Anticipating rotavirus vaccines – a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13

BMC Public Health, Jan 2015

Background Libya introduced rotavirus vaccine in October 2013. We examined pre-vaccine incidence of rotavirus hospitalizations and associated economic burden among children < 5 years in Libya to provide baseline data for future vaccine impact evaluations. Methods Prospective, hospital-based active surveillance for rotavirus was conducted at three public hospitals in two cities during August 2012 - April 2013. Clinical, demographic and estimated cost data were collected from children <5 hospitalized for diarrhea; stool specimens were tested for rotavirus with a commercial enzyme immunoassay. Annual rotavirus hospitalization incidence rate estimates included a conservative estimate based on the number of cases recorded during the nine months and an extrapolation to estimate 12 months incidence rate. National rotavirus disease and economic burden were estimated by extrapolating incidence and cost data to the national population of children aged <5 years. Results A total of 410 children <5 years of age with diarrhea were enrolled, of whom 239 (58%) tested positive rotavirus, yielding an incidence range of 418-557 rotavirus hospitalizations per 100,000 children <5 years of age. Most (86%) rotavirus cases were below two years of age with a distinct seasonal peak in winter (December-March) months. The total cost of treatment for each rotavirus patient was estimated at US$ 679 (range: 200–5,423). By extrapolation, we estimated 2,948 rotavirus hospitalizations occur each year in Libyan children <5 years of age, incurring total costs of US$ 2,001,662 (range: 1,931,726-2,094,005). Conclusions Rotavirus incurs substantial morbidity and economic burden in Libya, highlighting the potential value of vaccination of Libyan children against rotavirus.

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Anticipating rotavirus vaccines – a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13

Alkoshi et al. BMC Public Health Anticipating rotavirus vaccines - a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13 Salem Alkoshi 0 1 Eyal Leshem 2 Umesh D Parashar 2 Maznah Dahlui 1 0 17-4 pangasapuri permai putera , Jalan 13D, Desa Permai, Taman Dato, Ahmed Razali, 68000 Ampang Selangor , Malaysia 1 Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya , Kuala Lumpur , Malaysia 2 National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia , USA Background: Libya introduced rotavirus vaccine in October 2013. We examined pre-vaccine incidence of rotavirus hospitalizations and associated economic burden among children < 5 years in Libya to provide baseline data for future vaccine impact evaluations. Methods: Prospective, hospital-based active surveillance for rotavirus was conducted at three public hospitals in two cities during August 2012 - April 2013. Clinical, demographic and estimated cost data were collected from children <5 hospitalized for diarrhea; stool specimens were tested for rotavirus with a commercial enzyme immunoassay. Annual rotavirus hospitalization incidence rate estimates included a conservative estimate based on the number of cases recorded during the nine months and an extrapolation to estimate 12 months incidence rate. National rotavirus disease and economic burden were estimated by extrapolating incidence and cost data to the national population of children aged <5 years. Results: A total of 410 children <5 years of age with diarrhea were enrolled, of whom 239 (58%) tested positive rotavirus, yielding an incidence range of 418-557 rotavirus hospitalizations per 100,000 children <5 years of age. Most (86%) rotavirus cases were below two years of age with a distinct seasonal peak in winter (December-March) months. The total cost of treatment for each rotavirus patient was estimated at US$ 679 (range: 200-5,423). By extrapolation, we estimated 2,948 rotavirus hospitalizations occur each year in Libyan children <5 years of age, incurring total costs of US$ 2,001,662 (range: 1,931,726-2,094,005). Conclusions: Rotavirus incurs substantial morbidity and economic burden in Libya, highlighting the potential value of vaccination of Libyan children against rotavirus. Diarrhea; Rotavirus; Hospitalization; Incidence rate; Treatment cost; Libya - Background Rotavirus is a major cause of severe diarrhea and hospitalization among children aged < 5 years worldwide. In 2008, globally rotavirus caused an estimated 453,000 deaths among children in this age group [1]; more than half of these deaths occurred in sub-Saharan Africa. In Libya, health service facilities in Libya are publicly owned and managed by the Ministry of Health. Public hospitals provide preventive and curative treatment to all citizens free of charge. While the Libyan government encourages the expansion of private health, private facilities have insufficient infrastructure to provide a full treatment service to severe diarrhea patients such as admission for intravenous fluid (IVF). Rotavirus disease accounted for 24 – 45% of diarrheal hospitalizations among children <5 during the period 1980-2009 [2,3]. The economic burden of rotavirus infections includes hospital costs, as well as indirect costs incurred by the society [4,5]. The World Health Organization (WHO) Strategic Advisory Committee on Immunization (SAGE) recommended adding rotavirus vaccine to all national immunization programmes, especially where the mortality rate of diarrhea affected up approximately 10% among children aged below 5 years [6-9]. Two live attenuated vaccines have been approved for global use: RotaTeq (RV5, Merck, Whitehouse Station, NJ, USA) is a pentavalent (G1, G2, G3, G4, P[8]) human-bovine reassortant vaccine and Rotarix (RV1, GlaxoSmithKline Biologicals, Rixensart, Belgium) is a monovalent (G1P[8]) vaccine derived from an attenuated human strain [10,11]. RotaTeq is administered at 2nd, 4th and 6th months of age, while Rotarix is administered at 2nd and 4th months of age. In 2009, the World Health Organization recommended the inclusion of rotavirus vaccine in the national immunization programs of all countries globally and particularly in those countries with high child mortality due to diarrhea [12]. In Libya, a live attenuated pentavalent vaccine based on a human rotavirus strain (RV5; RotaTeq™, Merck & Co. Inc., West Point, PA, USA) was introduced during October 1, 2013. In February 2011, ongoing rotavirus surveillance activities in Libya were interrupted due to civil unrest. Our objective was to re-establish rotavirus surveillance to provide up-to-date estimates of the baseline pre-vaccine incidence of rotavirus hospitalizations among children aged < 5 years, and economic burden, in order to allow vaccine impact evaluations in the future. Methods Study design and (...truncated)


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Salem Alkoshi, Eyal Leshem, Umesh D Parashar, Maznah Dahlui. Anticipating rotavirus vaccines – a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13, BMC Public Health, 2015, pp. 26, 15, DOI: 10.1186/s12889-015-1400-7