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Rotavirus vaccination was introduced in the United States in 2006. Our objectives were to examine reductions in diarrhea-associated health care utilization after rotavirus vaccine implementation and to assess direct vaccine effectiveness (VE) in US children.Retrospective cohort study using claims data of US children under 5 years of age. We compared rates of diarrhea-associated health care utilization in prevaccine versus postvaccine introduction years. We also examined VE and duration of protection.Compared with the average rate of rotavirus-coded hospitalizations in the prevaccine years, overall vaccine rates were reduced by 75% in 2007 to 2008, 60% in 2008 to 2009, 94% in 2009 to 2010, 80% in 2010 to 2011, 97% in 2011 to 2012, 88% in 2012 to 2013, 98% in 2013 to 2014 and 92% in 2014 to 2015. RotaTeq-adjusted VE was 88% against rotavirus-coded hospitalization among 3–11 months of age, 88% in 12–23 months of age, 87% in 24–35 months of age, 87% in 36–47 months of age and 87% in 48–59 months of age. Rotarix-adjusted VE was 87% against rotavirus-coded hospitalization among 3–11 months of age, 86% in 12–23 months of age and 86% in 24–35 months of age.Implementation of rotavirus vaccines has substantially reduced diarrhea-associated health care utilization in US children under 5 years of age. Both vaccines provided good and enduring protection through the fourth year of life against rotavirus hospitalizations.