Abstract
Safety, efficacy, and cost-effectiveness are paramount to vaccine development. Following the isolation of rotavirus particles in 1969 and its evidence as an aetiology of severe dehydrating diarrhoea in infants and young children worldwide, the quest to find not only an acceptable and reliable but cost-effective vaccine has continued until now. Four live-attenuated oral rotavirus vaccines (LAORoVs) (Rotarix®, RotaTeq®, Rotavac®, and RotaSIIL®) have been developed and licensed to be used against all forms of rotavirus-associated infection. The efficacy of these vaccines is more obvious in the high-income countries (HIC) compared with the low- to middle-income countries (LMICs); however, the impact is far exceeding in the low-income countries (LICs). Despite the rotavirus vaccine efficacy and effectiveness, more than 90 countries (mostly Asia, America, and Europe) are yet to implement any of these vaccines. Implementation of these vaccines has continued to suffer a setback in these countries due to the vaccine cost, policy, discharging of strategic preventive measures, and infrastructures. This review reappraises the impacts and effectiveness of the current live-attenuated oral rotavirus vaccines from many representative countries of the globe. It examines the problems associated with the low efficacy of these vaccines and the way forward. Lastly, forefront efforts put forward to develop initial procedures for oral rotavirus vaccines were examined and re-connected to today vaccines.
Highlights
Overview of Rotavirus ParticlesRotavirus (RV) is an icosahedral non-enveloped Reoviridae family member with six structural proteins called viral proteins (VP) and six non-structural proteins (NSP)
Rotavirus can exist in three different forms; the single-layered particle (SLP), which consists of the VP2 enclosing the genomic materials and scaffolding the transcriptional enzymes, the double-layered particle (DLP), which consists of the VP6 enclosing the VP2, and the triple-layered particle (TLP), which consists of the VP7 that encloses the VP6 and VP2 [8] (Figure 1)
Demonstration that an antibody in the animal lumen could offer protection against RVI and that natural multiple rotavirus infections in human can induce heterotypic protection constituted an eyeopener than encouraged the development of live-attenuated oral rotavirus vaccines (LAORoVs) [66,67]
Summary
Rotavirus (RV) is an icosahedral non-enveloped Reoviridae family member with six structural proteins called viral proteins (VP) and six non-structural proteins (NSP). By interpretation, ≈1 out of 2 children globally has access to RoVs. Besides, various reports have indicated lower efficacies of Rotarix® and RotaTeq® vaccines in sub-Saharan Africa and parts of Asia, which are the two regions of the world with the highest-burden of RVI, accounting for more than 90% of the total global infections [38,39]. The current award price/dose/product/supplier/calendar year for RoVs given to the 64 GAVI-eligible countries through UNICEF procurement are as follows: Rotarix® (USD 2.10 per dose), RotaTeq® (USD 3.2 per dose), Rotavac® (USD 0.85 per dose), and RotaSIIL® (USD 0.95 per dose) [37,46]. Forecasting data analysis had shown that if RoVs are implemented just in the GAVI-eligible countries only, over 600,000 deaths related to diarrhoea and rotavirus-related infections can be averted and save over USD 900 million. Apart from these associated challenges, the choice of RoV is constantly being restrained due to the financial status of the affected countries (the majority of which are LICs), government policies, and law-makers [65]
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