Journal of Infectious Diseases
Volume 204 Issue 7 October 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Roger I. Glass
Editor’s Choice: Unexpected Benefits of Rotavirus Vaccination in the United States
J Infect Dis. (2011) 204(7): 975-977 doi:10.1093/infdis/jir477

The large-scale introduction of a new vaccine can uncover many secrets and surprises about the epidemiology of disease that might not be discovered in any other way. Examination of the outcome of a vaccine introduction can validate prior assumptions concerning the burden of disease and the economic consequences of the vaccination program, as well as determine herd effects of the program arising from either a reduction in the environmental load of the infectious agent or a decrease in the group of susceptibles that might blunt transmission of the agent. In this issue of the Journal, Lopman et al document the impact of the introduction of rotavirus vaccines in the United States and find some surprises that could not have been fully anticipated or predicted in advance [ 1].

In 2006, the United States introduced a new rotavirus vaccine that was immediately recommended for the routine immunization of all children [ 2]. Uptake was slow at first but by 2008, about 60% of American infants were being immunized. Small local surveys of diarrheal illnesses in children <2 years who had been immunized indicated a substantial reduction in hospitalizations and emergency room visits [ 3– 8], outcomes predicted by the large clinical trials that determined the vaccine’s efficacy to be 85% or more against severe disease [ 9, 10]. However, this was not the whole story. Lopman et al at the Centers for Disease Control and Prevention have analyzed a large database covering approximately 20% of all US hospital admissions and looked at the numbers of discharges coded for diarrhea due to rotavirus or for any unspecified cause among children from 0 to 24 years of age. They compared baseline rates of these …

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MAJOR ARTICLES AND BRIEF REPORTS
Ben A. Lopman, Aaron T. Curns, Catherine Yen, and Umesh D. Parashar
Editor’s Choice: Infant Rotavirus Vaccination May Provide Indirect Protection to Older Children and Adults in the United States
J Infect Dis. (2011) 204(7): 980-986 doi:10.1093/infdis/jir492

Abstract
Following the introduction of rotavirus vaccination in the United States, rotavirus and cause-unspecified gastroenteritis discharges significantly decreased in 2008 in the 0–4, 5–14, and 15–24-year age groups, with significant reductions observed in March, the historic peak rotavirus month, in all age groups. We estimate that 15% of the total 66 000 averted hospitalizations and 20% of the $204 million in averted direct medical costs attributable to the vaccination program were among unvaccinated 5–24 year-olds. This study demonstrates a previously unrecognized burden of severe rotavirus in the population >5 years and the primacy of very young children in the transmission of rotavirus.