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. 2025 Feb 27:48:126726.
doi: 10.1016/j.vaccine.2025.126726. Epub 2025 Jan 14.

Effectiveness of monovalent rotavirus vaccine against hospital-attended rotavirus gastroenteritis among children in Uganda

Hellen Tukamuhebwa Aanyu  1 , Cissy Nalunkuma  2 , Elizabeth Kaudha  3 , Esther Nalumansi  4 , Stephen Gyagenda  2 , Gladys Nakiragga  3 , David Mugisha  4 , Augustine Mulindwa  4 , Annet Kisakye  5 , Tyler Chavers  6 , Goitom G Weldegebriel  7 , Jason M Mwenda  8 , Reggis Katsande  8 , Keith Shaba  8 , Umesh D Parashar  6 , Jacqueline E Tate  6 , Paul A Gastañaduy  9
Affiliations

Effectiveness of monovalent rotavirus vaccine against hospital-attended rotavirus gastroenteritis among children in Uganda

Hellen Tukamuhebwa Aanyu et al. Vaccine. .

Abstract

Background: The underlying causes for lower rotavirus vaccine effectiveness (VE) in high-child-mortality settings are not well understood. Uganda introduced the human monovalent G1P[8] rotavirus vaccine (Rotarix) in June 2018. We determined the effectiveness of Rotarix against rotavirus diarrhea requiring hospital care among Ugandan children.

Methods: We compared the vaccination status of children with laboratory-confirmed rotavirus (cases) and non-rotavirus (controls) diarrhea who were age-eligible to receive Rotarix and admitted to 3 hospitals in Uganda October 2018-December 2022. VE ([1-odds ratio of vaccination among cases and controls] x 100]) was calculated using unconditional logistic regression adjusting for age, birth month-year, and hospital.

Results: Among 187 cases and 622 controls, respectively, 93 % (173/187) and 93 % (579/622) had received ≥1 doses of Rotarix. Adjusted full-series (2 dose) VE against rotavirus diarrhea was 29 % (95 % confidence interval: -37 %-63 %) in children 4-59 months of age. Two-dose VE was 62 % (9 %-84 %) in infants 4-11 months of age and - 69 % (-401 %-43 %) in children 12-59 months of age (P = 0.20). VE against strains partially-heterotypic to the vaccine strain (including G3P[8], the most common curculating genotype) was 59 % (1 %-83 %).

Conclusions: Routine Rotarix vaccination was effective in preventing hospital visits for rotavirus diarrhea among Ugandan infants, although protection was not sustained after the first year of life. Protection was demonstrated against partially heterotypic rotavirus strains. These results support the continued use of rotavirus vaccines in Uganda. Additional studies are needed to understand the lower rotavirus VE seen in Uganda and other high-mortality settings.

Keywords: Diarrhea; Rotavirus; Uganda; Vaccine effectiveness.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow chart depicting enrollment of children aged 4 to 59 months evaluated for acute watery diarrhea at three hospitals in Kampala, Uganda, October 2018–December 2022.
See this image and copyright information in PMC

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