Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study

Helen E. Hughes; Alex Elliot; Thomas C. Hughes; Daniel Hungerford; Roger Morbey; Gillian Smith; Roberto Vivancos; Sarah J. O’Brien

doi:10.1371/journal.pone.0240021

Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study

Helen E. Hughes^*
, Alex Elliot
, Thomas C. Hughes
, Daniel Hungerford
, Roger Morbey
, Gillian Smith
, Roberto Vivancos
, Sarah J. O’Brien

^*Corresponding author for this work

National Field Services (North West)

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

15 Downloads (Pure)

Abstract

Background: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England.

Methods: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011—June 2013) and 3 years post (July 2013—June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels.

Results: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0–4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3–10% of ED visits per week.

Conclusions: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.

Original language	English
Article number	e0240021
Journal	PLoS ONE
Volume	15
Issue number	10 October
DOIs	https://doi.org/10.1371/journal.pone.0240021
Publication status	Published - 8 Oct 2020

Bibliographical note

Funding Information: Helen E Hughes, Alex J Elliot, Daniel Hungerford, Gillian E Smith and Roberto Vivancos are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, a partnership between Public Health England and the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care.

Roberto Vivancos and Daniel Hungerford have worked in an evaluation of the childhood rotavirus vaccination programme in Merseyside which was partly funded by GlaxoSmithKline Biologicals. Daniel Hungerford is in receipt of research grant support from Sanofi Pasteur-MSD (SPMSD). This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publisher Copyright: © 2020 Hughes et al.

Citation: Hughes HE, Elliot AJ, Hughes TC, Hungerford D, Morbey RA, Smith GE, et al. (2020) Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study. PLoS ONE 15(10): e0240021.

DOI: https://doi.org/10.1371/journal.pone.0240021

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Cite this

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title = "Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study",

abstract = "Background: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90\%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. Methods: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011—June 2013) and 3 years post (July 2013—June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. Results: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0–4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8\% of visits to 6\% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16\% to 3–10\% of ED visits per week. Conclusions: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.",

author = "Hughes, \{Helen E.\} and Alex Elliot and Hughes, \{Thomas C.\} and Daniel Hungerford and Roger Morbey and Gillian Smith and Roberto Vivancos and O{\textquoteright}Brien, \{Sarah J.\}",

note = "Funding Information: Helen E Hughes, Alex J Elliot, Daniel Hungerford, Gillian E Smith and Roberto Vivancos are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, a partnership between Public Health England and the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care. Roberto Vivancos and Daniel Hungerford have worked in an evaluation of the childhood rotavirus vaccination programme in Merseyside which was partly funded by GlaxoSmithKline Biologicals. Daniel Hungerford is in receipt of research grant support from Sanofi Pasteur-MSD (SPMSD). This does not alter our adherence to PLOS ONE policies on sharing data and materials. Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Publisher Copyright: {\textcopyright} 2020 Hughes et al. Citation: Hughes HE, Elliot AJ, Hughes TC, Hungerford D, Morbey RA, Smith GE, et al. (2020) Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study. PLoS ONE 15(10): e0240021. DOI: https://doi.org/10.1371/journal.pone.0240021 ",

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T2 - A retrospective observational study

AU - Hughes, Helen E.

AU - Elliot, Alex

AU - Hughes, Thomas C.

AU - Hungerford, Daniel

AU - Morbey, Roger

AU - Smith, Gillian

AU - Vivancos, Roberto

AU - O’Brien, Sarah J.

N1 - Funding Information: Helen E Hughes, Alex J Elliot, Daniel Hungerford, Gillian E Smith and Roberto Vivancos are partly funded by the National Institute for Health Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, a partnership between Public Health England and the University of Liverpool. The views expressed are those of the author(s) and not necessarily those of the NIHR, Public Health England or the Department of Health and Social Care. Roberto Vivancos and Daniel Hungerford have worked in an evaluation of the childhood rotavirus vaccination programme in Merseyside which was partly funded by GlaxoSmithKline Biologicals. Daniel Hungerford is in receipt of research grant support from Sanofi Pasteur-MSD (SPMSD). This does not alter our adherence to PLOS ONE policies on sharing data and materials. Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Publisher Copyright: © 2020 Hughes et al. Citation: Hughes HE, Elliot AJ, Hughes TC, Hungerford D, Morbey RA, Smith GE, et al. (2020) Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study. PLoS ONE 15(10): e0240021. DOI: https://doi.org/10.1371/journal.pone.0240021

PY - 2020/10/8

Y1 - 2020/10/8

N2 - Background: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. Methods: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011—June 2013) and 3 years post (July 2013—June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. Results: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0–4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3–10% of ED visits per week. Conclusions: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.

AB - Background: Rotavirus infection is a common cause of gastroenteritis in children worldwide, with a high mortality burden in developing countries, particularly during the first two years of life. Rotavirus vaccination was introduced into the United Kingdom childhood vaccination schedule in July 2013, with high coverage (>90%) achieved by June 2016. We used an emergency department (ED) syndromic surveillance system to assess the impact of the rotavirus vaccination programme, specifically through the demonstration of any immediate and continuing impact on ED gastroenteritis visits in England. Methods: This retrospective, observational study used syndromic surveillance data collected from 3 EDs in the two years before (July 2011—June 2013) and 3 years post (July 2013—June 2016) introduction of rotavirus vaccination. The weekly levels of ED visits for gastroenteritis (by age group and in total) during the period before rotavirus vaccination was first described alongside the findings of laboratory surveillance of rotavirus during the same period. An interrupted time-series analysis was then performed to demonstrate the impact of rotavirus vaccination introduction on gastroenteritis ED visit levels. Results: During the two years before vaccine introduction ED visits for gastroenteritis in total and for the 0–4 years age group were seen to rise and fall in line with the seasonal rotavirus increases reported by laboratory surveillance. ED gastroenteritis visits by young children were lower in the three years following introduction of rotavirus vaccination (reduced from 8% of visits to 6% of visits). These attendance levels in young children (0-4years) remained higher than in older age groups, however the previously large seasonal increases in children were greatly reduced, from peaks of 16% to 3–10% of ED visits per week. Conclusions: ED syndromic surveillance demonstrated a reduction in gastroenteritis visits following rotavirus vaccine introduction. This work establishes ED syndromic surveillance as a platform for rapid impact assessment of future vaccine programmes.

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Using emergency department syndromic surveillance to investigate the impact of a national vaccination program: A retrospective observational study

Abstract

Bibliographical note

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