The impact of publicly funded rotavirus immunization programs on Canadian children.

backgroundIn 2008, the National Advisory Committee on Immunization recommended routine rotavirus immunizations in healthy Canadian infants. Over the following seven years, eight provinces and two territories introduced the rotavirus vaccine into their publicly funded immunization programs.

objectiveAssess the burden of rotavirus infections before and after implementation of publicly funded immunization programs.

methodsWe analyzed laboratory-confirmed community cases of rotavirus reported to the National Enteric Surveillance Program and hospitalizations of children younger than three years old from 2007 to 2017 with rotavirus diagnosis-specific ICD-10 codes. Rates of illness were calculated for each province for the two years prior to and after implementation of public funding of the vaccine. The year of implementation was not included to accommodate the uptake period of the vaccine. Age-specific rates were assessed in jurisdictions where five years of data were available the year after the vaccine was publicly funded. The pre-post and difference-in-difference (DID) methodologies were applied to hospital discharge data to evaluate changes between the funding and non-funding jurisdictions.

resultsCommunity cases of laboratory-confirmed rotavirus infection reported to the National Enteric Surveillance Program declined by 54% between 2010 and 2017. Rates of hospital discharges decreased significantly among children in six provinces after the adoption of the rotavirus vaccine. Hospital discharge rates in Alberta, Manitoba, Ontario and Prince Edward Island dropped between 53% and 71%, and by 75% for British Columbia and Saskatchewan.

conclusionPublic funding of the rotavirus vaccine appeared to lead to significant reductions in laboratory-confirmed rotavirus cases reported to the National Enteric Surveillance Program and in the rates of rotavirus gastroenteritis-related hospital discharges.