From the Journals

Rotavirus vaccination in last decade cuts AGE hospitalization

Publish date: April 27, 2017
By
Catherine Cooper Nellist

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Data support vaccine introduction decisions

Decisions to introduce a new vaccine into a number of national immunization programs are influenced by many factors, including local disease burden, vaccine efficacy and safety, and the cost-effectiveness of the vaccines.

Introduction of rotavirus vaccination never started in earnest in Asia, a region with large birth cohort countries carrying substantial disease, but that lack has now turned an important corner, with India, Pakistan, and Bangladesh implementing or planning to implement rotavirus vaccination.

Also, two large African countries with high rotavirus mortality, Nigeria and Democratic Republic of Congo, are approved for Gavi (the Vaccine Alliance) funding to introduce the vaccines in 2018. The dramatic impact of rotavirus vaccines on rotavirus-associated hospitalizations and deaths described by Burnett et al. support the decisions by these large countries with high rotavirus mortality to introduce rotavirus vaccines and will lead to greater global health impacts.

Countries considering rotavirus vaccine introduction now will increasingly have additional data on vaccine safety and effectiveness. Burnett and her colleagues’ review will likely provide important information to these national immunization technical advisory groups and other decision-making bodies. This review will also be important for the earlier-adopter countries by way of validating their earlier introduction decisions.

Finally, the information will be of value to Gavi, UNICEF, and other international bodies tasked with providing resources and support for rotavirus vaccine introduction in low-income and lower-middle income countries.

Anthony Nelson, MD , is in the department of paediatrics at the Chinese University of Hong Kong, and Duncan Steele, PhD, is at the Bill & Melinda Gates Foundation, Seattle. These comments were excerpted from an editorial accompanying the article by Burnett et al. ( J Infect Dis. 2017 Apr 18. doi: 10.1093/infdis/jix187 ). The authors had no conflicts of interest or funding to disclose.


 

FROM THE JOURNAL OF INFECTIOUS DISEASES

There have been important reductions in hospitalization for acute gastroenteritis (AGE) and mortality since licensure of rotavirus vaccines 10 years ago, even in low-income countries with high child mortality, according to a new analysis of data from 27 countries.

In a search of articles published between Jan. 1, 2006, and Dec. 6, 2016, in the PubMed database, Eleanor Burnett of the division of viral diseases at the National Center for Immunization and Respiratory Diseases, Atlanta, and her associates identified 57 articles reporting on 59 data sources from 27 countries.

A transmission electron micrograph shows intact rotavirus double-shelled particles. CDC/Dr. Erskine Palmer

A transmission electron micrograph shows intact rotavirus double-shelled particles.

Among children younger than 1 year, the median percent reduction in AGE hospitalizations and/or emergency department visits was 32% overall and 36%, 28%, and 33% in countries with low, medium, and high child mortality, respectively.

Among children younger than 5 years, the median percent reduction in AGE hospitalizations and/or ED visits was 38% overall, and 41%, 30%, and 46% in countries with low, medium, and high child mortality, respectively.

The median reduction in AGE mortality among children younger than 1 year was 31% overall. In countries with medium and high child mortality, it was 45% and 30%, respectively.

The median reduction in AGE mortality in children younger than 5 years was 42% overall. In countries with medium and high child mortality, it was 50% and 36%, respectively. No estimates have been published from countries with low child mortality (J Infect Dis. 2017 Apr 18. doi: 10.1093/infdis/jix186).

“In several, but not all studies, we observed reductions in rotavirus and AGE hospitalizations in age groups explicitly not eligible for vaccination, indicating evidence of indirect protection,” Ms. Burnett and her associates said. This population was not directly assessed in the studies.

The authors had no funding or conflicts of interest to disclose.

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