Elsevier

Vaccine

Volume 28, Issue 18, 19 April 2010, Pages 3118-3126
Vaccine

Modelling the seasonality of rotavirus disease and the impact of vaccination in England and Wales

https://doi.org/10.1016/j.vaccine.2010.02.060Get rights and content

Abstract

Two rotavirus vaccines are currently recommended for inclusion in routine childhood immunization programmes. We developed a deterministic age-structured model of rotavirus transmission and disease to investigate the population-level effects of vaccination in England and Wales. The model explicitly captures the natural history of infection and uses realistic population mixing patterns. The model accurately reproduces the strong seasonal pattern and age distribution of rotavirus disease observed in England and Wales. We predict vaccination will provide both direct and indirect protection within the population. If coverage levels comparable to other childhood vaccines are achieved, we predict that vaccination will reduce rotavirus disease incidence by 61% resulting in a potential fall in burden on health-care services.

Introduction

Rotavirus is the most common cause of acute gastroenteritis in children under 5 years of age [1]. In developed countries, rotavirus gastroenteritis remains a common cause of hospitalization at great cost to health services [2]. In England and Wales, the annual incidence of rotavirus hospitalizations is estimated at 4.5 per 1000 children under the age of 5 years and the cost to the National Health Service estimated to be GBP 14.2 million per year [3].

The second generation of live oral rotavirus vaccines have demonstrated safety and efficacy [4], [5] and are increasingly being used routinely as part of childhood immunization schedules in a number of middle and high income countries [6], [7]. The Rotarix vaccine, made from the most common human serotype G1P1A[8], is recommended by WHO as a two-dose schedule to be given at two and four months of age [8]. RotaTeq, a pentavalent vaccine developed from a bovine rotavirus strain and combined with reassorted strains of human serotypes G1, G2, G3, G4 and P1A[8], is WHO-recommended as a three-dose schedule to be given at two, four and six months of age [8]. In the United States, following the introduction of RotaTeq in 2006, there was a delay in the timing of peak incidence in the 2007–2008 season by two to four months and fewer cases overall compared to previous years [6]. This provides the first indication, post-licensure, that rotavirus vaccination reduces the burden of rotavirus disease in a large population and suggests that vaccination may also have an impact on transmission. Other high and middle income countries which have introduced rotavirus vaccination have shown similar effects [7], [9]. In England and Wales, the introduction of rotavirus vaccination is currently under consideration.

This study aims to develop a dynamic model of rotavirus transmission, and apply it to daily case reports of rotavirus disease from England and Wales. Using this model, we examine the potential epidemiological impact of a rotavirus mass vaccination programme.

Section snippets

Key features of rotavirus epidemiology captured in the model

In temperate countries, most rotavirus disease occurs in late winter or early spring [10]. Rotavirus groups A to C infect humans, and all groups (A to G) infect animals, but animals are not believed to play a role in the transmission to humans [11]. Globally, disease in children is caused predominantly by group A [11]. The virus is transmitted by the faeco-oral route; from person to person directly or via contaminated fomites, food or water [12]. Peak incidence of clinical disease is 6–24

Model fit

Parameters estimated from our model are summarised in Table 2. The force of infection was highest in the 1–4 year olds and lowest in over 5 year olds. The seasonality, age distribution and numbers of reported rotavirus cases predicted by the model were a good fit to the rotavirus surveillance data (Fig. 2, Fig. 3).

Impact of vaccination

An increasing decline in numbers and delay in the start of the rotavirus season is predicted in the first and second post-vaccination years (Fig. 4). Interestingly, there is a slight

Discussion

We found that rotavirus disease patterns in England and Wales can be modelled well by a dynamic model of rotavirus transmission which takes into account the natural history of rotavirus infections. The model reproduces the regular seasonal pattern of rotavirus gastroenteritis and the age distribution of cases seen. Vaccination is expected to reduce the observed seasonal peak in rotavirus disease incidence and reduce the overall burden of disease.

Model fit was obtained by using a cosine function

Acknowledgements

This work was supported by a grant from the Medical Research Council to Dr Atchison. The funding body had no role in the design, conduct, analysis or reporting of the study. The views and opinions expressed in this paper do not necessarily reflect those of the funding body.

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