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Reduction in hospitalisations for acute gastroenteritis-associated childhood seizures since introduction of rotavirus vaccination: a time-series and change-point analysis of hospital admissions in England
  1. Daniel James Hungerford1,2,3,4,
  2. Neil French1,5,
  3. Miren Iturriza-Gómara1,2,
  4. Jonathan M Read2,3,6,
  5. Nigel A Cunliffe1,7,
  6. Roberto Vivancos2,3,4
  1. 1 Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  2. 2 NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, United Kingdom
  3. 3 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
  4. 4 Field Service, National Infection Service, Public Health England, Liverpool, UK
  5. 5 Tropical and Infectious Disease Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
  6. 6 Centre for Health Informatics, Computing and Statistics, Lancaster University, Faculty of Health and Medicine, Lancaster, UK
  7. 7 Department of Microbiology, Alder Hey Children’s NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, United Kingdom
  1. Correspondence to Dr Daniel James Hungerford, Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK; d.hungerford{at}liverpool.ac.uk

Abstract

Introduction The incidence of severe childhood diarrhoea has fallen substantially following the introduction of rotavirus vaccine in the UK in July 2013. Since children with rotavirus infection may experience febrile and afebrile seizures, we evaluated the impact of rotavirus vaccination on seizure hospitalisations in children in England.

Methods Using data from Hospital Episode Statistics, we employed interrupted time-series analyses to assess changes in monthly hospital admissions for seizures among children aged <5 years from July 2000 to June 2017. Outcome measures comprised all seizures and febrile seizures, with and without a co-diagnosis of acute gastroenteritis (AGE). Models were adjusted for pneumococcal conjugate vaccine (PCV) introduction. Change-point analysis was used to independently identify step-changes in the time-series.

Results Among hospitalised children aged <5 years, the incidence of any seizures and febrile seizures with AGE decreased post-vaccine introduction by 23% (95% CI: 11% to 33%) and 31% (95% CI: 19% to 41%), respectively. For febrile seizures with AGE, a single change-point was identified in July 2013 (95% CI: June 2013 to December 2013). Reductions in seizure incidence were higher during the rotavirus season (49%, 95% CI: 37% to 58%) compared with out-of-season (13%, 95% CI: −4 to 28%) and showed no relation to PCV introduction. There were small reductions in any seizures with any co-diagnosis (4%, 95% CI: 0% to 8%) and in febrile seizures with any co-diagnosis (10%, 95% CI: 2% to 16%).

Conclusion Rotavirus vaccination has reduced hospitalisations for seizures associated with AGE in England, providing additional evidence of population-level impact of rotavirus vaccination on seizure incidence in high-income countries.

  • vaccination
  • time-series
  • diarrhoea
  • epidemiological methods
  • effectiveness

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Footnotes

  • Contributors NAC, MI-G, RV, DJH and NF conceived and designed the study. DJH and RV acquired the data; DJH analysed the data with support from NF, RV and JMR, and all authors interpreted the output; DJH wrote the first draft of the report; and all authors reviewed the draft and final manuscript.

  • Funding This study was supported by GlaxoSmithKline Biologicals SA (EPI-Rota-065) through financial support and the University of Liverpool. GlaxoSmithKline Biologicals SA was provided the opportunity to review a preliminary version of this manuscript for factual accuracy, but the authors are solely responsible for final content and interpretation. The authors received no financial support or other form of compensation related to the development of the manuscript. RV receives a salary contribution from the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections. RV and MI-G receive salary contributions from the NIHR Health Protection Research Unit in Gastrointestinal Infections. JMR acknowledges support from the Engineering and Physical Sciences Research Council (EP/N014499/1) and the Medical Research Council (MR/S004793/1).

  • Competing interests NAC, NF, MI-G, RV and DJH are in receipt of research grant support from GlaxoSmithKline (GSK) Biologicals. Outside of this study, MI-G and DJH are in receipt of research grant support on the topic of rotavirus vaccines from Sanofi Pasteur, and Merck & Co (Kenilworth, New Jersey, USA) after the closure of Sanofi Pasteur-MSD in December 2016. NAC has received honoraria for participation in GSK Rotavirus Vaccine DSMB meetings.

  • Patient consent for publication Not required.

  • Ethics approval The data accessed were aggregated and anonymised. Following consultation with the University of Liverpool Ethics Committee, Public Health England guidance and use of the NHS Health Research Authority Research tool “Do I need NHS REC approval” (http://www.hra-decisiontools.org.uk/research/), seeking of ethical approval deemed unnecessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available.

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