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. 2025 Aug 14;232(2):308-315.
doi: 10.1093/infdis/jiae597.

Rotavirus Vaccine Effectiveness Stratified By National-Level Characteristics: An Introduction to the 24-Country MNSSTER-V Project, 2007-2023

Eleanor Burnett  1 , Jazmina Umana  2 , Palwasha Anwari  3 , Hilda A Mujuru  4   5 , Michelle J Groome  6 , Nguyen Van Trang  7 , Volga Iniguez  8 , Stela Gheorghita  9 , Gayane Sahakyan  10 , Anvar Nazurdinov  11 , Fausta Michael  12 , Inacio Mandomando  13 , Anne Marie Desormeaux  14 , Umid Eraliev  15 , Christabel Enweronu-Laryea  16 , Cissy Nalunkuma  17 , Isidore Bonkoungou  18 , Khitam Muhsen  19 , Christophe Luhata Lungayo  20 , Richard Omore  21 , David M Goldfarb  22 , Annick Lalaina Robinson  23 , John McCracken  24 , Jeannine Uwimana  25 , Kofi N'Zue  26 , Gloria Rey-Benito  27 , Goitom Weldegebriel  28 , Jason M Mwenda  29 , Umesh D Parashar  1 , Jacqueline E Tate  1
Affiliations

Rotavirus Vaccine Effectiveness Stratified By National-Level Characteristics: An Introduction to the 24-Country MNSSTER-V Project, 2007-2023

Eleanor Burnett et al. J Infect Dis. .

Abstract

Background: Rotavirus vaccines are moderately protective against illness in settings with high compared with low mortality rates. Vaccine effectiveness (VE) evaluations may clarify our understanding of these disparities, but estimates among key subpopulations and against rare outcomes are not available in many analyses due to sample size. We combined 25 data sets from test-negative design case-control evaluations in 24 countries that enrolled children with medically attended diarrhea, laboratory-confirmed rotavirus stool testing, and documented vaccination status. We calculated rotavirus VE stratified by country-level characteristics.

Methods: Children 3-59 months old with birthdates and surveillance hospital arrival dates were included; other variables were standardized as available. Children were considered vaccinated if they received ≥1 dose of rotavirus vaccine >14 days before arrival. We summarized child- and country-level characteristics, including national <5-year-old mortality rate (U5M). Following the manufacturer recommended dose schedule, complete- and partial-series adjusted VE were estimated using logistic regression models.

Results: We included 6626 rotavirus-positive children (case patients) and 19 459 rotavirus negative children (controls). Adjusted complete-series VE was significantly higher among children from countries in the low and medium U5M stratum (74% [95% confidence interval, 64%-81%]) compared with all groups within the high U5M stratum (range, 52% [42%-60%]) to 46% [31%-57%]). Partial-series estimates were lower than complete-series estimates.

Conclusions: These findings are consistent with the published literature, though they suggest heterogeneity in vaccine performance within broad child mortality rate levels. Our findings also highlight the importance of complete-series vaccination.

Keywords: diarrhea; immunization; rotavirus; rotavirus vaccine; vaccine.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Number of children 3–59 months old included in the pooled analytic dataset by country, MNSSTER-V Project.
Figure 2.
Figure 2.
Adjusted rotavirus vaccine effectiveness against rotavirus diarrhea estimates with 95% confidence intervals (95%CI) for selected subgroups, MNSSTER-V Project. a Vaccine effectiveness b World Health Organization Region c Categorization of 2015 UNICEF overall <5-year-old child mortality estimates d 2022 level of Gavi support
See this image and copyright information in PMC

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