Abstract:
Background: Dehydration secondary to diarrhoea is a major cause of
hospitalization and mortality in children aged less than five years. Most diarrhoea
cases in childhood are caused by rotavirus, and routine introduction of rotavirus
vaccine is expected to reduce the incidence and severity of dehydration
secondary to diarrhoea in vaccinated infants. Previously, studies have examined
changes in admissions with stools positive for rotavirus but this study reports on
all admissions with dehydration secondary to diarrhoea regardless of stool
rotavirus results. We aimed to assess the changes in all-cause severe diarrhoea
and dehydration (DAD) admissions following the vaccine’s introduction.
Methods: We examined changes in admissions of all clinical cases of DAD before
and after introduction of routine vaccination with rotavirus vaccine in July 2014 in
Kenya. We use data from 13 public hospitals currently involved in a clinical
network, the Clinical
Information Network (CIN). Routinely collected data for children aged 2-36
months were examined. We used a segmented mixed effects model to assess
changes in the burden of diarrhoea and dehydration after introduction of
rotavirus vaccine. For sensitivity analysis, we examined trends for non-febrile
admissions (surgical or burns). Results: There were 17,708 patients classified as
having both diarrhoea and dehydration. Average monthly admissions due to DAD
for each hospital before vaccine introduction (July 2014) was 35 (standard
deviation: ±22) and 17 (standard deviation: ±12) after vaccine introduction.
Segmented mixed effects regression model showed there was a 33% (95% CI,
30% to 38%) decrease in DAD admissions immediately after the vaccine was
introduced to the Kenya
