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Original Article
- Childhood mortality from acute diarrheal disease in Paraguay and vaccination impact: a 31-year ecological study
- María Eugenia Galeano, Magaly Martínez, Anibal Francisco Espínola, Eliana Andrea Alvarenga, Margarita Samudio
- Epidemiol Health. 2026;48:e2026010. Published online February 20, 2026
- DOI: https://doi.org/10.4178/epih.e2026010
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AbstractOBJECTIVES
Acute diarrheal disease (ADD) remains a leading cause of morbidity and mortality in children under 5 worldwide. In Paraguay, the introduction of the rotavirus vaccine in 2010 aimed to reduce the burden of ADD in infants and young children. This study analyzed 31 years of public data on ADD morbidity and mortality in Paraguayan children under 5 and evaluated the impact of rotavirus vaccination.METHODSAnnual ADD incidence, total deaths, and mortality rates from 1993 to 2023 were obtained from public databases. Proportionate mortality due to ADD, cause-specific mortality rates, absolute risk reduction (ARR) and relative risk reduction (RRR), and joinpoint regression were calculated using EPIDAT 4.2 and Joinpoint 5.3.0 software, with data stratified by age group and vaccination period.RESULTSBetween 1993 and 2021, pediatric mortality in Paraguay declined steadily across all age groups. Following the introduction of Rotarix in 2010, infant mortality dropped from 2.36 to 0.19 deaths per 1,000 live births (ARR, 0.83; RRR, 81.4%). Joinpoint analysis showed a decline in under-5 mortality between 2009 and 2012 (annual percentage change=−35.2%, p<0.05), followed by stabilization. ADD incidence increased until 2019 and then declined, while vaccine coverage exceeded 70%.CONCLUSIONSParaguay has sustained declines in infant and childhood mortality over 3 decades through improvements in healthcare and immunization, with the 2010 introduction of Rotarix reducing the mortality rate by 43 deaths per 100,000 infants under 12 months. These results underscore the impact of vaccination and health system strengthening, while highlighting the need to monitor emerging threats. -
SummaryKey Message
Despite the introduction of rotavirus vaccination in Paraguay, long-term trends in acute diarrheal disease remained understudied. This 31-year analysis reveals a substantial decline in ADD-specific mortality following vaccine implementation, especially in children aged 1-4. However, ADD incidence resurged after 2013, highlighting gaps in disease control beyond vaccination. These findings underscore the vaccine’s impact while exposing the need for integrated surveillance and broader public health strategies to sustain progress and address residual disease burden.
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