VoICE Immunization Evidence: Vaccines Alleviate Health System Pressure
Immunization can decrease hospital admissions, thus alleviating pressure on overburdened health systems.
Key Evidence: Prior to the introduction of rotavirus vaccines in the U.S., there were an estimated 205,000 – 272,000 emergency department visits and 55,000 – 70,000 hospitalizations due to rotavirus in children each year. A series of studies found that hospitalizations in children under five due to rotavirus declined, on average by 80% from the pre-vaccine to the post-vaccine era, while both outpatient visits and emergency department visits due to rotavirus declined 57%.
Pindyck T, Tate JE, Parashar UD 2018. A decade of experience with rotavirus vaccination in the United States – vaccine uptake, effectiveness, and impact. Expert Review of Vaccines. 17(7).
Key Evidence: Two years after rotavirus vaccine introduction in Rwanda, the country saw nearly 400 fewer hospital admissions for diarrhea among young children at 24 district hospitals.
Ngabo, F., Tate, J.E., Gatera, M., et al 2016. Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhea and rotavirus in children in Rwanda: a time-series analysis. Lancet Global Health. 4:e129-36.
Key Evidence: A study based on population- and lab-based surveillance of bacterial infections in the U.S. estimated that, of the estimated 400,000 cases and 30,000 deaths from invasive pneumococcal disease (IPD) that were likely prevented from 2001 to 2012 with the introduction of PCV7 (in 2000) and PCV13 (in 2010) in the infant immunization schedule, more than half of cases prevented and nearly 90% of prevented deaths were among people older than 5 years of age.
Moore MR, Link-Gelles R, Schaffner W et al. 2015. Effect of use of 13-valent PCV in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. Lancet. 15.
Key Evidence: A study in Australia estimated that adding dTpa vaccination for pregnant women to the current pertussis immunization program for children would prevent an additional 8,800 symptomatic pertussis cases (mostly unreported) and 146 hospitalizations each year in all ages, including infants and their mothers, as well as one death every 22 months. The study found maternal pertussis vaccination to be cost-effective.
From the VoICE Editors: Note: The formulation used in this study is abbreviated dTpa.
Saul N, Wang, Bag S et al. 2018. Effectiveness of maternal pertussis vaccination in preventing infection and disease in infants: the NSW Public Health Network case-control study. Vaccine. 36(14).
Key Evidence: A review of evaluations of rotavirus vaccine impact on hospitalizations and all-cause acute gastroenteritis (AGE) across multiple countries showed that during the first decade since vaccine licensure, a 32% median reduction in hospitalizations due to AGE were observed in children under a year of age. In children younger than 5 years of age a 38% median reduction was noted. Additionally, laboratory confirmed cases of rotavirus-related hospitalization dropped by 80% and 67% in children under 1 year and 5 years of age respectively. The vaccine introduction also lead to a 46% decrease of AGE in children under 5 years of age in a high mortality setting.
From the VoICE Editors: These observations were evaluated using standardized, evidence- based PRISMA guideline.
Burnett, E., Jonesteller, C. L., Tate, J. E., et al. 2017. Global impact of rotavirus vaccination on childhood hospitalizations and mortality from diarrhea.. The Journal of Infectious Diseases. 215(11), 1666-1672..
Key Evidence: A study in four hospitals in Botswana found that over a two-year period following the introduction of rotavirus vaccine, hospitalizations from all causes of diarrhea fell by one-third in infants (0-11 months old), and by nearly one-quarter in all children under five years of age. Ninety percent of infants 4-11 months old in the study population received at least one dose of the vaccine, and 75% received both doses during this period. The vaccine’s impact was most apparent during the rotavirus season when the average number of hospitalizations from diarrhea fell 43% among infants and by one-third among all children under five.
Enane LA, Gastanaduy PA, Goldfarb DM, et al. 2016. Impact of rotavirus vaccination on hospitalizations and deaths from childhood gastroenteritis in Botswana. Clinical Infectious Diseases. 2016:62 (Supple 2).
Key Evidence: Following introduction of PCV in New Zealand, hospitalizations of children under 6 years of age due to invasive pneumococcal disease decreased by 73%, due to all-cause pneumonia decreased by 8%, and due to otitis media decreased by 25%.
Petousis-Harris, H., Howe, A.S., Paynter, J., Turner, N., Griffin, J. 2018. Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006-2015. Clinical Infectious Diseases. 68(5).
Key Evidence: In a Bangladeshi study, pneumonia and acute diarrhea were the first and third most common reasons for childhood hospital admission with over half (54%) of the acute diarrhea admissions caused by rotavirus. One in four children taken to this large pediatric hospital were refused admission because all beds were occupied. Vaccination could have prevented children with rotavirus from requiring essential hospital resources when one in four children refused admission had symptoms of pneumonia.
Saha, S., Santosham, M., Hussain, M. et al. 2018. Rotavirus Vaccine will Improve Child Survival by More than Just Preventing Diarrhea: Evidence from Bangladesh. American Journal of Tropical Medicine and Hygiene. 98(2).