Acute gastroenteritis hospitalizations in Estonia after implementation of universal mass vaccination against rotavirus

Abstract

Äge gastroenteriit (AGE) on globaalselt alla 5-aastaste laste hulgas viies peamine surmapõhjus, moodustades selles vanuserühmas 8,9% surmajuhtumitest. Alates 1990. aastast on Maailma Terviseorganisatsioon keskendunud AGE haiguskoormuse ja suremuse vähendamisele, mille oluliseks verstapostiks oli rotaviirusvaktsiini kasutuselevõtt 2006. aastal. 2024. aastaks oli 123 riiki, sealhulgas Eesti alates 2014. aasta juulist, lisanud vaktsiini oma riiklikusse vaktsineerimiskavasse. Käesoleva uurimistöö eesmärgiks oli kirjeldada haiglaravi vajava AGE epidemioloogiat 0-18 aastastel lastel Eestis enne (2007-2013) ja pärast (2015-2018) rotaviirusvaktsiini lisamist immuniseerimiskavasse. Uuringu tulemused näitasid, et vaktsineerimisprogrammi rakendamisele järgnes rotaviiruse (RV) hooaegade aktiivsuse langus ning rotaviirusliku gastroenteriidi (RVGE) ja AGE hospitaliseerimise vähenemine vastavalt 55% (95% CI 53-57) ja 19% (95% CI 17–21). Suurim efekt oli näha alla 1 ja 1-4 aastaste laste hulgas; AGE hospitaliseerimine vähenes vastavalt 31% (95% CI 27–35) ja 25% (95% CI 22–27) ning RVGE vastavalt 81% (95% CI 77–84) ja 55% (95% CI 52–58). Lisaks vähenes hospitaliseeritute haiguse raskusaste ja haiglaravi kestus. Sarnaselt teistele riikidele suurenes nororviirusliku ja adenoviirusliku gastroenteriidiga patsientide hospitaliseerimise määr, mis võib olla seotud viiruste aktiivsema levikuga teatud aastate järel, nagu nororviiruse puhul varasemalt on teada. Uuringus teostatud viiruste genotüpiseerimine kinnitas, et Eestis ringlesid uuringuperioodil peamiselt samad rota- ja noroviiruse genotüübid kui mujal Euroopas, mis toetab ühtsete üle-euroopaliste vaktsineerimisprogrammide rakendamist ka tulevikus.

Acute gastroenteritis (AGE) is a major global health issue affecting people of all ages. In 2016 globally it was estimated to be the fifth leading cause of death among children under the age of 5 years, being responsible for 8.9% of deaths in this age group. Since 1990 efforts have been made by the World Health Organization to reduce disease burden and mortality. Rotavirus (RV) vaccine launch in 2006 was an important milestone in altering global AGE burden. As of 2024, 123 countries, including Estonia in 2014 July, have included RV vaccine into their national immunization schedule. The aim of the research was to describe the epidemiology of AGE in hospitalized patients aged 0-18 years before (2007-2013) and after (2015-2018) the introduction of the national immunization program in Estonia. Our study showed that after the implementation of vaccination program the overall hospitalization rates for AGE and rotavirus gastroenteritis (RVGE) declined by 19% (95% CI 17–21) and 55% (95% CI 53-57), respectively. The most significant impact was seen in children under 1 year and those aged 1-4: AGE hospitalization rates decreased by 31% (95% CI 27-35) and 25% (95% CI 22-27), respectively, while RVGE hospitalization rates decreased by 81% (95% CI 77-84) and 55% (95% CI 52-58), respectively. We also saw a decreasing trend in the severity and duration of AGE hospitalizations. Similarly to other countries, there was an increase in the hospitalization rate for norovirus (NoV) and adenovirus gastroenteritis. However, interpreting the data one must acknowledge previously known fact that every two to three years there are high activity NoV seasons when after low activity seasons susceptible population increases leading to wider transmission of the virus. The virus genotyping performed in the study confirmed that same RV and NoV genotypes circulated in Estonia as in other parts of Europe supporting the implementation of unified pan-European vaccination programs in the future.