Rotavirus vaccine effectiveness and impact in Uzbekistan, the first country to introduce in central Asia.

Uzbekistan, the most populous country in central Asia, was the first in the region to introduce rotavirus vaccine into its national immunization program. Rotarix (GlaxoSmithKline Biologicals, RV1) was introduced in June 2014, with doses recommended at age 2 and 3 months. To evaluate vaccine impact, active surveillance for rotavirus diarrhea was reestablished in 2014 at 2 hospitals in Tashkent and Bukhara which had also performed surveillance during the pre-vaccine period 2005-2009. Children aged <5 y admitted with acute diarrhea had stool specimens collected and tested for rotavirus by enzyme immunoassay. Proportions testing rotavirus-positive in post-vaccine years were compared with the pre-vaccine period. Vaccine records were obtained and effectiveness of 2 RV1 doses vs 0 doses was estimated using rotavirus-case and test-negative design among children enrolled from Bukhara city. In 2015 and 2016, 8%-15% of infants and 10%-16% of children aged<5 y hospitalized with acute diarrhea at the sites tested rotavirus-positive, compared with 26% of infants and 27% of children aged<5 y in pre-vaccine period (reductions in proportion positive of 42%-68%, p <.001). Vaccine effectiveness of 2 RV1 doses vs 0 doses in protecting against hospitalization for rotavirus disease among those aged ≥6 months was 51% (95% CI 2-75) and is based on cases predominantly of genotype G2P[4]. Vaccine effectiveness point estimates tended to be higher against cases with higher illness severity (e.g., clinical severity based on modified Vesikari score ≥11). Our data demonstrate that the monovalent rotavirus vaccine is effective in reducing the likelihood of hospitalization for rotavirus disease in young children in Uzbekistan.

Clinical Features of COVID-19 in Uzbekistan.

BACKGROUND: As of April 30, 2020, a total of 2,039 cases of the novel coronavirus disease 2019 (COVID-19) were confirmed in the Republic of Uzbekistan after the first detection on March 15. Reports on symptoms of COVID-19 are non-specific and known to vary from asymptomatic, mild to severe, or fatal. This study aimed to analyze the symptomatic and clinical characteristics of study participants based on the medical records of participants hospitalized with COVID-19 in Uzbekistan. METHODS: We collected all data from medical records of COVID-19 confirmed patients in 19 hospitals from 13 regions of Uzbekistan between March 15 and April 30. We selected 1,030 patients discharged from the hospitals after COVID-19 treatment as study participants, excluding those with missing data. Further, we collected demographics, symptoms, clinical outcomes, and treatment data through medical records. RESULTS: More than half (57.6%) of confirmed cases of COVID-19 were males, and the median age was 36.0 years. The most frequent symptoms at the first inspection on hospital admission of all patients were fatigue (59.7%), dry cough (54.1%), pharyngalgia (31.6%), headache (20.6%), and anorexia (12.5%). Compared to the oldest group, the youngest group showed a lower frequency of symptoms. About half of the group aged 18-49 years reported that they came from abroad. One-fifth of patients in group 50-84 received oxygen support, while no patients in group aged 0-17 years received oxygen support. About two-thirds of the participants from intensive care unit (ICU) came from abroad, whereas 42.1% of the non-ICU group returned from other countries. Regarding symptoms, 16.9% of the patients in the ICU group were asymptomatic, while 5.8% in the non-ICU group were asymptomatic. CONCLUSION: This study suggests that the medical delivery system and resource distribution need to be implemented based on clinical characteristics by age and severity to delay and effectively respond to the spread of infections in the future. This study analyzed symptoms of COVID-19 patients across Uzbekistan, which is useful as primary data for policies on COVID-19 in Uzbekistan.