OBJECTIVES:

Rotavirus is the main cause of severe acute gastroenteritis (AGE) in children under 5 but has not been considered an important cause of AGE in older age groups. England introduced rotavirus universal vaccination for infants in July 2013. This study aims to evaluate the impact of rotavirus vaccination on all cause AGE episodes in England across all age groups using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) database.

METHODS:

We included all persons registered in CPRD between 1^st July 2010 and 30^th June 2016. Cut-off date to define pre- and post-vaccination periods was 1^st July 2013. AGE general practitioner (GP) episodes and hospitalizations were defined using AGE related Read and ICD10 codes with a 14 day disease free period. We calculated crude episode rates of AGE, overall and stratified per age group, health care setting and calendar time.

RESULTS:

There were 28 AGE GP episodes per 1,000 person-years in the pre-vaccination period compared to 23 post-vaccination overall, a 18% (95% CI: 17.5-18.6) reduction. The largest decrease was observed in children < 5 years: 26.6% (95% CI: 25.5-27.6) reduction. A significant decrease was also observed among age groups not vaccinated, particularly among 65 to 74 year olds: 16.9% (95% CI: 15.1-18.6) decrease. Impact on AGE hospitalizations was minimal overall (2%, 95%CI: 0.3-3.1), but with reductions of 29% (95%CI: 26-32) < 5 years, and 6% (95%CI: 2.3-9.6) in 85+ years.

CONCLUSIONS:

This ecological analysis suggests that the introduction of rotavirus vaccination in England may have resulted in a significant impact on all cause AGE episodes across all age groups, similar to what has been seen following the introduction of pneumococcal vaccination among infants. Although trends before vaccination suggested a stable background rate, we cannot rule out a coincidental decrease of AGE unrelated to rotavirus vaccination.