Impact of the national recommendation for routine rotavirus vaccination in infants and vaccine uptake in Germany, 2013-18

  • Vaccine preventable diseases
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Background:
Routine rotavirus (RV) vaccination for infants has been recommended in Germany since 08/2013 to reduce severe and nosocomial RV-gastroenteritis (RVGE) in under 5-year-olds. We aimed to assess vaccination coverage and determine the impact of the recommendation.

Methods:
We estimated vaccination coverage from 2014-2017 using statutory health-insurance prescription data (covering ~85% of the German population). We used RVGE-surveillance data of the German mandatory notification system stratified by epidemiological years (calendar-week 40 until the following year’s calendar-week 39) for impact assessment. We defined RVGE-associated hospitalizations of community-acquired RVGE as severe and RVGE-notifications with disease-onset of ≥2 days after hospitalization as nosocomial. We compared the time-period before RV-vaccine was utilized (2005/06-2007/08) with the period after the recommendation (2013/14-2017/18) and calculated incidence rate ratios (IRR) using Poisson regression. We analyzed hospital-discharge data (2006-2016) to determine the effect on intussusception using Wilcoxon rank-sum test.

Results:
Vaccination coverage/birth-cohort increased from 59% (2014) to 81% (2017). Incidences of RVGE-outpatient cases, severe RVGE, and nosocomial RVGE among under 5-year-olds decreased by 74% (IRR=0.26; 95%CI=0.26-0.27), 70% (IRR=0.30; 95%CI=0.30–0.31), and 70% (IRR=0.30; 95%CI=0.30–0.31), respectively. Incidence of RVGE-outpatient cases in age groups ineligible for RV-vaccination decreased by 38% (IRR 0.62; 95%CI=0.61-0.63).
The average number of intussusceptions in the 1st year of life decreased from 443 (range: 434-456) to 377 (range 369-384) (p=0.03), while at age of the 1st vaccine-dose (7th-12th week of age) the average number was 18 (range: 14-21) compared to 27 (range16-30) (p=0.16).

Conclusion:
Routine RV-vaccination in Germany is well accepted and coverage continues to increase. With reduction of RVGE in under 5-year-olds and developing herd immunity in non-vaccinated age groups, the recommendations’ objectives were reached. The decrease of intussusceptions in the 1st year of life suggests potential protection by RV-vaccination but further research is needed. Therefore routine RV-vaccination should be continued and vaccine uptake further increased to extent the positive effects.

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