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    Hospital-based Surveillance to Evaluate the Impact of Rotavirus Vaccination in São Paulo, Brazil
    (Lippincott Williams & Wilkins, 2010-11-01) Palazzi Safadi, Marco Aurelio; Berezin, Eitan Naaman; Munford, Veridiana; Almeida, Flavia Jaqueline; Moraes, Jose Cassio de; Pinheiro, Cid Fernando; Racz, Maria Lucia; Universidade Federal de São Paulo (UNIFESP); Sao Luiz Hosp; Universidade de São Paulo (USP)
    Background: Brazil implemented routine immunization with the human rotavirus vaccine, Rotarix, in 2006 and vaccination coverage reached 81% in 2008 in São Paulo. Our aim was to assess the impact of immunization on the incidence of severe rotavirus acute gastroenteritis (AGE).Methods: We performed a 5-year (2004-2008) prospective surveillance at a sentinel hospital in São Paulo, with routine testing for rotavirus in all children less than 5 years of age hospitalized with AGE. Genotypes of positive samples were determined by reverse transcription polymerase chain reaction.Results: During the study, 655 children hospitalized with AGE were enrolled; of whom 169 (25.8%) were positive for rotavirus. in the post-vaccine period, a 59% reduction in the number of hospitalizations of rotavirus AGE and a 42.2% (95% confidence interval [CI], 18.6%-59.0%; P = 0.001) reduction in the proportion of rotavirus-positive results among children younger than 5 years were observed, with the greatest decline among infants (69.2%; 95% CI, 24.7%-87.4%; P = 0.004). Furthermore, the number of all-cause hospitalizations for AGE was reduced by 29% among children aged <5 years. the onset and peak incidences of rotavirus AGE occurred 3 months later in the 2007 and 2008 seasons compared with previous years. Genotype G2 accounted for 15%, 70%, and 100% of all cases identified, respectively, in 2006, 2007, and 2008.Conclusions: After vaccine implementation, a marked decline in rotavirus AGE hospitalizations was demonstrated among children younger than 5 years of age, with the greatest reduction in the age groups targeted for vaccination. the predominance of genotype G2P[4] highlights the need of continued postlicensure surveillance studies.