National Trends in Paediatric Acute Gastroenteritis Following Universal Rotavirus Vaccination in Thailand: A Nationwide Database Study
Year: 2026
Type: preprint
Abstract: Background Rotavirus is a major cause of acute gastroenteritis (AGE) in young children. Thailand introduced rotavirus vaccination into its National Immunization Program (NIP) in fiscal year (FY) 2020. Longer-term, nationwide health-system impacts of this programme remain incompletely characterized. This study evaluated national trends in AGE-related healthcare utilisation, mortality, seasonality, healthcare expenditure, and vaccine coverage among children under 5 years following rotavirus vaccine introduction in Thailand. Methods We conducted a nationwide population-based ecological study using administrative healthcare data from Thailand's National Health Security Office (NHSO), FY2017–FY2024. AGE was identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM). FY2020 was excluded as a transition year; pre-NIP (FY2017–FY2019) and post-NIP (FY2021–FY2024) periods were compared. Outcomes included outpatient visit and hospitalization rates, mortality, monthly seasonal case distribution, vaccine coverage, and healthcare expenditure. Results The study included a total of 2,116,494 outpatient visits, 621,437 hospitalizations, and 188 AGE-related deaths. First-dose rotavirus vaccine coverage increased from 84.0% in FY2020 to 97.2% to FY2024. After expanding the NIP, outpatient visits declined from 12.84 to 8.29 per 100 person-years (IRR 0.646, 95% CI 0.644–0.647; −35.4%), and hospitalizations declined from 3.37 to 2.79 per 1,000 person-years (IRR 0.828, 95% CI 0.824–0.832; −17.2%). Mortality decreased from 1.08 to 0.79 per 100,000 person-years (IRR 0.75, 95% CI 0.54–0.98; −27%). A cool-season peak persisted post-NIP but with markedly attenuated case volumes. Mean annual inpatient expenditure decreased by THB 53.3 million (USD 1.61 million), with an estimated 37,160 admissions averted and total cost savings of THB 295.6 million (USD 8.91 million) post-NIP. Conclusions Rotavirus vaccine introduction into Thailand's NIP was temporally associated with sustained reductions in AGE-related outpatient visits, hospitalizations, and mortality, alongside attenuated seasonal peaks and substantial cost savings. Given the ecological design, these findings may reflect population-level health-system impact. Sustaining high vaccination coverage should be promoted to maximize long-term benefits.
Source: Research Square
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225617341