions between 2005 and 2020 at 12 pediatric hospitals. We used yearly rates of community-acquired rotavirus per 10 000 admissions and hospital-acquired rotavirus infections per 1000 patient-days to determine changes in the pre- and post-vaccine program periods.

Results: During the 15-year study period, 5691 rotavirus hospital admissions and hospital-acquired infections were detected, including 4323 (76%) community-acquired infections and 1368 (24%) hospital-acquired infections. The average community-acquired rate in the pre-vaccine period was 60.3 (95% confidence interval [CI] 53.7-68.3) per 10 000 admissions, with a decline to 11.0 (95% CI 7.5-15.1) per 10 000 admissions in the post-vaccine period, resulting in an average reduction of 81.7% (95% CI 74.4%-87.8%). The rate of hospital-acquired rotavirus declined from 0.35 (95% CI 0.29-0.41) per 1000 patient-days in the pre-vaccine period to 0.05 (95% CI 0.03-0.07) per 1000 patient-days in the post-vaccine period, resulting in an 85.3% (95% CI 77.7%-91.9%) average decline. Herd protection was present among children aged 2-16 years.

Interpretation: Although start dates of rotavirus vaccine programs across provinces varied, there was around an 80% average decrease in both community-acquired and hospital-acquired rotavirus infections at pediatric hospitals in Canada in the 1- to 9-year interval after implementation of rotavirus vaccine programs. Herd protection is an important aspect of rotavirus vaccines for other children who are not vaccine eligible, and rotavirus vaccines continue to provide important benefits both for children and health care systems.