Rotavirus Vaccine and Health Care Utilization for Diarrhea in US Children
Rotavirus Vaccine and Health Care Utilization for Diarrhea in US Children
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DOI：
10.1056/nejmoa1000446
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发表时间：
2011-09-22
影响因子：
158.5
通讯作者：
Parashar, Umesh D.
中科院分区：
文献类型：
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作者：
Cortes, Jennifer E.;Curns, Aaron T.;Parashar, Umesh D.
美国婴儿常规接种五价轮状病毒疫苗(RV5)始于2006年。方法利用MarketScan数据库，我们评估了2007年7月至2009年6月与2001年7月至2006年6月5岁以下儿童的RV5覆盖率和腹泻相关医疗保健使用情况。我们将2008年和2009年1月至6月期间(轮状病毒最流行的时期)未接种疫苗的儿童中与腹泻相关的医疗保健使用率与预防疫苗使用率进行比较，以估计间接收益。结果截至2008年12月31日，73%的1岁以下儿童、%的1岁以下儿童和8%的2-4岁儿童至少接种了一剂RV5。在5岁以下儿童中，2001-2006年、2007-2008年和2008-2009年因腹泻住院的比率分别为每万人年52、35和39例，与2001-2006年相比，2007-2008年相对减少了33%(95%可信区间，31-35)，2008-2009年相对减少了25%(95%可信区间，23-27)；轮状病毒感染的特殊编码住院率分别为每万人年14例、4例和6例，2001-2006年和2008-2009年的发病率分别相对下降了75%(95%可信区间，72至77)和60%(95%可信区间，58至63)。2008年和2009年1-6月，与未接种儿童相比，接种疫苗儿童的相对下降率分别为：因腹泻住院，44%(95%CI，33~53)和58%(95%CI，52对)；轮状病毒编码住院，89%(95%CI，79~94)和89%(95%CI，84~93)；因腹泻急诊就诊，37%(95%CI，31~43)和48%(95%CI，44~51)；腹泻的门诊就诊率分别为9%(95%CI，6~11)和12%(95%CI，10~15)。间接受益(未接种疫苗的儿童)出现在2007-2008年，但没有出现在2008-2009年。在全国范围内，2007-2009年间，估计减少了64,855例住院治疗，节省了约2.78亿美元的治疗费用。结论自从轮状病毒疫苗推出以来，美国儿童与腹泻相关的医疗利用和医疗费用大幅下降。
BackgroundRoutine vaccination of U. S. infants with pentavalent rotavirus vaccine (RV5) began in 2006.MethodsUsing MarketScan databases, we assessed RV5 coverage and diarrhea-associated health care use from July 2007 through June 2009 versus July 2001 through June 2006 in children under 5 years of age. We compared the rates of diarrhea-associated health care use in unvaccinated children in the period from January through June (when rotavirus is most prevalent) in 2008 and 2009 with the prevaccine rates to estimate indirect benefits. We estimated national reductions in the number of hospitalizations for diarrhea, and associated costs, by extrapolation.ResultsBy December 31, 2008, at least one dose of RV5 had been administered in 73% of children under 1 year of age, 64% of children 1 year of age, and 8% of children 2 to 4 years of age. Among children under 5 years of age, rates of hospitalization for diarrhea in 2001-2006, 2007-2008, and 2008-2009 were 52, 35, and 39 cases per 10,000 person-years, respectively, for relative reductions from 2001-2006 by 33% (95% confidence interval [CI], 31 to 35) in 2007-2008 and by 25% (95% CI, 23 to 27) in 2008-2009; rates of hospitalization specifically coded for rotavirus infection were 14, 4, and 6 cases per 10,000 person-years, respectively, for relative reductions in the rate from 2001-2006 by 75% (95% CI, 72 to 77) in 2007-2008 and by 60% (95% CI, 58 to 63) in 2008-2009. In the January-June periods of 2008 and 2009, the respective relative rate reductions among vaccinated children as compared with unvaccinated children were as follows: hospitalization for diarrhea, 44% (95% CI, 33 to 53) and 58% (95% CI, 52 to 64); rotavirus-coded hospitalization, 89% (95% CI, 79 to 94) and 89% (95% CI, 84 to 93); emergency department visits for diarrhea, 37% (95% CI, 31 to 43) and 48% (95% CI, 44 to 51); and outpatient visits for diarrhea, 9% (95% CI, 6 to 11) and 12% (95% CI, 10 to 15). Indirect benefits (in unvaccinated children) were seen in 2007-2008 but not in 2008-2009. Nationally, for the 2007-2009 period, there was an estimated reduction of 64,855 hospitalizations, saving approximately $278 million in treatment costs.ConclusionsSince the introduction of rotavirus vaccine, diarrhea-associated health care utilization and medical expenditures for U. S. children have decreased substantially.