Abstract
Rotavirus claims thousands of lives of children globally every year with a disproportionately high burden in low- and lower-middle income countries where access to health care is limited. Oral, live-attenuated rotavirus vaccines have been evaluated in multiple settings in both low- and high-income populations and have been shown to be safe and efficacious. However, the vaccine efficacy observed in low-income settings with high rotavirus and diarrheal mortality was significantly lower than that seen in high-income populations where rotavirus mortality is less common. Rotavirus vaccines have been introduced and rolled out in more than 112 countries, providing the opportunity to assess effectiveness of the vaccines in these different settings. We provide an overview of the efficacy, effectiveness, and impact of rotavirus vaccines, focusing on high-mortality settings and identify the knowledge gaps for future research. Despite lower efficacy, rotavirus vaccines substantially reduce diarrheal disease and mortality and are cost-effective in countries with high burden. Continued evaluation of the effectiveness, impact, and cost–benefit of rotavirus vaccines, especially the new candidates that have been recently approved for global use, is a key factor for new vaccine introductions in countries, or for a switch of vaccine product in countries with limited resources.
Highlights
Academic Editors: Vincenzo BaldoGlobal surveillance data show that nearly 40% of diarrheal hospitalizations among children under 5 years of age are rotavirus-related and that diarrhea continues to be a leading cause of mortality in children [1,2]
The number of severe rotavirus gastroenteritis episodes averted in the first year of life was greater in Malawi (8.4 episodes prevented per 100 children vaccinated) than in South Africa (2.5 episodes prevented per 100 children vaccinated), even though the efficacy estimates were lower in Malawi (49.4%; 95% CI: 19.2–68.3) in comparison to South Africa (76.9%; 95% CI: 56.0–88.4) [15]
Multiple factors beyond the vaccine price including the costs of delivery, cold chain volume, product presentation, doses per the schedule, and vaccine wastage need to be systematically assessed before making a choice, but it is clear that rotavirus vaccination is advantageous as compared to standard treatment regimes in high-mortality countries [92]
Summary
VE: vaccine effectiveness; CI, confidence interval; ND, no data. VE is calculated for completes series. Based on a time-series analysis from Rwanda, diarrheal hospitalizations dropped by 29% in the first year following vaccine introduction, rising to 47% when analyzing data only for the rotavirus season [75]. In India (unpublished data), a substantial drop in rotavirus hospitalization by 40–50% was observed in 2–5-year-old children with Rotavac. No such indirect effects were reported from Bangladesh [36]. Multiple factors beyond the vaccine price including the costs of delivery, cold chain volume, product presentation, doses per the schedule, and vaccine wastage need to be systematically assessed before making a choice, but it is clear that rotavirus vaccination is advantageous as compared to standard treatment regimes in high-mortality countries [92]
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