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Jonathan L. Temte, MD/PhD

Rotavirus Vaccine: use in Wisconsin, effects on primary care visits, hospitalizations, and laboratory detections. Jonathan L. Temte, MD/PhD Associate Professor of Family Medicine & Advisory Committee on Immunization Practices Stephanie L. Schauer, Richard T. Heffernan, Jeffrey P. Davis

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Jonathan L. Temte, MD/PhD

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  1. Rotavirus Vaccine: use in Wisconsin,effects on primary care visits, hospitalizations, and laboratory detections Jonathan L. Temte, MD/PhD Associate Professor of Family Medicine & Advisory Committee on Immunization Practices Stephanie L. Schauer, Richard T. Heffernan, Jeffrey P. Davis Wisconsin Division of Public Health Carol J. Kirk, Peter A. Shult Wisconsin State Laboratory of Hygiene Thomas R. Maerz Wisconsin Immunization Registry

  2. “my bowels are troubled, my liver is poured upon the earth" Lamentations 2:11

  3. Rotavirus • The most common cause of severe diarrhea among children • Results in hospitalization of approximately 55,000 children each year in the United States • Causes the death of over 600,000 children annually worldwide… • Vaccines that become routine in the U.S. become cheap in the developing world

  4. RotavirusVaccineTimeline RotaTeq Licensed February 2006 RotaShield Licensed 8-31-1998 ACIP Recommendation June 2006 RotaShied Withdrawn October 1999 Wisconsin VFC Distribution September 2006

  5. Study Objective and Approaches • Objectives: Assess the uptake of this vaccine and evaluate correlates of effectiveness on rotavirus morbidity within one state • Design: Secondary data analysis of existing data sets • Setting: Wisconsin from January 2002 through December 2008 • Participants: Anonymous patient interactions as extracted from the Wisconsin Immunization Registry, hospital discharge diagnosis surveillance, a network of 27 specimen testing sites, and a primary care clinical data warehouse

  6. Data Sources • Wisconsin Immunization Registry • UW- Department of Family Medicine’s Clinical Data Warehouse • Wisconsin State Laboratory of Hygiene • Network of virus labs • Passive surveillance of rotavirus • Wisconsin Department of Health and Family Services • Hospital discharge diagnosis reporting

  7. Wisconsin Immunization Registry (WIR) • Computerized Internet database application • Records and tracks immunization dates of Wisconsin's children and adults • Tool for assuring that children and adults: • receive immunizations according to recommended schedules • prevent over-immunizing • 1,100 immunization providers and 2,650 schools • 27 million immunizations • 3.7 million clients

  8. Use of RotaTeqWisconsin birth cohort = 67,000 ~ 63% Coverage by late 2007 ~ 3800 doses per week to provide 100% coverage

  9. Clinical Data Warehouse • Existing warehouse of patient data • Demographic information • ICD-9 codes • CPT codes • EPIC EMR Data • Extensive universe of Primary Care data • Approximately 176,624 unique patients • 3.2% of Wisconsin’s total population • Approximately 312,663 visits per year • Easily accessible for queries

  10. DFM Acute Diarrheal IllnessRate of ADI Visits per 1000 per week (2001-2008)(denominator = 2.5 million visits) Focus on 2006-2008

  11. Slight decline in total visits for ADI 50% decline in ADI visits for <1 year old children 25% decline in ADI visits for 1-4 year old children

  12. No change in ADI visits for patients 5–24 years • No change in ADI visits for patients 25-64 years • 25% decline in ADI visits for 65+year old adults

  13. Wisconsin State Laboratory of Hygiene • Coordinates the Wisconsin Clinical Laboratory Network in the state to ensure timely and effective response to clinical laboratory and public health needs • emergency preparedness • disease surveillance • laboratory diagnostics • training and education • communications • Laboratory Surveillance Reports webpage • access to the current laboratory-based surveillance reports and graphs generated as a testing reports provided by Wisconsin laboratories • current and historical graphs

  14. 2004-2005

  15. 2005-2006

  16. 2006-2007

  17. 2007-2008

  18. 2008-2009

  19. Wisconsin Department of Health and Family Services

  20. Weekly Rotavirus HospitalizationsWisconsin 2000–2008 84% decline in Rotavirus Hospitalizations Vaccine uptake 2001 2002 2003 2004 2005 2006 2007 2008

  21. Conclusions • Implementation of an immunization policy resulted in rapid uptake of vaccine • There is evidence for overall reduction in target syndrome in target population • Vaccine use is correlated with rapid declines in detections of rotavirus • Hospitalizations from the pathogen have rapidly and significantly declined • There is evidence for effects of herd immunity

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