Abstract
BackgroundRotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines.MethodsWe describe the effectiveness of rotavirus vaccines to prevent rotavirus infections and hospitalizations and the main rotavirus strains circulating before and after vaccine introduction through a systematic review and meta-analysis of studies published between 1990 and 2014. 203 studies were included to estimate the proportion of infections due to rotavirus and 10 to assess the impact of the vaccines. 41 of 46 studies in the post-vaccination period were used for meta-analysis of genotypes, 20 to calculate VE against infection, eight for VE against hospitalisation and seven for VE against severe rotavirus-diarrhoea.Results24.3 % (95 % CI 22.1–26.5) and 16.1 % (95 % CI 13.2–19.3) of cases of diarrhoea were due to rotavirus before and after vaccine introduction, respectively. The most prevalent G types after vaccine introduction were G2 (51.6 %, 95 % CI 38–65), G9 (14.5 %, 95 % CI 7–23) and G1 (14.2 %, 95 % CI 7–23); while the most prevalent P types were P[4] (54.1 %, 95 % CI 41–67) and P[8] (33 %, 95 % CI 22–46). G2P[4] was the most frequent genotype combination after vaccine introduction. Effectiveness was 53 % (95 % CI 46–60) against infection, 73 % (95 % CI, 66–78) against hospitalisation and 74 % (95 % CI, 68.0–78.0) against severe diarrhoea. Reductions in hospitalisations and mortality due to diarrhoea were observed in countries that adopted universal rotavirus vaccination.ConclusionsRotavirus vaccines are effective in preventing rotavirus-diarrhoea in children in Latin America. The vaccines were associated with changes in genotype distribution.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0173-2) contains supplementary material, which is available to authorized users.
Highlights
Rotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines
Forty-one of the latter studies were used for genotype meta-analysis
The trials conducted for the registration of the vaccines included a large number of children from middleand high-income countries from Europe, North America and Latin America (LA) and their main end-points focused on severe diarrhoea episodes and hospitalisation
Summary
Rotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines. Diarrhoea is the second most important cause of childhood death worldwide and rotavirus is the pathogen most frequently associated with severe diarrhoea [1]. In 2006, two live-attenuated rotavirus vaccines were licensed [4, 5], which was followed in 2009 by the World Health Organization (WHO) recommendation to include them in the national immunization programmes of all countries with high diarrhoea-related child mortality [6]. The LA region was among the early adopters of the vaccines with 16 countries and one territory introducing at least one of these vaccines in their national immunization programs. National programs have since reported significant reductions in severe rotavirus-diarrhoea episodes, allcause diarrhoea-related hospitalisations and ambulatory consultations [7,8,9]
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