Does rota vaccine reduce attacks of acute gastroenteritis among children under 15 months of age?

Does rota vaccine reduce attacks of acute gastroenteritis among children under 15 months of age?
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This study aimed to evaluate the effect of rotavirus vaccine in reducing the attacks of acute gastroenteritis among children between (2-15) months of age. A cross-sectional study was carried out at the Central Teaching Hospital of Pediatrics in Baghdad, Iraq, from 1st of July to 31st of December 2013.

Nội dung Text: Does rota vaccine reduce attacks of acute gastroenteritis among children under 15 months of age?

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 10 (2017) pp. 1178-1184 Journal homepage: Original Research Article Does Rota Vaccine Reduce Attacks of Acute Gastroenteritis among Children Under 15 Months of Age? Rabab Hassan Baaker1*, Ban Adil Alkaaby2 and Shurooq Talib Sadoon3 1 CABP, Department of Pediatrics, College of Medicine, Al-Mustansiryah University, Iraq 2 MRCPCH, FICMS, Department of Pediatrics, College of Medicine, Al-Mustansiryah University, Iraq 3 FICMS-Ped., Central Teaching Hospital, Iraq *Corresponding author ABSTRACT This study aimed to evaluate the effect of rotavirus vaccine in reducing the attacks of acute gastroenteritis among children between (2-15) months of age. A cross-sectional study was carried out at the Central Teaching Hospital of Pediatrics in Baghdad, Iraq, from 1 st of July Keywords to 31st of December 2013. 1240 patients, grouped into two groups, (618) vaccinated and Rota vaccine, Acute (622) unvaccinated group with Rota virus vaccine, aged from >2-15 months. They were gastroenteritis, attending the Hospital for different reasons. Data collected about sex, age, type of feeding, Diarrhoea in Rota virus vaccination status, the past medical history of acute watery diarrhea, and a children. number of attacks that need hospitalization. In the studied sample about 40% of the Article Info vaccinated group reported a past medical history of acute gastroenteritis, compared to more than three quarters in the unvaccinated group. The need to hospital admission was Accepted: reduced noticeably from 64.3% in the unvaccinated group to 37.2% in the vaccinated 10 September 2017 group. It was shown that children less than one year were more protected than older age Available Online: group. However, gender, type of feeding did not show a significant effect on the frequency 10 October 2017 of gastroenteritis in both groups studied. In conclusion, The rota virus vaccination is effective in reducing the attacks and the severity of gastroenteritis among children under 15 months of age. Introduction Rotavirus is the most common cause of severe Rotavirus appears to be responsible for gastroenteritis in infants and young children. approximately 5%-10% of all diarrheal Worldwide, rotavirus is a major cause of episodes among children aged less than 5 childhood death. The spectrum of rotavirus years, and for a much higher proportion of illness ranges from mild, watery diarrhea of severe diarrheal episodes. Although rotavirus limited duration to severe, dehydrating gastroenteritis results in relatively few deaths, diarrhea with vomiting and fever, which it accounts for more than 500,000 physician results in death. Virtually all children become visitsand approximately 50,000 infected in the first 3-5 years of life, but hospitalizations each year among children severe diarrhoea and dehydration occur aged less than 5 years. Rotavirus is primarily among children aged 3-35 months1 responsible for 30%-50% of all 1178

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 hospitalizations for diarrheal disease among children aged less than 5 years, and more than Patients and Methods 50% of hospitalizations for diarrheal disease during the seasonal peaks. Among children A cross-sectional study was carried out at the aged less than 5 years, 72% of rotavirus Central Teaching Hospital of Pediatrics in hospitalizations occur during the first 2 years Baghdad, over a period of 6 months, from 1st of life, and 90% occur by age 3 years, and one of July to 31st of December 2013. in 200,000 will die from rotavirus diarrhoea (2) . A total of (1240) patients aged above 2 months till 15 months [(646) male, and (594) Several reasons exist to adopt immunization female], who were attending the outpatient for of infants as the primary public health any simple illness, attended our vaccination intervention to prevent rotavirus disease. department or admitted the hospital for acute illnesses, were studied. First, similar rates of illness among children in industrialized and less developed countries All those patients were asked about sex, age, indicate that clean water supplies and good type of feeding, vaccination state, past hygiene have not decreased the incidence of medical history of watery diarrhea, and rotavirus diarrhea in developed countries, so numbers of admission because of acute further improvements in water or hygiene are gastroenteritis. unlikely to have a substantial impact. Second, a high level of rotavirus morbidity continues Gastroenteritis considered positive when there to occur despite currently available therapies. is a history of acute watery diarrhea with or For example, hospitalizations for diarrhea in without vomiting, and/or fever. young children declined only 16% from 1979 to 1992, despite the widespread availability of They were grouped into two groups according oral rehydration solutions and to their vaccination status (for Rota vaccine): recommendations by experts, including the group (A), are those who have received Rota American Academy of Pediatrics, for the use vaccine (as the studied group), and group (B), of oral rehydration solutions in the treatment are those who are not (as a control group). All of dehydrating gastroenteritis. Third, studies chronically ill children and those with bloody of natural rotavirus infection indicate that diarrhea, or history of bloody diarrhea, as well initial infection protects against subsequent as partially vaccinated children (above 6 severe diarrheal disease, although subsequent months and have received just one dose of the asymptomatic infections and mild disease vaccine), were excluded from the study. Also, might still occur. Thus, immunization early in those cases whose mothers did not remember life, which mimics a child's first natural if their children got previous gastroenteritis. infection, will not prevent all subsequent disease but should prevent most cases of A comparison has been made according to the severe rotavirus diarrhea and its sequelae number of attacks of acute gastroenteritis (e.g., dehydration, physician visits, and between the two groups, so also the attacks hospitalizations) (3). that need hospitalization. Then each group was divided into sub-groups according to The main of this study to evaluate the effect their sex, and type of feeding, and we studied of rotavirus vaccine in reducing the attacks of if there is any effect of these two factors on acute gastroenteritis among children between the percentage of acute gastroenteritis. (2-15) months of age. 1179

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 Also, we divided each group into three sub- while 309/480 in the control group (64.3%) groups according to their age: which was statically significant, so there was a significant decrease in the admission to the Above 2 months-6 months (period of hospital due to acute gastroenteritis during the introduction of the vaccine). first 15 months of life in those who were received rotavirus vaccination. as shown in > 6 months-12 months (period after complete the table 2. vaccination). This table also shows that the percentage of >12 months – 15 months (reasonable period admission for patients with AGE of after vaccination that the mothers could vaccinated group between age 2-6, 6-12 and remember the past history). 12-15 were 39.1%, 38.8%, and 33.3%, respectively, while among those who were A comparison of the percentage of attacks of unvaccinated, were 71%, 68.3%, and 51.2%, acute gastroenteritis in each group had been respectively. done with different age groups. It seems that the protection is more obvious in The statistical method used is p value those patients less than one-year-old according to SPSS version 13. When the p compared with those aged 12-15 months [p value is less than 0.05, it considered value 0.0001 vs. 0.0162]. significant, if less than 0.001, it is highly significant, and if it is more than 0.05, it is not Also we found that the AGE presented in significant. 41.8% in male, and 39.9% in female of vaccinated group, versus 75.4% in male, and Limitations of the study 79.1% in female of unvaccinated group, so the sex had no effect on frequency of AGE, The study was based on history taking so the neither in those who were vaccinated nor in mother might not exactly remember the whole those were not vaccinated (Table 3 and Fig. events. 2). P value > 0.05. The study was hospital-based so the sample is The percentage of AGE in different age not representative of the whole community. groups [2-6 months, 6-12 months, and 12-15 months’ age] of vaccinated patients, were Results and Discussion 37%, 39.6%, and 45.7% respectively, while in those unvaccinated patients were 72.3%, We found that there was significantly lower 79%, and 77%, respectively, which was frequency of AGE among babies who statistically significant as shown in table 4. received Rota vaccine as compared to those who did not receive it [253 cases out of 618 For that patient aged 2-6m, whom the attacks who were vaccinated got attacks of of AGE were significantly less in the gastroenteritis (40.9%) while for unvaccinated vaccinated group, analysis of their attacks group 480 cases out of 622 one (77.1%), P according to the type of feeding was done and value =0.01] as shown in table 1. Regarding showed that there was no significant those cases who needed hospitalization, we difference in the frequency of the attacks (Fig. found that only 94/253 patients needed 1). hospitalization (37.2%) in the study group 1180

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 Table.1 Distribution of cases of AGE both in the study and control groups Title Total No. patients Percentage (%) No. with AGE Group (A) 618 253 40.9% Vaccinated group Group (B) 622 480 77.1% Not vaccinated group P value= 0.01. (Significant) Table.2 Distribution of study group by admission to hospital due to acute gastroenteritis according to state of vaccination and age group (A) group (B) Age No. of No. of No. of No. of P-value (months) (%) (%) AGE pt. admission AGE pt. admission 2-6 67 27 39.1% 107 76 71.02% 0.0001 6-12 90 35 38.8% 246 168 68.3% 0.0001 12-15 96 32 33.3% 127 65 51.2% 0.0162 Total 253 94 37.2% 480 309 64.3% Table.3 Sex distribution of study and control groups Status of Male Female Total P-value vaccinated Total (%) Total (%) NO. patients NO. NO. Group (A): 320 134 41.8% 298 119 39.9% 618 0.744 Vaccinated Group (B): Not 326 246 75.4% 296 234 79.1% 622 0.693 vaccinated Total 646 380 58.8% 594 353 59.4% 1240 Table.4 Age distribution of the studied groups Age Group (A) Group (B) (months) Total Pt. with (%) Total Pt. with (%) P No. AGE No. AGE value 2-6 181 67 37% 148 107 72.3% 0.0001 6-12 227 90 39.6% 311 246 79% 0.0001 12-15 210 96 45.7% 163 127 77% 0.0001 Total 618 253 40.9 622 480 77.2% 0.0001 1181

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 Table.5 Frequency of acute gastroenteritis in studied groups in related to types of feeding for infants 2-6 months of age Type of feeding Group (A) Group (B) Total No. Pt. with (%) Total No. Pt. with (%) AGE AGE Exclusive breast feeding 53 19 35.8% 41 28 68.3% Bottle feeding 66 25 37.8% 56 40 71% Mixed feeding 62 23 37.1% 51 39 76.5% Total 181 67 37% 148 107 72.3% P-value 0.0927 P-value 0.899 Fig.1 Frequency of AGE in both groups 700 600 500 400 300 200 100 0 Group A Group B Fig.2 Distribution of patients according to their sex There was slight difference in percentage of (35.8%, 37.8%, and 37% respectively), and AGE in children who were exclusive breast, unvaccinated patients (68.3%, 71%, and bottle, and mixed feeding in both vaccinated 76.5% respectively), but this difference was 1182

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 statically not significant (P-value > 0.05) This study also shows that there is no (Table 5), so the types of feeding for infants significant effect between the type of feeding 2-6 months of age had no significant effect on and the incidence of acute gastroenteritis for frequency of acute gastroenteritis in related to infants aged 2-6 months for both groups. rotavirus vaccine in studied groups. Unlike other studies were done in the Philippines (9), Tehran (10), and Mexico City (11) A cross-sectional study shows that the . These studies show that a low rate of frequency of acute gastroenteritis was lower acute watery diarrhea in infants under six in patients who received rota virus vaccine months of age has been attributed to a higher (40.9%), compared with those who did not rate of breast feeding in this age group, which receive the vaccine (77.1%), and this is due to the passive immunity that the infant difference, which is statistically significant, is received from his mother. The difference in similar to study done in U.S.A, which our study may be explained by many factors, estimates the effectiveness of the pentavalent like no accurate reality of exclusive breast rotavirus vaccine observed in cross-sectional feeding because many mothers denied, poor studies undertaken in the U.S (4). With the mothers-babies care, and hygiene, and the effectiveness of two doses of the monovalent introduction of early weaning food, which rotavirus vaccine against rotavirus may be contaminated by enteropathogens. gastroenteritis being 76% in El Salvador (5), The diff erence in our study may be explained and an overall efficacy of the monovalent by the small number of babies who were rotavirus vaccine in preventing episodes of exclusively breastfed. severe rotavirus gastroenteritis of 61% in a clinical trial that was designed to simulate real In patients who received rotavirus vaccine, world conditions of use in Malawi and South there was a significant effectof lowering the Africa (6). number of admission to the hospital due to acute watery diarrhea, unlike those who have This study shows that there is no relation not received the vaccine. This result is similar between the rotavirus vaccine and certain age to study performed in Belgium, showed that group including >2-6, 6-12, and 12-15 rotavirus vaccination is effective for the months, for both studies groups, this result is prevention of admission to hospital for nearly equal or similar to another study in rotavirus gastroenteritis among young Central Australia, that’s found no difference children. Results of an intention to vaccinate in effectiveness between children aged 3-11 analysis showed that at least one dose of any months and those aged 12 months or older rotavirus vaccine can provide 91% protection that have suggested vaccine effectiveness against hospital admission (12). This study is in might decrease slightly during the second line with the reported reduction in the number year of life (7). of admissions attributable to rotavirus gastroenteritis in a regional Belgian hospital This study shows that the gender had no that was not selected for participation in this effect on the frequency of acute study. In Latin America, the US, Europe, and gastroenteritis in both studies groups. This Australia considerable reductions in rotavirus result is nearly equal to study performed in infections and related admissions among Al-Bahrain by Dutta et al., 1990, which young children have been reported after estimate no significant difference between introduction of rotavirus vaccine (13,14,15,16,17), males and females (males are slightly higher with vaccination associated with a significant than females) (8). decline in overall deaths related to diarrhea 1183

Int.J.Curr.Microbiol.App.Sci (2017) 6(10): 1178-1184 among children aged under 5 in Mexico (18). Malek MA, et al., 2006. Diarrhea-and rotavirus- associated hospitalizations among children There is a significant reduction of attacks of less than 5 years of age: The United States, acute gastroenteritis after the introduction of 1997 and 2000. Pediatrics; 117:1887–1892. Rota vaccine in our community. Paje-Villar E, et al., 1994. Non-bacterial diarrher in children in the Philippines. Ann Trop Med Parasitol; 88(1):53-8. The effect of vaccination was obvious even in Paulke-Korinek M, et al., 2010. Universal mass the period of vaccine evolution. vaccination against rotavirus gastroenteritis: impact on hospitalization References rates in Austrian children. Pediatric Infect Dis J; 29:319-23. Ballal M, Shivananda PG. 2002. Rotavirus in Puerto FI, et al., 1989 Role of rotavirus and infantile diarrhea in Manipal, South India. enteric adenovirus in acute pediatric Indian J Pediatric; 69(5):393-6. diarrhea at an urban hospital in Mexico. Boom JA, et al., 2010. Effectiveness of Trans R Soc Trop Med Hyg; 38(3): 396-8. pentavalent rotavirus vaccine in a large Quintanar-Solares M, et al., 2010. Impact of urban population in the United States. rotavirus vaccination on diarrhea-related Pediatrics; 125:199-207. hospitalizations among children

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