Abstract
BackgroundRotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination. Since 2006 there have been two licensed vaccines available; with successful clinical trials leading the World Health Organization to recommend rotavirus vaccination for all children worldwide. In order to inform immunisation policy we have conducted a systematic review and meta-analysis of observation studies to assess population effectiveness against acute gastroenteritis.MethodsWe systematically searched PubMed, Medline, Web of Science, Cinhal and Academic Search Premier and grey literature sources for studies published between January 2006 and April 2014. Studies were eligible for inclusion if they were observational measuring population effectiveness of rotavirus vaccination against health care attendances for rotavirus gastroenteritis or AGE. To evaluate study quality we use used the Newcastle-Ottawa Scale for non-randomised studies, categorising studies by risk of bias. Publication bias was assessed using funnel plots. If two or more studies reported a measure of vaccine effectiveness (VE), we conducted a random effects meta-analysis. We stratified analyses by World Bank country income level and used study quality in sensitivity analyses.ResultsWe identified 30 studies, 19 were from high-income countries and 11 from middle-income countries. Vaccine effectiveness against hospitalization for laboratory confirmed rotavirus gastroenteritis was highest in high-income countries (89% VE; 95% CI 84-92%) compared to middle-income countries (74% VE; 95% CI 67-80%). Vaccine effectiveness was higher for those receiving the complete vaccine schedule (81% VE; 95% CI 75-86%) compared to partial schedule (62% VE; 95% CI 55-69%). Two studies from high-income countries measured VE against community consultations for AGE with a pooled estimate of 40% (95% CI 13-58%; 2 studies).ConclusionsWe found strong evidence to further support the continued use of rotavirus vaccines. Vaccine effectiveness was similar to that reported in clinical trials for both high and middle-income countries. There is limited data from Low income settings at present. There was lower effectiveness against milder disease. Further studies, should continue to report effectiveness against AGE and less-severe rotavirus disease because as evidenced by pre-vaccine introduction studies this is likely to contribute the greatest burden on healthcare resources, particularly in high-income countries.
Highlights
Rotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination
A study by Mast et al, [16] measuring vaccine effectiveness against rotavirus gastroenteritis (RVGE) hospitalisation and emergency department (ED) attendances included only cases with severe disease defined by a Vesikari score of greater than 11 in their VE estimate [16, 46, 47]
The study by Fontes Vieira et al 2011 conducted in Brazil on a community cohort examined effectiveness of vaccination against laboratory confirmed RVGE but did not report an estimate of VE; a crude estimate was calculated by the authors [17]
Summary
Rotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination. Rotavirus gastroenteritis (RVGE) was estimated to be responsible for 453,000 deaths worldwide in children under 5 years of age in 2008, with over 90% of deaths occurring in low-income countries [1]. In middle and high income countries without vaccination the burden of RVGE remains substantial in infants and young children with high rates of disease and RV the major contributor to diarrhoea hospitalisation. The large majority of severe RVGE occurs among young children, older children and adults can be affected, rotavirus infection often causes milder symptoms or is asymptomatic in these ages, meaning the true burden and rate of disease incidence is poorly understood
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