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Review
. 2011 Apr 13;11 Suppl 3(Suppl 3):S16.
doi: 10.1186/1471-2458-11-S3-S16.

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size

Christa L Fischer Walker  1 , Robert E Black
Affiliations
Review

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size

Christa L Fischer Walker et al. BMC Public Health. .

Abstract

Background: Diarrhea mortality remains a leading cause of child death and rotavirus vaccine an effective tool for preventing severe rotavirus diarrhea. New data suggest vaccine efficacy may vary by region.

Methods: We reviewed published vaccine efficacy trials to estimate a regional-specific effect of vaccine efficacy on severe rotavirus diarrhea and hospitalizations. We assessed the quality of evidence using a standard protocol and conducted meta-analyses where more than 1 data point was available.

Results: Rotavirus vaccine prevented severe rotavirus episodes in all regions; 81% of episodes in Latin America, 42.7% of episodes in high-mortality Asia, 50% of episodes in sub-Saharan Africa, 88% of episodes low-mortality Asia and North Africa, and 91% of episodes in developed countries. The effect sizes observed for preventing severe rotavirus diarrhea will be used in LiST as the effect size for rotavirus vaccine on rotavirus-specific diarrhea mortality.

Conclusions: Vaccine trials have not measured the effect of vaccine on diarrhea mortality. The overall quality of the evidence and consistency observed across studies suggests that estimating mortality based on a severe morbidity reduction is highly plausible.

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Figures

Figure 1
Figure 1
Forest plot for the effect of rotavirus vaccine as compared to placebo on severe rotavirus gastroenteritis among children living in sub-Saharan Africa
Figure 2
Figure 2
Forest plot for the effect of rotavirus vaccine as compared to placebo on severe rotavirus gastroenteritis among children living in low mortality* Asian and North African countries * Low mortality defined as countries with an under 5 mortality rate less than 25 per 1000 live births
Figure 3
Figure 3
Forest plot for the effect of rotavirus vaccine as compared to placebo on severe rotavirus gastroenteritis among children living in developed* countries * Developed countries defined as countries in the North American and European regions with an under 5 mortality rate less than 25 per 1000 live births
Figure 4
Figure 4
Country level* vaccine efficacy against severe rotavirus diarrhea incidence and 2009 under five mortality * Country level data used when possible. Linhares et al, Vesikari et al (2006 & 2007) and Phua et al do not provide country level data. For these papers we present overall vaccine efficacy and median under 5 mortality rate for countries included in analysis.
Figure 5
Figure 5
Final effect sizes for severe rotavirus gastroenteritis as a proxy for rotavirus specific mortality by region
See this image and copyright information in PMC

References

    1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R. et al.Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet. 2010;375(9730):1969–1987. doi: 10.1016/S0140-6736(10)60549-1. - DOI - PubMed
    1. Parashar UD, Gibson CJ, Bresse JS, Glass RI. Rotavirus and severe childhood diarrhea. Emerg Infect Dis. 2006;12(2):304–306. - PMC - PubMed
    1. Munos MK, Walker CL, Black RE. The effect of rotavirus vaccine on diarrhoea mortality. Int J Epidemiol. 2010;39(Suppl 1):i56–62. doi: 10.1093/ije/dyq022. - DOI - PMC - PubMed
    1. Soares-Weiser K, Goldberg E, Tamimi G, Pitan OC, Leibovici L. Rotavirus vaccine for preventing diarrhoea. Cochrane Database Syst Rev. 2004. p. CD002848. - PMC - PubMed
    1. Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, Ngwira B, Victor JC, Gillard PH, Cheuvart BB. et al.Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med. 2010;362(4):289–298. doi: 10.1056/NEJMoa0904797. - DOI - PubMed

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