Rotavirus vaccines in routine use

Abstract

Vaccines are now available to combat rotavirus, the most common cause of severe diarrhea among children worldwide. We review clinical trial data for available rotavirus vaccines and summarize postlicensure data on effectiveness, impact, and safety from countries routinely using these vaccines in national programs. In these countries, rotavirus vaccines have reduced all-cause diarrhea and rotavirus hospitalizations by 17%-55% and 49%-92%, respectively, and all-cause diarrhea deaths by 22%-50% in some settings. Indirect protection of children who are age-ineligible for rotavirus vaccine has also been observed in some high and upper middle income countries. Experience with routine use of rotavirus vaccines in lower middle income countries has been limited to date, but vaccine introductions in such countries have been increasing in recent years. The risk-benefit analysis of rotavirus vaccines is extremely favorable but other strategies to improve the effectiveness of the vaccine, particularly in lower middle income settings, should be considered.

Keywords: rotavirus; rotavirus vaccine.

Figure 1.

Countries that have introduced rotavirus vaccine into their national immunization program through 31 March 2014, by income level*. *Income level based on World Bank classification[123] Figure created from data in ref[68]

Figure 2.

Percent reduction in the number of a) diarrhea deaths, b) diarrhea hospitalizations, and c) rotavirus hospitalizations in children <5 years of age following rotavirus vaccine introduction by country income level. (Note: for papers which reported percent reduction separately by year, individual bars were included for each data point).

Figure 2.

Percent reduction in the number of a) diarrhea deaths, b) diarrhea hospitalizations, and c) rotavirus hospitalizations in children <5 years of age following rotavirus vaccine introduction by country income level. (Note: for papers which reported percent reduction separately by year, individual bars were included for each data point).

Figure 2.

Percent reduction in the number of a) diarrhea deaths, b) diarrhea hospitalizations, and c) rotavirus hospitalizations in children <5 years of age following rotavirus vaccine introduction by country income level. (Note: for papers which reported percent reduction separately by year, individual bars were included for each data point).

Figure 3.

Vaccine effectiveness against rotavirus hospitalizations (Note: for papers which reported multiple vaccine effectiveness estimates, individual bars were included for each estimate)