331. Potential Intussusception Risk versus Health Benefits from Rotavirus Vaccination in Latin America
Session: Poster Abstract Session: Challenges in Vaccinology and Vaccine Exploration
Friday, October 21, 2011
Room: Poster Hall B1
Background: With the recent post-licensure identification of an increased risk of intussusception with rotavirus vaccine, the 14 Latin American countries currently using rotavirus vaccine must now weigh the health benefits versus risks to assess whether to continue vaccination.

Methods: We estimated excess intussusception cases and mortality potentially caused by rotavirus vaccine for each of the 14 countries and compared these estimates to hospitalisations and deaths expected to be averted through vaccination.  We used regional rotavirus disease burden and rotavirus vaccine efficacy data, global natural intussusception, and country-specific DTP vaccination coverage rates to estimate rotavirus vaccine coverage rates.  We applied intussusception risk ratio estimates generated by a recent post-licensure study in Mexico and Brazil for week 1 after dose 1 (RR: 5.3, 95% CI: 3 – 9.3) and for week 1 after dose 2 (RR: 2.6, 95% CI: 1.3 – 5.2) to the baseline estimates.  We performed a probabilistic sensitivity analysis to account for uncertainty in these parameters.

Results: For an aggregate birth cohort of 9·5 million infants in these 14 countries, rotavirus vaccine would annually be expected to prevent 137,498 (123,369 – 148,548) hospitalisations and 2,523 (2,100 – 3,004) deaths due to rotavirus in their first five years of life, but could result in an additional 162 (107 – 254) hospitalisations and 10 (5 – 15) deaths due to intussusception, yielding benefit to risk ratios for hospitalisation and death of 846:1 (527:1 – 1,275:1) and 255:1 (166:1 – 506:1), respectively. 

Conclusion: The health benefits of vaccination far outweigh the short-term risks and support continued rotavirus vaccination in Latin America.


Subject Category: I. Adult and Pediatric Vaccines

Rishi Desai, MD, MPH1, Umesh D. Parashar, MBBS, MPH2, Ben A. Lopman, MSc, PhD2, Lucia Helena de Oliveria3, Andrew Clark, BA, MA4, Colin Sanderson, MA MSc PhD5, Jacqueline Tate, PhD2, Cuahtemoc Ruiz Matus3, Jon Andrus3 and Manish Patel, MD6, (1)Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Atlanta, GA, (3)Pan American Health Organization, Washington DC, DC, (4)London School of Hygiene and Tropical Medicine, London, United Kingdom, (5)London School of Hygiene and Tropical Medicine, London, United Kingdom, (6)National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

R. Desai, None

U. D. Parashar, None

B. A. Lopman, None

L. H. de Oliveria, None

A. Clark, None

C. Sanderson, None

J. Tate, None

C. R. Matus, None

J. Andrus, None

M. Patel, None

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