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Both rotavirus vaccines RotaTeq and Rotarix were efficacious against severe rotavirus gastroenteritis in clinical trials; yet real-world data on the effect of rotavirus vaccines on mild to moderate disease are limited. We used a large computerised database of Maccabi Health Services Health Maintenance Organisation (HMO), the second largest HMO in Israel covering 25% of the Israeli population, to compare the incidence of acute gastroenteritis (AGE) clinic visits in community settings (n = 302,445) before (2005–10) and after (2011–13) the introduction of universal rotavirus immunisation in Israel. We retrieved laboratory results of rotavirus antigen tests (n = 18,133) and using a weighted analysis, we estimated the impact of rotavirus immunisation on the disease burden of rotavirus AGE clinic visits. Following the introduction of universal rotavirus immunisation, the typical winter peaks of rotavirus AGE were substantially lower and significant reductions of 14.8% (95% confidence interval (CI): 13.5–16.1) in all-cause AGE clinic visits and of 59.7% (95% CI: 59.8–62.6) in rotavirus AGE clinic visits were observed. The decrease was observed in all age groups, but it was greater in children aged 0 to 23 months than those aged 24 to 59 months. Continued rotavirus laboratory surveillance is warranted to monitor the sustainability of these changes.


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  1. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003;9(5):565-72.  https://doi.org/10.3201/eid0905.020562  PMID: 12737740 
  2. Musher DM, Musher BL. Contagious acute gastrointestinal infections. N Engl J Med. 2004;351(23):2417-27.  https://doi.org/10.1056/NEJMra041837  PMID: 15575058 
  3. Glass RI, Parashar UD, Bresee JS, Turcios R, Fischer TK, Widdowson MA, et al. Rotavirus vaccines: current prospects and future challenges. Lancet. 2006;368(9532):323-32.  https://doi.org/10.1016/S0140-6736(06)68815-6  PMID: 16860702 
  4. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD, et al. . 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(2):136-41.  https://doi.org/10.1016/S1473-3099(11)70253-5  PMID: 22030330 
  5. Melliez H, Boelle PY, Baron S, Mouton Y, Yazdanpanah Y. [Morbidity and cost of rotavirus infections in France]. Med Mal Infect. 2005;35(10):492-9. French.  https://doi.org/10.1016/j.medmal.2005.08.007  PMID: 16316731 
  6. Ogilvie I, Khoury H, Goetghebeur MM, El Khoury AC, Giaquinto C. Burden of community-acquired and nosocomial rotavirus gastroenteritis in the pediatric population of Western Europe: a scoping review. BMC Infect Dis. 2012;12(1):62.  https://doi.org/10.1186/1471-2334-12-62  PMID: 22429601 
  7. Lee BP, Azimi PH, Staat MA, Louie L, Parada E, Berke T, et al. Nonmedical costs associated with rotavirus disease requiring hospitalization. Pediatr Infect Dis J. 2005;24(11):984-8.  https://doi.org/10.1097/01.inf.0000183754.29707.cd  PMID: 16282934 
  8. Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006;354(1):11-22.  https://doi.org/10.1056/NEJMoa052434  PMID: 16394298 
  9. Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. . Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006;354(1):23-33.  https://doi.org/10.1056/NEJMoa052664  PMID: 16394299 
  10. Patel MM, Parashar UD. Assessing the effectiveness and public health impact of rotavirus vaccines after introduction in immunization programs. J Infect Dis. 2009;200(s1) Suppl 1;S291-9.  https://doi.org/10.1086/605059  PMID: 19817612 
  11. Lopman BA, Payne DC, Tate JE, Patel MM, Cortese MM, Parashar UD. Post-licensure experience with rotavirus vaccination in high and middle income countries; 2006 to 2011. Curr Opin Virol. 2012;2(4):434-42.  https://doi.org/10.1016/j.coviro.2012.05.002  PMID: 22749491 
  12. Patel MM, Glass R, Desai R, Tate JE, Parashar UD. Fulfilling the promise of rotavirus vaccines: how far have we come since licensure? Lancet Infect Dis. 2012;12(7):561-70.  https://doi.org/10.1016/S1473-3099(12)70029-4  PMID: 22742639 
  13. Parez N, Giaquinto C, Du Roure C, Martinon-Torres F, Spoulou V, Van Damme P, et al. Rotavirus vaccination in Europe: drivers and barriers. Lancet Infect Dis. 2014;14(5):416-25.  https://doi.org/10.1016/S1473-3099(14)70035-0  PMID: 24758998 
  14. Huppertz H, Borte M, Schuster V, Giaquinto C, Vesikari T. Report of the Third European Expert Meeting on Rotavirus Vaccination: Progress in rotavirus universal mass vaccination in Europe. Vaccine. 2014;32(34):4243-8.  https://doi.org/10.1016/j.vaccine.2014.05.029  PMID: 24852720 
  15. Muhsen K, Shulman L, Kasem E, Rubinstein U, Shachter J, Kremer A, et al. Effectiveness of rotavirus vaccines for prevention of rotavirus gastroenteritis-associated hospitalizations in Israel: a case-control study. Hum Vaccin. 2010;6(6):450-4.  https://doi.org/10.4161/hv.6.6.11759  PMID: 20448471 
  16. Paulke-Korinek M, Rendi-Wagner P, Kundi M, Kronik R, Kollaritsch H. Universal mass vaccination against rotavirus gastroenteritis: impact on hospitalization rates in austrian children. Pediatr Infect Dis J. 2010;29(4):319-23. PMID: 19935446 
  17. Leino T, Ollgren J, Salo H, Tiihonen P, Kilpi T. First year experience of rotavirus immunisation programme in Finland. Vaccine. 2012;31(1):176-82.  https://doi.org/10.1016/j.vaccine.2012.10.068  PMID: 23122991 
  18. Braeckman T, Van Herck K, Meyer N, Pirçon JY, Soriano-Gabarró M, Heylen E, et al. . Effectiveness of rotavirus vaccination in prevention of hospital admissions for rotavirus gastroenteritis among young children in Belgium: case-control study. BMJ. 2012;345(aug08 1):e4752.  https://doi.org/10.1136/bmj.e4752  PMID: 22875947 
  19. Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, Esparza-Aguilar M, Johnson B, Gomez-Altamirano CM, et al. Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. N Engl J Med. 2010;362(4):299-305.  https://doi.org/10.1056/NEJMoa0905211  PMID: 20107215 
  20. do Carmo GM, Yen C, Cortes J, Siqueira AA, de Oliveira WK, Cortez-Escalante JJ, et al. Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. PLoS Med. 2011;8(4):e1001024.  https://doi.org/10.1371/journal.pmed.1001024  PMID: 21526228 
  21. Nolan SM, Prasad P, Fiks AG, Zaoutis T, Tenhave TR, Coffin SE. Effect of rotavirus vaccine on reducing acute gastroenteritis in a large outpatient pediatric network. Arch Pediatr Adolesc Med. 2012;166(3):232-9.  https://doi.org/10.1001/archpediatrics.2011.628  PMID: 22393181 
  22. Leshem E, Moritz RE, Curns AT, Zhou F, Tate JE, Lopman BA, et al. Rotavirus vaccines and health care utilization for diarrhea in the United States (2007-2011). Pediatrics. 2014;134(1):15-23.  https://doi.org/10.1542/peds.2013-3849  PMID: 24913793 
  23. Muhsen K, Shulman L, Rubinstein U, Kasem E, Kremer A, Goren S, et al. Incidence, characteristics, and economic burden of rotavirus gastroenteritis associated with hospitalization of israeli children <5 years of age, 2007-2008. J Infect Dis. 2009;200(s1) Suppl 1;S254-63.  https://doi.org/10.1086/605425  PMID: 19817606 
  24. Muhsen K, Chodick G, Goren S, Shalev V, Cohen D. The uptake of rotavirus vaccine and its effectiveness in preventing acute gastroenteritis in the community. Vaccine. 2010;29(1):91-4.  https://doi.org/10.1016/j.vaccine.2010.10.010  PMID: 20969927 
  25. World Health Organization (WHO). International statistical classification of diseases and related health problems. Ninth revision. Geneva: WHO; 1995.
  26. Pocock SJ. Harmonic-Analysis Applied to Seasonal-Variations in Sickness Absence. J R Stat Soc Ser C Appl Stat. 1974;23(2):103-20.
  27. Amador JJ, Vasquez J, Orozco M, Pedreira C, Malespin O, De Oliveira LH, et al. Rotavirus disease burden, Nicaragua 2001-2005: defining the potential impact of a rotavirus vaccination program. Int J Infect Dis. 2010;14(7):e592-5.  https://doi.org/10.1016/j.ijid.2009.08.014  PMID: 20022778 
  28. Ngabo F, Gatera M, Karema C, Donnen P, Lepage P, Parashar UD, et al. Can routinely collected national data on childhood morbidity and mortality from diarrhea be used to monitor health impact of rotavirus vaccination in Africa? Examination of pre-vaccine baseline data from Rwanda. Pediatr Infect Dis J. 2014;33(Suppl 1):S89-93.  https://doi.org/10.1097/INF.0000000000000054  PMID: 24343621 
  29. Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013;382(9888):209-22.  https://doi.org/10.1016/S0140-6736(13)60844-2  PMID: 23680352 
  30. Centers for Disease Control and Prevention (CDC). Rotavirus surveillance--worldwide, 2001-2008. MMWR Morb Mortal Wkly Rep. 2008;57(46):1255-7. PMID: 19023263 

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