Real-World Effectiveness of Pentavalent Rotavirus Vaccine Among Bedouin and Jewish Children in Southern Israel

• Published in: Clinical infectious diseases 2016-05, Vol.62 (suppl 2), p.S155-S160
• Main Authors: Leshem, Eyal, Givon-Lavi, Noga, Tate, Jacqueline E., Greenberg, David, Parashar, Umesh D., Dagan, Ron
• Format: Article
• Language: English
• Subjects: Arabs; Bedouins; Child, Preschool; Children & youth; EAST EUROPE/CENTRAL ASIA; Effectiveness; Emergency Service, Hospital; Feces - virology; Female; Gastroenteritis - epidemiology; Gastroenteritis - ethnology; Gastroenteritis - prevention & control; Gastroenteritis - virology; Genotype; Hospitalization; Humans; Immunization Programs; Immunogenicity, Vaccine; Infant; Israel - epidemiology; Jewish people; Jews; Male; Rotavirus; Rotavirus - immunology; Rotavirus Infections - epidemiology; Rotavirus Infections - ethnology; Rotavirus Infections - prevention & control; Rotavirus Infections - virology; Rotavirus Vaccines - administration & dosage; Rotavirus Vaccines - immunology; Vaccination - statistics & numerical data; Vaccine Potency; Vaccines; Vaccines, Attenuated - administration & dosage; Vaccines, Attenuated - immunology; Viruses
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/civ1012

Background. Pentavalent rotavirus vaccine (RV5) was introduced into the Israeli National Immunization Program in January 2011. We determined RV5 vaccine effectiveness (VE) in southern Israel, a region characterized by 2 distinct populations: Bedouins living in a low- to middle-income, semirural setting, and Jews living in a high-income, urban setting. Methods. We enrolled vaccine-eligible children who visited the emergency department (ED) or were hospitalized due to acute gastroenteritis (AGE) during the first 3 rotavirus seasons after RV5 vaccine introduction (2011–2013). Fecal specimens were tested for rotavirus by enzyme immunoassay and genotyped. Vaccination among laboratory-confirmed rotavirus cases was compared with rotavirus-negative AGE controls. Regression models were used to calculate VE estimates by age, clinical setting, and ethnicity. Results. Of 515 enrolled patients, 359 (70%) were Bedouin. Overall, 185 (36%) patients were rotavirus positive; 79 of 119 (66%) were G1P[8] genotype. The adjusted VE for a full 3-dose course of RV5 against ED visit or hospitalization was 63% (95% confidence interval [CI], 38%–78%). RV5 provided G1P[8] genotype-specific effectiveness of 78% (95% CI, 58%–88%). By age, RV5 VE was 64% (95% CI, 21%–84%) and 71% (95% CI, 39%–86%) among children aged 6–11 months and 12–23 months, respectively. By clinical setting, RV5 VE was 59% (95% CI, 23%–78%) against hospitalization, and 67% (95% CI, 11%–88%) against ED visit. The adjusted VE of a full RV5 course among Bedouin children was 62% (95% CI, 29%–79%). Conclusions. RV5 significantly protected against rotavirus-associated ED visits and hospitalizations in a diverse population of vaccine-eligible children living in southern Israel.