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. Rotavirus is the Leading Cause Of Severe
Gastroenteritis in Children <5 Years
Developed Countries Developing Countries
Unknown Unknown Rotavirus
Rotavirus
Other
Bacterial
Other Bacterial
A. Kapikian, Fields Virology 2003 2

3. The face of rotavirus
Diarrhea
Vomiting
Dehydration
Shock
Death

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
4
CDC, MMWR, 2006

5. Global Distribution of 527,000 Annual
Rotavirus Deaths in Young Children
1 dot = 250 deaths 5
Parashar et al, JID, 2009

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
6
Vesikari et al and Ruiz-Palacios et al, NEJM 2006

7. Countries in the Americas with Rotavirus Vaccine Programs
Rotateq & Rotarix
Rotarix only
Rotateq only
No program

8. Rotavirus Vaccines in USA
• Feb 2006 – RotaTeq recommended
• June 2008 – Rotarix recommended
8

9. National Rotavirus Laboratory Surveillance
• Network of 67 laboratories
reporting since 2000
• Weekly reporting:
– # specimens tested for rotavirus
– # positive tests

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
500
Number
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Tate et al, Pediatrics 2009 and CDC unpublished data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. Active Rotavirus Surveillance
Payne et al, PAS 2009 11

12. Total AGE and Rotavirus AGE Hospitalizations
NVSN, 2006-2008
Total AGE Rotavirus
200 181 179
180
160
139
Number 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. 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. Rotavirus Vaccination in El Salvador
• October 2006 – Rotarix recommended
14

15. Reduction in Rotavirus Admissions in Children < 5
Years after Rotarix Introduction, El Salvador
Vaccination (October, 2006)
2500 Total diarrhoea cases
2274
Rotavirus positive cases
Number of hospitalizations
2000
1771
1500
1092 1117 1066
1000 863
500 342
171
0
2006 2007 2008 2009
Surveillance year
70-80% reduction in rotavirus hospitalizations children < 5 years
15
In press, BMJ, 2010

16. 16
Richardson et al, NEJM 2010

17. Marked Decline in Childhood Diarrhea
Deaths After Rotarix Introduction, Mexico
Vaccine Introduction
250 Age ≤11 months (May 2007)
Age 12-23 months
Age 24-59 months
200 2008
Number of diarrhea deaths
2009
150
100
50
0
Month-Year
17

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
160
No. 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. Global Distribution of 527,000 Annual
Rotavirus Deaths in Young Children
1 dot = 250 deaths 19

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
20
Madhi, S et al. NEJM 2010

21. 2006-2010
Incredible years for rotavirus vaccines!....
And great promise for the future!!
21

22. Acknowledgements
22