Source:

Pringle
KD
,
Burke
RM
,
Steiner
CA
, et al
.
Trends in rate of seizure-associated hospitalizations among children <5 years old before and after rotavirus vaccine introduction in the United States, 2000–2013
.
J Infect Dis
.
2018
;
217
(
4
):
581
588
; doi:
https://doi.org/10.1093/infdis/jix589

Investigators at multiple institutions conducted a before-and-after study to determine the incidence and trends in seizure-associated hospitalizations among children since the introduction of rotavirus vaccine in the United States. Data were obtained from 26 states that consistently provided hospitalization data regarding children <5 years old from 2000–2013 to the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. Seizure hospitalizations were identified using ICD-9 discharge diagnosis codes.

The primary outcome was hospitalization rates for seizures. Hospitalization rates were calculated by dividing the annual number of seizure hospitalizations by the number of children <5 years old residing in a participating state over the study period. The mean hospitalization rate for seizures before rotavirus vaccine was introduced in the United States (2000–2006) was compared with the rate after rotavirus vaccine was introduced (2008–2013). This comparison was done among all participants and among age subgroups (eg, 0–2 month, 3–5 month, 6–11 month, 12–17 month, and 18–23 month) using regression models.

There were 962,899 seizure hospitalizations during the study period. The mean annual seizure hospitalization rate before rotavirus vaccine introduction was 388 cases/100,000 among all participants. After rotavirus vaccine introduction, the mean annual hospitalization rates ranged from 382 cases/100,000 in 2008 to 357 cases/100,000 in 2013, corresponding to a 1%–8% reduction in hospitalization rates compared to the pre-vaccine period. Among age subgroups, the greatest reduction in seizure hospitalization rates (14%–16%) was observed among children 0–2 months old and 12–23 months old.

The authors conclude that there has been a reduction in hospitalizations for seizures since the introduction of rotavirus vaccine.

Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Common clinical manifestations of rotavirus acute gastroenteritis (AGE) include fever, watery diarrhea, and occasionally dehydration. Electrolyte abnormalities associated with dehydration can lead to seizures. Although rotavirus is usually thought of as a pathogen limited to the intestine, rotavirus antigens have been detected in the serum of approximately one-half of children hospitalized with rotavirus AGE. In some children who have seizures associated with AGE, wild-type rotavirus has been detected in their cerebrospinal fluid (CSF) by polymerase chain reaction. Rotavirus nonstructural protein 4 (NSP4), an enterotoxin, has been suggested as a mediator of rotavirus-associated seizures. Antibodies against NSP4 are, in fact, associated with protection against rotavirus-associated seizures.

The results of the present study support those of an earlier study that found a full course of rotavirus vaccination was statistically associated with an 18%–21% reduction in the risk of seizures requiring hospitalization or ED care in the year following vaccination, compared with unvaccinated children. The present study, however, has...

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