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The introduction of the rotavirus vaccine in July 2013 has reduced rates of infectious diarrhoea (acute gastroenteritis) in children up to five years by 15%, with a 41% reduction during February to April, when rotavirus incidence is traditionally high.
This NIHR-funded study used time series data to calculate the fall in infectious diarrhoea episodes after the introduction of the vaccine. The resulting reduced contact with the NHS was estimated to have saved the NHS in England £12.5 million from July 2013 to June 2014. Savings were calculated from data collected in GP surgeries, hospitals and emergency departments. Two thirds of the savings came from reduced hospitalisation costs.
Vaccine coverage is good, at around 90%, but is lower in some geographic locations and ethnic groups. Future work is needed to understand why uptake is not higher. However, these preliminary findings suggest that the vaccination programme has successfully reduced burden on the NHS across both primary and secondary care settings.
Why was this study needed?
Rotavirus is the most common cause of infectious diarrhoea in children. Nearly every child will have at least one episode of rotavirus by five years of age. The virus typically strikes babies and young children, causing diarrhoea and sometimes vomiting, stomach ache and fever. Most children recover at home within a few days, but nearly one in five will need to see their doctor, and one in 10 of these end up in hospital as a result of complications. A very small number of children die from rotavirus infection each year.
In July 2013, the NHS introduced a childhood vaccination programme against rotavirus infection. The aim of this study was to investigate the reduction in incidence of infectious diarrhoea in children for the two years after the introduction of the vaccine, and calculate the likely healthcare savings due to reduced number of visits to NHS facilities.
What did this study do?
The researchers used routinely collected NHS contact data from the Clinical Practice Research Datalink database, Hospital Episode Statistics and the Emergency Department Syndromic Surveillance System. They recorded the number of infectious diarrhoea episodes per month for children up to five years of age pre-vaccination were taken from July 2008 to June 2013, and post vaccination from July 2013 to April 2015.
Monthly incidence rates were modelled using age-stratified time series. Costs per visit were calculated from a number of NHS data sources from GP surgeries, hospitals and emergency departments.
The authors used reasonable assumptions in their model and corrected for other possible factors that might have impacted on the incidence of childhood infectious diarrhoea, such as temperature and rainfall.
What did it find?
- Rates of infectious diarrhoea in children up to five years fell by 15% overall in the two years following introduction of the vaccine (adjusted Incidence Rate Ratio [IRRa] 0.85, 95% confidence interval [CI] 0.76 to 0.95). The greatest reduction of 41% was seen between February to April, when rotavirus incidence is traditionally high (IRRa 0.59, 95% CI 0.53 to 0.66).
- The reduced number of healthcare visits of children up to five years because of this fall in incidence of infectious diarrhoea was estimated to have saved the NHS in England £12.5 million from July 2013 to June 2014.
- Savings came from reduced numbers of visits to GPs (64,457 fewer visits, savings of £2.7 million), hospitals (12,683 fewer visits, £8.5 million savings), and emergency departments (10,236 fewer visits, £1.2 million savings).
- Incidence rates of infectious diarrhoea in older children and to a lesser extent in adults also fell, indicating herd immunity. This is an indirect effect where if a high proportion of the population is vaccinated, it is harder for the disease to spread.
What does current guidance say on this issue?
Guidance in Public Health England’s Green Book 2015 states that the oral vaccine (Rotarix) should be provided in two doses. The first vaccine dose of 1.5 ml of Rotarix should be swallowed at two months (approximately eight weeks) of age, with the second dose of 1.5 ml at least four weeks after the first dose.
Rotavirus vaccine can be given at the same time as the other vaccines administered as part of the routine NHS childhood immunisation programme, including BCG, and so should ideally be given at the scheduled two month and three month vaccination visits.
What are the implications?
The winter of 2013/14 was mild and wet, and so rates were likely to be lower, as witnessed for example in the Netherlands where there is no vaccine. However, the reduced incidence of diarrhoea was sustained in England the following year, while it rose in the Netherlands, suggesting that reduced rates were due to the vaccine.
Over the first 14 months of the programme, rotavirus vaccine coverage for children averaged 93.3% for one dose and 88.3% for two doses. Coverage is lower in some locations and ethnic groups, and these inequalities could be investigated further.
Citation and Funding
Thomas SL, Walker JL, Fenty J, et al. Impact of the national rotavirus vaccination programme on acute gastroenteritis in England and associated costs averted. Vaccine. 2017 23;35(4):680-686.
This project was funded by the National Institute for Health Research Protection Research Unit (NIHR HPRU) in partnership with Public Health England
Bibliography
NHS Choices. Rotavirus vaccine. London: NHS Choices; 2015.
Public Health England. Green Book (Immunisation against infectious disease). Chapter 27b. Rotavirus. London: Department of Health; 2015.
Public Health England. Rotavirus infant immunisation programme 2014/15: Vaccine uptake report on the temporary sentinel data collection for England. London: Public Health England; 2015.
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