Burden of Rotavirus Disease & Impact of Rotavirus Vaccination

1. Burden of Rotavirus Disease & Impact of Rotavirus Vaccination TM Umesh D. Parashar, MBBS, MPH Lead, Viral Gastroenteritis Epidemiology Team Centers for Disease Control Prevention Atlanta, GA

2. Rotavirus is the Leading Cause Of Severe Gastroenteritis in Children <5 Years Developed Countries Developing Countries Unknown Rotavirus Unknown Rotavirus Other Bacterial Bacterial Other A. Kapikian, Fields Virology 2003

3. The face of rotavirus Diarrhea Vomiting Dehydration Shock Death

4. 20-60 Deaths 55-70,000 Hospitalizations 500,000 Outpatient visits 3.2 Million episodes Burden of Rotavirus in the US in 2006 Cost: $300 M medical; >$1 B total CDC, MMWR, 2006

5. Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children 1 dot = 250 deaths Parashar et al, JID, 2009

6. 2006 -- Phase 3 Trials of Two Rotavirus Vaccines • Trials of 60-70,000 infants • No increased risk of intussusception or other SAE • Efficacy of 85%-98% against severe disease Vesikari et al and Ruiz-Palacios et al, NEJM 2006

7. Countries in the Americas with Rotavirus Vaccine Programs Rotateq & Rotarix Rotarix only Rotateq only No program

8. Rotavirus Vaccines in USA • Feb 2006 – RotaTeq recommended • June 2008 – Rotarix recommended

9. National Rotavirus Laboratory Surveillance • Network of 67 laboratories reporting since 2000 • Weekly reporting: • # specimens tested for rotavirus • # positive tests

10. Total and Positive Rotavirus Tests, July 2000-Mar 2010 Vaccine introduced * 3-week moving averages Tate et al, Pediatrics 2009 and CDC unpublished data

11. Active Rotavirus Surveillance Payne et al, PAS 2009

12. Total AGE and Rotavirus AGE HospitalizationsNVSN, 2006-2008 6 % Rota+ 50 % Rota+ 45 % Rota+ National reduction of 45,000-62,000 hospitalizations in 2008

13. Age-Specific Rotavirus Hospitalization Rate Reduction and Vaccine Coverage, NVSN This age cohort was ineligible to receive rotavirus vaccine

14. Rotavirus Vaccination in El Salvador • October 2006 – Rotarix recommended

15. Reduction in Rotavirus Admissions in Children < 5 Years after Rotarix Introduction, El Salvador 70-80% reduction in rotavirus hospitalizations children < 5 years In press, BMJ, 2010

16. Richardson et al, NEJM 2010

17. Vaccine Introduction (May 2007) 2008 2009 Marked Decline in Childhood Diarrhea Deaths After Rotarix Introduction, Mexico

18. Winter Blunting of Diarrhea Deaths Suggests Effect Against Rotavirus

19. Global Distribution of 527,000 Annual Rotavirus Deaths in Young Children 1 dot = 250 deaths

20. Rotarix Trial in Malawi & So. Africa Madhi, S et al. NEJM 2010

21. 2006-2010 Incredible years for rotavirus vaccines!.... And great promise for the future!!

22. Acknowledgements