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Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005-2015

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dc.contributor.author Delahoy, Miranda J.
dc.contributor.author Cárcamo Cavagnaro, César Paul Eugenio
dc.contributor.author Ordoñez, Luis
dc.contributor.author Vasquez Apéstegui, Bertha Vanessa
dc.contributor.author Lopman, Benjamin
dc.contributor.author Clasen, Thomas
dc.contributor.author Gonzales Rengifo, Gustavo Francisco
dc.contributor.author Steenland, Kyle
dc.contributor.author Levy, Karen
dc.date.accessioned 2020-07-14T00:01:07Z
dc.date.available 2020-07-14T00:01:07Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8275
dc.description.abstract BACKGROUND: We conducted a national impact evaluation of routine rotavirus vaccination on childhood diarrhea in Peru, accounting for potential modifying factors. METHODS: We utilized a dataset compiled from Peruvian governmental sources to fit negative binomial models investigating the impact of rotavirus vaccination, piped water access, sewerage access and poverty on the rate of diarrhea clinic visits in children under 5 years old in 194 Peruvian provinces. We considered the interaction between these factors to assess whether water access, sanitation access, or poverty modified the association between ongoing rotavirus vaccination and childhood diarrhea clinic visits. We compared the "pre-vaccine" (2005-2009) and "post-vaccine" (2010-2015) eras. RESULTS: The rate of childhood diarrhea clinic visits was 7% [95% confidence interval (CI): 3%-10%] lower in the post-vaccine era compared to the pre-vaccine era, controlling for long-term trend and El Niño seasons. No impact of rotavirus vaccination was identified in provinces with the lowest access to piped water (when <40% of province households had piped water) or in the lowest category of sewerage (when <17% of province households had a sewerage connection). Accounting for long-term and El Niño trends, the rate of childhood diarrhea clinic visits was lower in the post-vaccine era by 7% (95% CI: 2%-12%), 13% (95% CI: 7%-19%) and 15% (95% CI: 10%-20%) in the second, third and fourth (highest) quartiles of piped water access, respectively (compared to the pre-vaccine era); results for sewerage access were similar. CONCLUSION: Improved water/sanitation may operate synergistically with rotavirus vaccination to reduce childhood clinic visits for diarrhea in Peru. en_US
dc.language.iso eng
dc.publisher Wolters Kluwer Health
dc.relation.ispartofseries Pediatric Infectious Disease Journal
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject diarrhea en_US
dc.subject rotavirus en_US
dc.subject vaccination en_US
dc.subject drinking water en_US
dc.subject sanitation en_US
dc.title Impact of Rotavirus Vaccination Varies by Level of Access to Piped Water and Sewerage: An Analysis of Childhood Clinic Visits for Diarrhea in Peru, 2005-2015 en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1097/INF.0000000000002702
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.03
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1532-0987


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