Modeling Improved Coverage of Rotavirus Vaccines Open Access

Abstract

Background: Rotavirus is a leading cause of severe diarrhea in children under five years of age. Rotavirus vaccine coverage has remained low (70 – 75%) for several years in the U.S. Family practitioners offer rotavirus vaccines only 45% of the time while pediatricians routinely offer 85% of the time. Higher rotavirus vaccine coverage provided by family practitioners should be considered to decrease further rotavirus disease burden. This study adapted and used a dynamic transmission (SIR) model to assess the impact of rotavirus vaccine coverage offered by family practitioners versus pediatricians on the incidence of rotavirus in children under 5 in the U.S.

 

Methods: A deterministic age-structured dynamic model with susceptible, infectious, and recovered compartments (SIR model) was used to represent rotavirus transmission. We estimated the reduction of rotavirus severe gastroenteritis cases by 2 doses of rotavirus vaccine with three vaccination scenarios: (scenario 1: 85% coverage by pediatricians and 45% coverage by family practitioners; scenario 2: 85% coverage by pediatricians and family practitioners; scenario 3: 95% coverage by pediatricians and family practitioners). Scenario 2 and scenario 3 were initiated in 2018. In addition, we tested the sensitivity of the model to the assumption of mixing patterns between children visiting pediatricians and children visiting family practitioners by setting contact within a group to be higher than contact between groups to depict an assortative mixing pattern.

 

Results: In this model, higher vaccine coverage provided by family practitioners and pediatricians leads to lower incidence of severe rotavirus cases including indirect vaccine benefits. One critical impact of higher total vaccine coverage is the effect on rotavirus epidemic patterns in the U.S.; the biennial rotavirus epidemic patterns shifted to reduced annual epidemic patterns. Additionally, assortative mixing patterns in children visiting pediatricians and family practitioners amplify the impact of increasing vaccine coverage.

Conclusion: Under these high vaccine coverage levels (>85%), our model predicted that biennial patterns shifted to annual patterns with lower magnitude of rotavirus incidence peaks. Promoting vaccine coverage targeting children visiting family practitioners will provide population level benefits (both direct and indirect effects) and significant reduction of severe rotavirus incidence in children under 5 years of age in the U.S.

Table of Contents

INTRODUCTION............................................................................................................. 1

Burden of rotavirus........................................................................................................... 1

Classification.................................................................................................................... 1

Natural History and Epidemiology..................................................................................... 2

Impact of Rotavirus Vaccine.............................................................................................. 3

Epidemiological Models.................................................................................................... 5

Rotavirus vaccination in the United States......................................................................... 6

Attitude to Rotavirus Vaccination...................................................................................... 6

METHODS......................................................................................................................... 8

Model design and model parameters.................................................................................. 8

Parameters estimates......................................................................................................... 9

Vaccine scenario............................................................................................................. 10

Sensitivity analysis to assumption of assortative mixing patterns between children visiting pediatricians and family practitioners      11

RESULTS......................................................................................................................... 12

Severe rotavirus incidence cases reduction....................................................................... 12

Four-year average of severe rotavirus incidence reduction............................................... 12

Epidemic patterns shift.................................................................................................... 12

Indirect benefits of improved rotavirus vaccine coverage in family practitioner population 13

Sensitivity to assumptions about mixing patterns of children visiting pediatricians and family practitioners   13

DISCUSSION................................................................................................................... 15

REFERENCES................................................................................................................ 20

TABLES........................................................................................................................... 24

FIGURES......................................................................................................................... 27

APPENDECES................................................................................................................ 29

Appendix A:.................................................................................................................... 29

Appendix B:.................................................................................................................... 31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Environmental Health
Keyword	Mathematical modeling Rotavirus vaccine Transmission Dynamics
Committee Chair / Thesis Advisor	Benjamin Lopman, Emory University

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