로타바이러스 백신 도입 후 소아 입원 환자에서의 로타바이러스 위장관염 발생 변화 및 로타바이러스 백신 효과추정

Abstract

목적: 로타바이러스(rotavirus [RV]) 백신 도입에 따른 소아 입원 환자에서의 로타바이러스 장염(rotavirus gastroenteritis [RGE]) 발생 변화와 백신 효과를 추정하였다.방법: 2014–2015년과 2004–2005년, 두 기간 동안 한양대학교 서울병원 소아청소년과에 급성 장염(acute gastroenteritis [AGE])으로 입원한 환자의 자료를 후향적으로 비교 분석하였다. 백신 효과는환자 검사-음성 대조군 연구를 통해 추정하였다.결과: AGE에서의 RGE 비율은 2004–2005년(22.7%)에 비해 2014–2015년(9.0%)에 유의하게 감소하였다(P <0.001). 2014–2015년 RV 백신 완전접종률은 66.0%, 불완전접종률은 6.2%로, 백신의 예방 효과는 완전접종자에서 83.3% (95% confidence interval [CI], 60.5%–92.9%), 불완전접종자에서는 27.4% (95% CI, -163.7%–80.0%)였다.결론: RV 백신이 도입된 이후 RGE 발생이 뚜렷이 감소하였다. 백신접종률을 향상시킴으로써 RGE로인한 질병 부담을 더욱 낮출 수 있을 것으로 기대된다.Purpose: This study aimed to investigate the changes in the occurrence of rotavirus gastroenteritis (RGE) after the introduction of rotavirus vaccine and estimate rotavirus vaccine effectiveness in hospitalized children.Methods: We compared the retrospective data of 671 patients with acute gastroenteritis (AGE) admitted to the Department of Pediatrics, Hanyang University Seoul Hospital from January 1, 2014, to December 31, 2015, with retrospective data of 1,243 patients admitted to the same institution with AGE from January 1, 2004, to December 31, 2005. The vaccine effectiveness was estimated using a case-positive control test-negative study.Results: The proportion of RGE in AGE was significantly lower in 2014 to 2015 (9.0%, 48/531) than in 2004 to 2005 (22.7%, 282/1,243) (P <0.001). In particular, there was a significant decrease in the 6- to 11-, 12- to 23-, and 24- to 35-month-old groups (P <0.001), whose rotavirus vaccination rates were higher than the remaining age groups. The monthly distribution of patients with RGE in 2004 to 2005 was higher from November to May, peaked in January, followed by December and February. In 2014 to 2015, the monthly distribution of patients with RGE slightly peaked in January. In 2014 to 2015 study, the complete rotavirus vaccination rate was 66.0% (332/503) and incomplete vaccination rate was 6.2% (31/503). Presumed rotavirus vaccine effectiveness was 83.3% (95% confidence interval [CI], 60.5% to 92.9%) in the complete vaccination group and 27.4% (95% CI, –163.7% to 80.0%) in the incomplete group.Conclusions: The proportion of RGE in AGE has markedly decreased since the introduction of rotavirus vaccines, and improving vaccination coverage will further reduce the burden of RGE in Korea.