A health surveillance data-based assessment of the impact of routine paediatric rotavirus vaccination on all-cause acute childhood diarrhoea

Abstract

Background: To improve the fight against faecal-orally transmitted rotavirus infection, which is the leading cause of severe diarrhoea among children aged < 5 years, Ghana has incorporated rotavirus vaccination into its expanded programme of immunization. Rotavirus diarrhoea constitutes a significant portion of all-cause acute childhood diarrhoea (ACD) in children. Objective: This study was designed to investigate the impact of routine rotavirus vaccination on ACD cases. Methods: The study was completed through a cross-sectional review of health institutional childhood diarrhoea surveillance data from 2012 to 2021, which includes the year when rotavirus vaccination was introduced. The study dataset was abstracted from the DHIMS-2 internet-based health data repository and was descriptively analyzed by administrative regions using Epi InfoTM version 3.5.1(CDC, USA). Results: The burden of ACD in terms of both absolute and mean values remained the lowest among infants aged under 28 days across all regions, as they had not yet received rotavirus vaccination. In contrast, children aged 1 to 4 years, who are typically exposed to rotavirus serotypes 1 and 2, consistently experienced the highest burden of ACD. With increasing rotavirus vaccination coverage, children aged 1 month to 4 years recorded a marginal, but sustained decline in mean ACD cases from 2016 to 2021. The ACD also similarly declined slowly among the rotavirus vaccine naïve infants aged < 28 days. Despite a spike in 2017, the burden of ACD was low in the Ahafo administrative region. However, increasing rotavirus vaccination coverage did not appear to have a significant impact on reducing ACD in the Ashanti, Bono, Bono East, Eastern, and Northeast administrative regions. From 2012 to 2021, the Central, Greater Accra, Oti, Upper East, Volta, and Western administrative regions recorded a marginal decline in the burden of ACD among children aged 1 to 4 years, and this was accompanied by an increase in rotavirus vaccination coverage. The ACD cases rose as rotavirus vaccination coverage decreased in the Western North Region between 2015 and 2019. Conclusion: Routine rotavirus vaccination may have contributed to a reduction in severe childhood ACD cases even though this study cannot exclude the impact of other anti-diarrhoeal interventions. To evaluate the population effectiveness of rotavirus vaccines, it is recommended to widely promote routine rotavirus disease surveys, which can be nested within ACD surveillance.