Hospital-based study of the severity and economic burden associated with rotavirus diarrhea in Sri Lanka

Abstract

The objective of this study was to determine the morbidity and associated costs of rotavirus infection in Sri Lanka in anticipation of rotavirus vaccines. From April 2005 to October 2006 stool samples of 606 children (335 males) mean age 27.3 ± 31.53 months (range 1–144 months) admitted with gastroenteritis to the pediatric units of the Colombo North teaching Hospital were screened for rotavirus antigens by enzyme-immunoassay (EIA) (Rotaclone^®) Severity of gastroenteritis was assessed by the Vesikari scoring system. Using an interviewer administered questionnaire the average expense incurred per-episode of rotavirus gastroenteritis was determined among randomly selected rotavirus cases (n = 45). Cost of universal rotavirus vaccination was assessed assuming a cost of US$ 7 per vaccine dose for a two-dose regime (World Bank cost-effectiveness standard for low-income countries). One hundred and sixteen (19.1%) had group A rotavirus antigens. The prevalence of rotavirus infection among the 0–4 years age group was 20.8%. The mean severity score was 12.8 and 11 in rotavirus positive and non-rotavirus diarrheas, respectively (P < 0.001). Nausea, vomiting and severe dehydration were significantly associated with rotavirus. The average cost of an episode of rotavirus gastroenteritis hospitalization was Rs. 3626 (US$ 33). The estimated annual expenditure of universal rotavirus vaccination in Sri Lanka was US$ 5 million. Cost saved through averting rotavirus hospitalizations per year was US$ 0.26 million. Deaths averted were eight per year. Rotaviruses constitute an important health and economic burden in Sri Lanka. Vaccine safety, efficacy and affordability are requirements for implementation of universal rotavirus vaccination.

Keywords

Rotavirus - Sri Lanka - Vesikari score - cost analysis - vaccination