Comparative public health impact of rotavirus vaccination in china

Intro: Two rotavirus vaccines are licensed in China (RotaTeq and Lanzhou Lamb Rotavirus [LLR] vaccine), but their use is not widespread. We sought to understand the public health impact of widespread rotavirus vaccination with these two vaccines on public health outcomes, in China, among children ages 0- 7 years old. Methods: We developed a Markov Model to simulate a birth cohort from 0 to 7 years of age under three scenarios- i) vaccination with RotaTeq; ii) vaccination with LLR; iii) no-vaccination; and calculated each scenario's expected number of health outcomes. The model was parameterized using published information on rotavirus epidemiology, RotaTeq and LLR effectiveness in China, as abstracted from national estimates and peer-reviewed literature. We assumed individuals could have up to five rotavirus infections, the first two being the ones that could lead to hospitalization. We considered high (90%) and low (50%) vaccination coverage scenarios (since rotavirus vaccines are not reimbursed) and fitted the model by changing the percent of immunity conferred by previous infection and the asymptomatic to symptomatic ratio. Findings: For a cohort of 100,000 children over the first 7 years of life, and in the absence of a rotavirus vaccine in China, 899 hospitalizations, 11,708 outpatient visits, and 64,746 symptomatic rotavirus cases are expected. Using RotaTeq, 67% (39%) of hospitalizations, and 61% (35%) of outpatient visits and rotavirus cases can be averted under the high (low) vaccination coverage scenario. Given lower vaccine effectiveness estimates for LLR, its use would avert 24% (14%) hospitalizations, 24% (14%) outpatient visits, and 24% (14%) rotavirus symptomatic cases compared to no vaccination, in the high (low) vaccination coverage scenario. Conclusion: Widespread use of rotavirus vaccination can avert a significant number of rotavirus gastroenteritis outcomes, with a three to two times higher potential public health impact for RotaTeq compared to LLR.