Rotavirus Vaccine:

use in Wisconsin,effects on primary care

visits,

hospitalizations, and laboratory

detectionsJonathan L. Temte, MD/PhD

Associate Professor of Family Medicine & Advisory Committee on Immunization Practices

Stephanie L. Schauer, Richard T. Heffernan, Jeffrey P. DavisWisconsin Division of Public Health

Carol J. Kirk, Peter A. ShultWisconsin State Laboratory of Hygiene

Thomas R. MaerzWisconsin Immunization Registry

“my bowels are troubled, my liver is

poured upon the earth "

Lamentations 2:11

Rotavirus The most common cause

of severe diarrhea among children

Results in hospitalization of approximately 55,000 children each year in the United States

Causes the death of over 600,000 children annually worldwide…

Vaccines that become routine in the U.S. become cheap in the developing world

RotaShieldLicensed

8-31-1998

RotaShiedWithdrawn

October 1999

RotaTeqLicensed

February 2006

ACIP Recommendation

June 2006

Wisconsin VFCDistribution

September 2006

RotavirusVaccineTimeline

Study Objective and Approaches Objectives: Assess the uptake of this vaccine

and evaluate correlates of effectiveness on rotavirus morbidity within one state

Design: Secondary data analysis of existing data sets

Setting: Wisconsin from January 2002 through December 2008

Participants: Anonymous patient interactions as extracted from the Wisconsin Immunization Registry, hospital discharge diagnosis surveillance, a network of 27 specimen testing sites, and a primary care clinical data warehouse

Data Sources Wisconsin Immunization Registry UW- Department of Family Medicine’s

Clinical Data Warehouse Wisconsin State Laboratory of Hygiene

Network of virus labs Passive surveillance of rotavirus

Wisconsin Department of Health and Family Services Hospital discharge diagnosis reporting

Wisconsin Immunization Registry (WIR) Computerized Internet database application Records and tracks immunization dates of

Wisconsin's children and adults Tool for assuring that children and adults:

receive immunizations according to recommended schedules

prevent over-immunizing 1,100 immunization providers and 2,650

schools 27 million immunizations 3.7 million clients

0

500

1000

1500

2000

2500

3000

3500

1/7/2

006

4/7/2

006

7/7/2

006

10/7/

2006

1/7/2

007

4/7/2

007

7/7/2

007

10/7/

2007

1/7/2

008

4/7/2

008

Week

Do

se

s o

f R

ota

Te

qUse of RotaTeqWisconsin birth cohort = 67,000

~ 3800 doses per week to provide 100% coverage

~ 63% Coverageby late 2007

Clinical Data Warehouse

Existing warehouse of patient data Demographic information ICD-9 codes CPT codes EPIC EMR Data

Extensive universe of Primary Care data Approximately 176,624 unique patients

3.2% of Wisconsin’s total population Approximately 312,663 visits per year

Easily accessible for queries

All Ages

0.00

5.00

10.00

15.00

20.00

25.00

30.00

0 52.15 104.3 156.45 208.6 260.75 312.9

Week Number

AD

I Vis

its

per

100

0

DFM Acute Diarrheal IllnessRate of ADI Visits per 1000 per week (2001-2008) (denominator =

2.5 million visits)

Focus on 2006-2008

all ages

y = -0.0116x + 20.792R2 = 0.0539

0.00

5.00

10.00

15.00

20.00

25.00

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0

<1 year

y = -0.0032x + 1.6376R2 = 0.1334

0.00

0.50

1.00

1.50

2.00

2.50

3.00

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0

1-4 years

y = -0.0019x + 1.5946R2 = 0.0327

0.00

0.50

1.00

1.50

2.00

2.50

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0

Slight decline in total visits for ADI

50% decline in ADI visits for <1 year old children

25% decline in ADI visits for 1-4 year old children

5-24 years

y = -0.0006x + 2.8975R2 = 0.0015

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0

25-64 years

y = -0.0002x + 9.555R2 = 5E-05

0.00

2.00

4.00

6.00

8.00

10.00

12.00

14.00

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0

65+ years

y = -0.0057x + 5.1075R2 = 0.099

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

209 261.15 313.3 365.45

Week Number

AD

I Vis

its

per

100

0 No change

in ADI visits for patients 5–24 years

No change in ADI visits for patients 25-64 years

25% decline in ADI visits for 65+year old adults

Wisconsin State Laboratory of Hygiene Coordinates the Wisconsin Clinical Laboratory

Network in the state to ensure timely and effective response to clinical laboratory and public health needs emergency preparedness disease surveillance laboratory diagnostics training and education communications

Laboratory Surveillance Reports webpage access to the current laboratory-based surveillance reports

and graphs generated as a testing reports provided by Wisconsin laboratories

current and historical graphs

2004-2005

2005-2006

2006-2007

2007-2008

2008-2009

Wisconsin Department of Health and Family Services

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-00

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-01

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-01

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-02

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-02

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-08

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Week of admission

Nu

mb

er o

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osp

ital

izat

ion

s

0

500

1000

1500

2000

2500

3000

3500

Weekly Rotavirus HospitalizationsWisconsin 2000–2008

2001 2002 2003 2004 2005 2006 2007 2008

Vaccineuptake

84% decline in Rotavirus Hospitalizations

Conclusions Implementation of an immunization policy

resulted in rapid uptake of vaccine There is evidence for overall reduction in

target syndrome in target population Vaccine use is correlated with rapid

declines in detections of rotavirus Hospitalizations from the pathogen have

rapidly and significantly declined There is evidence for effects of herd

immunity