627. Gastroenteritis-related Nurse Triage Calls for Young Children Following Introduction of Rotavirus Vaccine
Session: Poster Abstract Session: Pediatric Vaccines
Friday, October 21, 2011
Room: Poster Hall B1

Background:  Rotavirus vaccine has resulted in substantial declines in gastroenteritis (GE) hospitalizations among young children in the United States; the impact on non-severe disease is less clear.  Our objective was to assess the relationship between rotavirus vaccine uptake and nurse triage call volume for GE-related complaints among young children.

Methods:  We utilized data from Vanderbilt's Telephone Triage system from May 2004-April 2010, a 24-hour electronic nurse triage system which provides support for pediatric practices in Middle Tennessee.  We included all triage calls for children <6 years old from 30 practices consistently reporting over the study period.  Calls with a chief complaint of vomiting and/or diarrhea were considered GE calls.  Weekly call volumes were calculated for GE and total calls; the ratio of GE to non-GE calls was the outcome variable.  Generalized linear models (controlling for calendar month) were used to compare call ratios before rotavirus vaccine licensure (May 2004-April 2007) and after (May 2007- April 2010), overall and stratified by GE season (GE season: November to April; non-GE season: May-October).  Monthly call ratios were also compared between pre- and post-vaccine eras.  Vaccine uptake was determined through ongoing CDC-funded surveillance in Davidson Co., TN.

Results:  There were 84,558 calls during the study period, including 12,791 GE calls (15.1%) (Figure 1). Compared with the pre-vaccine era, the ratio of GE to non-GE calls decreased by 7% in 2007-08 (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.87-0.99); 9% in 2008-2009 (OR 0.91, CI=0.83-0.99); and 18% in 2009-2010 (OR 0.82, CI=0.75-0.89).  Declines during the post-vaccine era were limited to the GE season (overall decrease of 17% [OR 0.83, CI=0.76-0.91]), and were most significant during the months of March (37% decline [OR 0.63, CI=0.49-0.82]) and April (32% decline [OR 0.68, CI=0.57-0.82]).

Conclusion:  GE call volumes declined during the post-vaccination era and the decline was pronounced during the traditional rotavirus season.  This suggests rotavirus vaccine decreased the burden of mild GE in the community. These results also highlight the potential of a novel method for disease surveillance.

Subject Category: P. Pediatric and perinatal infections

Derek J. Williams, MD, MPH1, Kathryn Edwards, MD, FIDSA1, Daniel Payne, PhD, MSPH2, Judith Manning, RN1, Yuwei Zhu, MD, MS1, Umesh D. Parashar, MBBS, MPH2 and Ben A. Lopman, MSc, PhD2, (1)Vanderbilt University School of Medicine, Nashville, TN, (2)Centers for Disease Control and Prevention, Atlanta, GA


D. J. Williams, None

K. Edwards, None

D. Payne, None

J. Manning, None

Y. Zhu, None

U. D. Parashar, None

B. A. Lopman, None

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