Rotavirus disease burden, Nicaragua 2001-2005: defining the potential impact of a rotavirus vaccination program

Background: In October 2006, a rotavirus vaccine was introduced in Nicaragua for routine immunization of all children. We document the baseline diarrheal disease burden in Nicaragua prior to the vaccine program to facilitate future studies to measure vaccine impact. Methods: We analyzed national data for 2001-2005 on total acute gastroenteritis healthcare visits, hospitalizations, and mortality in Nicaraguan children aged <5 years. Results: Prior to vaccine introduction, by age 5 years, one in four Nicaraguan children required an outpatient consultation, one in 34 were hospitalized, and one in 2487 died from rotavirus-associated diarrhea, representing approximately 41 122 outpatient visits, 4460 hospitalizations, and 60 deaths per year that are preventable through vaccination. Almost half of the total acute gastroenteritis burden was in children <1 year of age. Two distinct seasonal peaks were noted in acute gastroenteritis hospitalizations and deaths. Conclusions: Existing data sources on all-cause acute gastroenteritis could be useful for establishing diarrhea disease burden and monitoring trends after vaccine introduction. Blunting of winter season peaks in rates of diarrhea, particularly among children aged <1-2 years, would be a useful indicator of impact from rotavirus vaccination. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.