Global rotavirus vaccine introductions and coverage: 2006 – 2016

Alice J Abou-Nader,Molly A Sauer,A Duncan Steele,Jacqueline E Tate,Deborah Atherly,Umesh D Parashar,Mathuram Santosham,E Anthony S Nelson

doi:10.1080/21645515.2018.1470725

Abstract

ABSTRACTAn estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and lower-middle income countries. Since 2009 the World Health Organization (WHO) recommends the use of rotavirus vaccines in all national immunization programs. This review compares rotavirus vaccine (RV) introductions and vaccine coverage by region, country income status and Gavi-eligibility from 2006–2016. Gross National Income data from the World Bank and surviving infant population from United Nations Population Division was obtained for 2016. Data from WHO were collected on rotavirus vaccine coverage, national immunization schedules, and new vaccine introductions for 2016 while estimated rotavirus deaths were collected for 2013, the last year of available WHO data. As of December 2016, the majority of countries (57%, 110/194) had not introduced universal rotavirus vaccine despite WHO's 2009 recommendation to do so. Countries in the WHO African region had the greatest proportion of introductions (37%, 31/84) by December 2016 and a great majority of these (77%, 24/31) were supported by new vaccine introduction (NVI) grants from Gavi. Almost half (48%) of global introductions were in low and lower-middle income Gavi-eligible and Gavi-graduating countries. Conversely, countries in the Southeast Asia WHO region and those not eligible for Gavi NVI support have been slow to introduce rotavirus vaccine. High-income countries, on average, had poorer rotavirus vaccine coverage compared to low and lower-middle income countries. The over-representation of African countries within the Gavi subset and high estimated rotavirus deaths in these African countries, likely explains why introduction efforts have been focused in this region. While much progress has been made with the integration and implementation of rotavirus vaccine into national immunization programs, 110 countries representing 69% of the global birth cohort had yet to introduce the vaccine by December 2016.

Highlights

Deaths caused by rotavirus infection are largely preventable through immunization
Half (49%) of these deaths were in India, Nigeria, Pakistan, and the Democratic Republic of Congo,[1] which are low and lower-middle income countries (LICs and Lower-middle Income Countries (LMICs)) eligible to receive financial assistance from Gavi through new vaccine introduction (NVI) grants
World Health Organization (WHO) position papers recommend that National Immunization Technical Advisory Groups (NITAGs) consider cost-effectiveness and the local disease burden when considering whether rotavirus vaccine should be introduced into the National Immunization Programs (NIP)

Summary

Introduction

Deaths caused by rotavirus infection are largely preventable through immunization. An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide.[1]. Half (49%) of these deaths were in India, Nigeria, Pakistan, and the Democratic Republic of Congo,[1] which are low and lower-middle income countries (LICs and LMICs) eligible to receive financial assistance from Gavi through new vaccine introduction (NVI) grants. In 2009, following efficacy studies in LICs and LMICs in Africa and Asia, WHO recommended that all countries introduce rotavirus vaccine into their National Immunization Programs (NIP).[4]. In Europe, approximately 30% (526/1,736) of estimated rotavirus deaths took place in the 14 non-introducing UMICs (Albania, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Croatia, Kazakhstan, Macedonia, Montenegro, Romania, Russia, Serbia, Turkey, Turkmenistan). This is the only income-group in the region that has not had a single rotavirus vaccine introduction by 2016. UNICEF - JRF datasets aInclusion of rotavirus vaccine in National Immunization Programs collected from the WHO/UNICEF - JRF dataset, downloaded on July 7, 2017 bCountry reported rotavirus vaccine coverage estimates for Rota[1] and Rota[2-3] reported from 2008-16 collected from the WHO/UNICEF - JRF dataset, downloaded on July

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