Global Experience With Rotavirus Vaccines

Abstract

Rotavirus is a major cause of severe pediatric diarrhea worldwide. In 2006, 2 live, oral rotavirus vaccines, Rotarix and RotaTeq, were licensed for use in infants and were rapidly adopted in many high- and middle-income settings where efficacy had been demonstrated in clinical trials. Following completion of successful trials in low-income settings, the World Health Organization (WHO) recommended rotavirus vaccination for all infants globally in 2009. In 2018, 2 new rotavirus vaccines, Rotasiil and Rotavac, were prequalified by WHO, expanding global availability. As of March 2021, rotavirus vaccines have been introduced nationally in 106 countries. Since, Rotavirus vaccines have demonstrated effectiveness against severe disease and mortality, even among age groups in eligible for vaccination. Cross-genotypic protection has been demonstrated, and the favorable benefit-risk profile of these vaccines continues to be confirmed. Ongoing research seeks to better understand reasons for the geographic disparities in effectiveness observed, in order to optimize vaccine strategies worldwide.

Keywords: acute gastroenteritis; pediatric gastroenteritis; rotavirus; rotavirus vaccines; vaccine effectiveness; vaccine-preventable disease.

Figure 1.

Vaccine impact (episodes prevented) and vaccine efficacy by country: Malawi and South Africa. Adapted from Madhi et al 2010 [25] analysis of clinical trial data collected 2005–2007.

Figure 2.

Estimates of incidence rate ratio for intussusception in the 1–7 days following rotavirus vaccine administration, using the self-controlled case series method, by country and dose [34, 36, 39, 40–42]. Study data from 2006 through 2016. Dots indicate point estimates for incidence rate ratios, and lines and whiskers indicate 95% confidence intervals. Abbreviations: AFRO = African Rotavirus Surveillance Network Countries (Ethiopia, Ghana, Kenya, Malawi, Tanzania, Zambia, and Zimbabwe); UK = United Kingdom.

Figure 3.

Map of rotavirus vaccine introductions by country, with program status (universal vs regional vs none).