Subregional meeting looks at progress and sustainability of rotavirus surveillance in Europe

Members of the Rotavirus Sentinel Surveillance Network in the WHO European Region met in Riga, Latvia, on 20–22 June 2017. The meeting, organized by WHO/Europe, provided hands-on training in surveillance data management and analysis. It gave all participants the opportunity to discuss national, regional and global progress in rotavirus sentinel surveillance, as well as the Network’s future priorities and sustainability.

Vaccination against rotavirus, a disease that causes severe diarrhoea among young children, is included in the routine immunization programmes of 17 countries in the Region. Five of these countries (Armenia, Georgia, the Republic of Moldova, Tajikistan and Uzbekistan), together with 2 additional countries that have not yet introduced the vaccine (Azerbaijan and Ukraine), participate in the Network. The Network is part of the WHO-coordinated Global Rotavirus Surveillance Network (GRSN). The GRSN is funded by Gavi, the Vaccine Alliance.

Across the 7 participating countries in the Region, 11 sentinel hospitals enrol children under 5 years of age who have been hospitalized for treatment of diarrhoea in the GRSN, and then collect case-based demographic, clinical and laboratory data on the cases. Together these sites enrolled a larger number of diarrhoea cases in the GRSN in 2016 than the collective sentinel sites of any other WHO region.

The data collected through the Network are used to:

  • help countries make informed decisions about the introduction of the rotavirus vaccine and evaluate its impact; and
  • better understand regional and country distribution of rotavirus genotypes.

Future of the GRSN in Europe

The GRSN is solely supported by Gavi, and 5 of the 7 European countries in the Network will have transitioned from Gavi support by the end of 2017. Network members therefore discussed ways to reduce costs, ensure sustainable funding for surveillance and leverage the existing rotavirus surveillance platform to detect other enteric diseases.

In order to lower regional costs,  the number of specimens sent annually for genotyping to the Regional Reference Laboratory in Belarus has already been reduced from 100 to 60 per country.

Case study: Armenia

A study of the Network’s activities in Armenia illustrates its added value for the control of rotavirus. Armenia used data compiled through the country’s GRSN sentinel sites in its decision to introduce the rotavirus vaccine in its national immunization programme, and to advocate for continued use of the vaccine.

An economic evaluation using surveillance data and data collected from other agencies showed that the vaccine would reduce health care costs and be cost-saving for the country in the long term. These data were instrumental in the country’s decision to introduce monovalent rotavirus vaccine in 2012.

After the vaccine’s introduction, surveillance data demonstrated the vaccine’s dramatic impact in protecting against rotavirus hospitalization, and in reducing rotavirus positivity among children hospitalized for acute gastroenteritis. Rotavirus positivity dropped by 48% in the first year of its use and by at least 75% in the second and third years.

Surveillance data also indicated that the rotavirus vaccine provided indirect protection, as there was a reduction of at least 30% in hospitalizations due to gastrointestinal infections among children who were too old to receive the vaccine.