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In 2006, Belgium was the first country in the European Union to recommend rotavirus vaccination in the routine infant vaccination schedule and rapidly achieved high vaccine uptake (86–89% in 2007). We used regional and national data sources up to 7 years post-vaccination to study the impact of vaccination on laboratory-confirmed rotavirus cases and rotavirus-related hospitalisations and deaths. We showed that (i) from 2007 until 2013, vaccination coverage remained at 79–88% for a complete course, (ii) in children 0–2 years, rotavirus cases decreased by 79% (95% confidence intervals (CI): 68–­89%) in 2008–2014 compared to the pre-vaccination period (1999–­2006) and by 50% (95% CI: 14–82%) in the age group ≥ 10 years, (iii) hospitalisations for rotavirus gastroenteritis decreased by 87% (95% CI: 84–90%) in 2008–­2012 compared to the pre-vaccination period (2002–­2006), (iv) median age of rotavirus cases increased from 12 months to 17 months and (v) the rotavirus seasonal peak was reduced and delayed in all post-vaccination years. The substantial decline in rotavirus gastroenteritis requiring hospitalisations and in rotavirus activity following introduction of rotavirus vaccination is sustained over time and more pronounced in the target age group, but with evidence of herd immunity.


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  1. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UDWHO-coordinated Global Rotavirus Surveillance Network. 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 
  2. Payne DC, Wikswo M, Parashar UD. Centers for Disease Control and Prevention (CDC). Manual for the surveillance of vaccine-preventable diseases. Chapter 13: Rotavirus.Atlanta: CDC; 2014. Available from: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt13-rotavirus.html
  3. Bilcke J, Van Damme P, Van Ranst M, Hens N, Aerts M, Beutels P. Estimating the incidence of symptomatic rotavirus infections: a systematic review and meta-analysis. PLoS One. 2009;4(6):e6060.  https://doi.org/10.1371/journal.pone.0006060  PMID: 19557133 
  4. Bilcke J, Van Damme P, De Smet F, Hanquet G, Van Ranst M, Beutels P. The health and economic burden of rotavirus disease in Belgium. Eur J Pediatr. 2008;167(12):1409-19.  https://doi.org/10.1007/s00431-008-0684-3  PMID: 18317802 
  5. Belgisch Centrum voor Farmacotherapeutische Informatie - Centre Belge d'Information Pharmacothérapeutique (BCFI-CBIP). [Belgian Center for Pharmacotherapeutic Information]. Gecommentarieerd Geneesmiddelenrepertorium. Vaccin tegen rotavirus. [Commented Repertory of medicines. Rotavirus vaccine]. [Accessed 6 Aug 2015]. Dutch. Available from: http://www.bcfi.be/GGR/MPG/MPG_LAAJ.cfm
  6. Hanquet G, Ducoffre G, Vergison A, Neels P, Sabbe M, Van Damme P, et al. Impact of rotavirus vaccination on laboratory confirmed cases in Belgium. Vaccine. 2011;29(29-30):4698-703.  https://doi.org/10.1016/j.vaccine.2011.04.098  PMID: 21571023 
  7. Raes M, Strens D, Vergison A, Verghote M, Standaert B. Reduction in pediatric rotavirus-related hospitalizations after universal rotavirus vaccination in Belgium. Pediatr Infect Dis J. 2011;30(7):e120-5.  https://doi.org/10.1097/INF.0b013e318214b811  PMID: 21436757 
  8. Zeller M, Rahman M, Heylen E, De Coster S, De Vos S, Arijs I, et al. Rotavirus incidence and genotype distribution before and after national rotavirus vaccine introduction in Belgium. Vaccine. 2010;28(47):7507-13.  https://doi.org/10.1016/j.vaccine.2010.09.004  PMID: 20851085 
  9. Braeckman T, Van Herck K, Meyer N, Pirçon JY, Soriano-Gabarró M, Heylen E, et al. RotaBel Study Group. 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 
  10. Braeckman T, Theeten H, Lernout T, Hens N, Roelants M, Hoppenbrouwers K, et al. Rotavirus vaccination coverage and adherence to recommended age among infants in Flanders (Belgium) in 2012. Euro Surveill. 2014;19(20):20806.  https://doi.org/10.2807/1560-7917.ES2014.19.20.20806  PMID: 24871757 
  11. Robert E, Dramaix M, Swennen B. Vaccination coverage for infants: cross-sectional studies in two regions of Belgium. Biomed Res Int. 2014;2014:838907.
  12. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna: 2014. Available from: http://www.R-project.org
  13. Directorate General Statistics and Economic Information. Statistics Belgium. [Accessed 30 Jan 2015). Available from: http://statbel.fgov.be/
  14. Agentschap Zorg en Gezondheid. [Agency for Care and Health]. Vaccinnet. [Accessed 30 Jan 2015]. Dutch. Available from: https://www.vaccinnet.be/Vaccinnet/welkom.do
  15. Scientific Institute of Public Health B. Sentinel Laboratory Network. [Accessed: 30 Jan 2015]. Available from: https://epidemio.wiv-isp.be/ID/Surveillance/Pages/sentinelLabs.aspx
  16. Mutualiteit C. Landsbond der Christelijke Mutualiteiten. Jaarverslag 2013. [National Alliance of Christian Sickness Funds. Annual Report 2013]. [Accessed: 30 Jan 2015]. Dutch. Available from: http://www.cm.be/binaries/Jaarverslag-2013_tcm375-130990.pdf
  17. Centers for Disease Control and Prevention (CDC). International classification of diseases, ninth revision, clinical modification (ICD-9-CM). Atlanta: CDC; 2010. Available from: http://www.cdc.gov/nchs/icd/icd9cm.htm
  18. World Health Organization (WHO). International statistical classification of diseases and related health problems. 10th Revision. Volume 2. Instruction manual. 2010 ed. Geneva: WHO; 2011. Available from: http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf
  19. Drieskens S, van Oyen H, Tafforeau J, Lafontaine MF. Interactive analysis of Belgian vital statistics on the Internet. Med Inform Internet Med. 2006;31(4):237-45.  https://doi.org/10.1080/14639230500512499  PMID: 17135056 
  20. Afdeling Informatie en Zorgberoepen. Cijfers sterfte. [Departement of Information and Care professions]. Accessed: 30 Jan 2015]. Dutch. Available from: http://www.zorg-en-gezondheid.be/cijfers/
  21. European Centre for Disease Prevention and Control (ECDC). Impact of rotavirus vaccination - Generic study protocol. Stockholm: ECDC; 2013.
  22. Tate JE, Haynes A, Payne DC, Cortese MM, Lopman BA, Patel MM, et al. Trends in national rotavirus activity before and after introduction of rotavirus vaccine into the national immunization program in the United States, 2000 to 2012. Pediatr Infect Dis J. 2013;32(7):741-4.  https://doi.org/10.1097/INF.0b013e31828d639c  PMID: 23426425 
  23. Hanquet G, Valenciano M, Simondon F, Moren A. Vaccine effects and impact of vaccination programmes in post-licensure studies. Vaccine. 2013;31(48):5634-42.  https://doi.org/10.1016/j.vaccine.2013.07.006  PMID: 23856332 
  24. Fieller EC. The biological standardization of insulin. Suppl to J R Statist Soc. 1940;7:1-64.
  25. Panozzo CA, Becker-Dreps S, Pate V, Jonsson Funk M, Stürmer T, Weber DJ, et al. Patterns of rotavirus vaccine uptake and use in privately-insured US infants, 2006-2010. PLoS One. 2013;8(9):e73825.  https://doi.org/10.1371/journal.pone.0073825  PMID: 24066076 
  26. Krishnarajah G, Landsman-Blumberg P, Eynullayeva E. Rotavirus vaccination compliance and completion in a Medicaid infant population. Vaccine. 2015;33(3):479-86.  https://doi.org/10.1016/j.vaccine.2014.06.059  PMID: 24962753 
  27. Krishnarajah G, Davis EJ, Fan Y, Standaert BA, Buikema AR. Rotavirus vaccine series completion and adherence to vaccination schedules among infants in managed care in the United States. Vaccine. 2012;30(24):3717-22.  https://doi.org/10.1016/j.vaccine.2011.12.077  PMID: 22214886 
  28. Forster J, Guarino A, Parez N, Moraga F, Román E, Mory O, et al. Rotavirus Study Group. Hospital-based surveillance to estimate the burden of rotavirus gastroenteritis among European children younger than 5 years of age. Pediatrics. 2009;123(3):e393-400.  https://doi.org/10.1542/peds.2008-2088  PMID: 19254975 
  29. Soriano-Gabarró M, Mrukowicz J, Vesikari T, Verstraeten T. Burden of rotavirus disease in European Union countries. Pediatr Infect Dis J. 2006;25(1) Suppl;S7-11.  https://doi.org/10.1097/01.inf.0000197622.98559.01  PMID: 16397431 
  30. Van Damme P, Giaquinto C, Huet F, Gothefors L, Maxwell M, Van der Wielen MREVEAL Study Group. Multicenter prospective study of the burden of rotavirus acute gastroenteritis in Europe, 2004-2005: the REVEAL study. J Infect Dis. 2007;195(s1) Suppl 1;S4-16.  https://doi.org/10.1086/516714  PMID: 17387650 
  31. Bilcke J, Van Damme P, Beutels P. Cost-effectiveness of rotavirus vaccination: exploring caregiver(s) and "no medical care" disease impact in Belgium. Med Decis Making. 2009;29(1):33-50.  https://doi.org/10.1177/0272989X08324955  PMID: 18948433 
  32. Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2012;11:CD008521. PMID: 23152260 
  33. 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 
  34. Atchison C, Lopman B, Edmunds WJ. Modelling the seasonality of rotavirus disease and the impact of vaccination in England and Wales. Vaccine. 2010;28(18):3118-26.  https://doi.org/10.1016/j.vaccine.2010.02.060  PMID: 20197142 
  35. Hahné S, Hooiveld M, Vennema H, van Ginkel A, de Melker H, Wallinga J, et al. Exceptionally low rotavirus incidence in the Netherlands in 2013/14 in the absence of rotavirus vaccination. Euro Surveill. 2014;19(43):20945.  https://doi.org/10.2807/1560-7917.ES2014.19.43.20945  PMID: 25375899 
  36. Royal Meteorological Institute of Belgium (RMI). [Accessed: 30 March 2015]. Dutch. Available from: http://www.meteo.be/meteo/view/en/65239-Home.htm
  37. Elam-Evans LD, Yankey D, Singleton JA, Kolasa MCenters for Disease Control and Prevention (CDC). National, state, and selected local area vaccination coverage among children aged 19-35 months - United States, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(34):741-8. PMID: 25166924 
  38. Bilcke J, Chapman R, Atchison C, Cromer D, Johnson H, Willem L, et al. Quantifying Parameter and Structural Uncertainty of Dynamic Disease Transmission Models Using MCMC: An Application to Rotavirus Vaccination in England and Wales. Med Decis Making. 2015;35(5):633-47.  https://doi.org/10.1177/0272989X14566013  PMID: 25623063 
  39. Pitzer VE, Atkins KE, de Blasio BF, Van Effelterre T, Atchison CJ, Harris JP, et al. Direct and indirect effects of rotavirus vaccination: comparing predictions from transmission dynamic models. PLoS One. 2012;7(8):e42320.  https://doi.org/10.1371/journal.pone.0042320  PMID: 22912699 
  40. Paulke-Korinek M, Kollaritsch H, Aberle SW, Zwazl I, Schmidle-Loss B, Vécsei A, et al. Sustained low hospitalization rates after four years of rotavirus mass vaccination in Austria. Vaccine. 2013;31(24):2686-91.  https://doi.org/10.1016/j.vaccine.2013.04.001  PMID: 23597718 
  41. Matthijnssens J, Bilcke J, Ciarlet M, Martella V, Bányai K, Rahman M, et al. Rotavirus disease and vaccination: impact on genotype diversity. Future Microbiol. 2009;4(10):1303-16.  https://doi.org/10.2217/fmb.09.96  PMID: 19995190 
  42. Sudarmo SM, Shigemura K, Athiyyah AF, Osawa K, Wardana OP, Darma A, et al. Genotyping and clinical factors in pediatric diarrhea caused by rotaviruses: one-year surveillance in Surabaya, Indonesia. Gut Pathog. 2015;7(1):3.  https://doi.org/10.1186/s13099-015-0048-2  PMID: 25793014 
  43. Cascio A, Vizzi E, Alaimo C, Arista S. Rotavirus gastroenteritis in Italian children: can severity of symptoms be related to the infecting virus? Clin Infect Dis. 2001;32(8):1126-32.  https://doi.org/10.1086/319744  PMID: 11283801 
  44. Matthijnssens J, Zeller M, Heylen E, De Coster S, Vercauteren J, Braeckman T, et al. RotaBel study group. Higher proportion of G2P[4] rotaviruses in vaccinated hospitalized cases compared with unvaccinated hospitalized cases, despite high vaccine effectiveness against heterotypic G2P[4] rotaviruses. Clin Microbiol Infect. 2014;20(10):O702-10.  https://doi.org/10.1111/1469-0691.12612  PMID: 24580887 
  45. Velázquez FR, Matson DO, Calva JJ, Guerrero L, Morrow AL, Carter-Campbell S, et al. Rotavirus infections in infants as protection against subsequent infections. N Engl J Med. 1996;335(14):1022-8.  https://doi.org/10.1056/NEJM199610033351404  PMID: 8793926 
  46. Paul A, Gladstone BP, Mukhopadhya I, Kang G. Rotavirus infections in a community based cohort in Vellore, India. Vaccine. 2014;32(Suppl 1):A49-54.  https://doi.org/10.1016/j.vaccine.2014.03.039  PMID: 25091680 

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