The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji

Adam W.J. Jenney, Rita Reyburn, Felisita T. Ratu, Evelyn Tuivaga, Cattram Nguyen, Sokoveti Covea, Sarah Thomas, Eric Rafai, Rachel Devi, Kathryn Bright, Kylie Jenkins, Beth Temple, Lisi Tikoduadua, Joe Kado, E. Kim Mulholland, Carl D. Kirkwood, Kimberley K. Fox, Julie E. Bines, Varja Grabovac, Aalisha Sahu KhanMike Kama, Fiona M. Russell

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    Background: In 2012, Fiji became the first independent Pacific island country to introduce rotavirus vaccine. We describe the impact of rotavirus vaccine on all-cause diarrhoea admissions in all ages, and rotavirus diarrhoea in children <5 years of age. 

    Methods: An observational study was conducted retrospectively on all admissions to the public tertiary hospitals in Fiji (2007–2018) and prospectively on all rotavirus-positive diarrhoea admissions in children <5 years at two hospital sites (2006–2018, and 2010–2015), along with rotavirus diarrhoea outpatient presentations at one secondary public hospital (2010–2015). The impact of rotavirus vaccine was determined using incidence rate ratios (IRR) of all-cause diarrhoea admissions and rotavirus diarrhoea, comparing the pre-vaccine and post-vaccine periods. All-cause admissions were used as a control. Multiple imputation was used to impute missing stool samples. 

    Findings: All-cause diarrhoea admissions declined among all age groups except among infants ≤2 months old and adults ≥55 years. For children <5 years, all-cause diarrhoea admissions declined by 39% (IRR)=0•61, 95%CI; 0•57–0•65, p-value<0•001). There was an 81% (95%CI; 51–94%) reduction in mortality among all-cause diarrhoea admissions in children under <5 years. Rotavirus diarrhoea admissions at the largest hospital among children <5 years declined by 87% (IRR=0•13, 95%CI; 0•10–0•17, p-value<0•001). Among rotavirus diarrhoea outpatient presentations, the IRR was 0•39 (95%CI; 0•11, 1.21, p-value=0.077). 

    Interpretations: Morbidity and mortality due to rotavirus and all-cause diarrhoea in Fiji has declined in people aged 2 months to 54 years after the introduction of the RV vaccine. 

    Original languageEnglish
    Article number100053
    Pages (from-to)1-8
    Number of pages8
    JournalThe Lancet Regional Health - Western Pacific
    Early online dateNov 2020
    Publication statusPublished - Jan 2021


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