• Orbelina de Palma, Lilian Cruz, Hector Ramos, Amada de Baires, Nora Villatoro, Desiree Pastor, Lucia Helena de Oliveira, Tara Kerin, Michael Bowen, Jon Gentsch, Douglas H Esposito, Umesh Parashar, Jacqueline Tate, and Manish Patel.
• Ministerio de Salud, San Salvador, El Salvador.
• BMJ. 2010 Jan 1;340:c2825.

ObjectiveTo evaluate the effectiveness of a monovalent rotavirus vaccine against severe rotavirus disease and to assess its impact on diarrhoea in children aged less than 2 years after national introduction in El Salvador, a low-middle income country in Central America.DesignMatched case-control study.SettingSeven hospitals in cities across El Salvador, January 2007 to June 2009.Participants323 children aged less than 2 years admitted with laboratory confirmed rotavirus diarrhoea and 969 healthy controls matched for age and neighbourhood.Main Outcome MeasureEffectiveness of rotavirus vaccination ((1-adjusted odds ratio of vaccination)x100) against rotavirus diarrhoea requiring hospital admission.ResultsCases and controls were similar for breast feeding, premature birth, maternal education, and socioeconomic variables. G1P[8] strains were identified in 92% of rotavirus cases. Effectiveness of two doses of vaccination against diarrhoea requiring hospital admission was 76% (95% confidence interval 64% to 84%). Protection was significantly lower (P=0.046) among children aged 12 months or more (59%, 27% to 77%) compared with children aged 6-11 months (83%, 68% to 91%). One dose of vaccine was 51% (26% to 67%) effective. At the sentinel hospitals, all admissions for diarrhoea among children under 5 declined by 40% in 2008 and by 51% in 2009 from the prevaccine year 2006.ConclusionsA monovalent rotavirus vaccine was highly effective against admissions for rotavirus diarrhoea in children aged less than 2 years in El Salvador and substantially reduced the number of such admissions in this low-middle income setting. The impact on disease epidemiology after vaccination, particularly among older children, warrants future attention.

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