The Sustained Rotavirus Vaccination Impact on Nosocomial Infection, Duration of Hospital Stay, and Age: The RotaBIS Study (2005-2012)

Baudouin Standaert, Danielle Strens, Xiao Li, Nadia Schecroun, Marc Raes, Baudouin Standaert, Danielle Strens, Xiao Li, Nadia Schecroun, Marc Raes

Abstract

Introduction: The benefits of rotavirus (RV) vaccination in developed countries have focused on reductions in mortality, hospitalization and medical visits, and herd protection. We investigated other aspects related to RV-induced nosocomial infection, duration of hospital stay, age shift, and sustained vaccine impact (VI) over time.

Method: RotaBIS (Rotavirus Belgian Impact Study; ClinicalTrials.gov identifier, NCT01563146) annually collects retrospective data on hospitalization linked to RV testing in children up to 5 years old from 11 pediatric wards located all over Belgium. Data from 2005 to 2012 have been split in pre- (2005-2006) and post-vaccination (2007-2012) period. Information was collected on age, gender, RV test result, nosocomial infection caused by RV and duration of hospital stay.

Results: Over the 6-year period after the introduction of the RV vaccine, an 85% reduction in nosocomial infections was observed (221 in 2005 to 33 in 2012, p < 0.001). A significant reduction of almost 2 days in average duration of hospital stay per event was observed overall (7.62 days in 2005 to 5.77 days in 2012, p < 0.001). The difference is mainly explained by the higher reduction in number of nosocomial infections. A pronounced age shift (+24%, p < 0.01) of RV nosocomial infection to infants ≤2 months old was observed, increasing with length of post-vaccination period. VI was maintained over the follow-up (±79% VI per birth cohort). A decrease was seen depending on age, 85% (95% CI 76-91%) in the youngest to 63% (95% CI 22-92%) in the oldest age group.

Conclusion: The higher reduction in nosocomial infection may affect the overall average duration of hospital stay for RV infection. No change in VI by birth cohort, but a reduction by age group was observed. These findings could be important for decision-makers considering the introduction of universal mass RV vaccination programs.

Trial registration: ClinicalTrials.gov identifier, NCT01563146.

Funding: GlaxoSmithKline Biologicals SA (Rixensart, Belgium).

Keywords: Age shift; Bed occupancy; Duration of hospital stay; Hospitalization; Nosocomial infection; Quality of care; Rotavirus; Vaccination; Vaccine impact.

Figures

Fig. 1
Fig. 1
Spread of RV-induced nosocomial infections over the years. Dotted red line indicates when RV vaccine was reimbursed. RV rotavirus
Fig. 2
Fig. 2
Overall average duration in days for a hospital rotavirus event over time with linear time trend line for the last 5 years and standard errors of the mean
Fig. 3
Fig. 3
Shift in the spread of duration of all rotavirus-hospital stay pre- (2005) versus post-vaccination (2012)
Fig. 4
Fig. 4
Comparing the average hospital duration (days) according to age and year (2005 pre- and 2012 post-vaccination) for rotavirus-induced nosocomial infection (full duration)
Fig. 5
Fig. 5
The relative contribution of rotavirus-induced nosocomial infections by age group and by year
Fig. 6
Fig. 6
Measuring rotavirus vaccine impact by year, birth cohort, and age group
Fig. 7
Fig. 7
Comparison of the cumulative frequency (%) of patients as a function of the duration of hospital stay for rotavirus-induced nosocomial and community-acquired infection of infants Red dashed lines indicate the frequency of hospitalizations >30 days in 2005 and 2012

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