Post-licensure experience with rotavirus vaccination in high and middle income countries; 2006 to 2011☆
Highlights
► Since 2006 approximately thirty countries have introduced rotavirus vaccines into their immunization programs. ► Major reductions in rotavirus hospitalizations have occurred. ► In select countries there have been impacts on gastroenteritis mortality associated with rotavirus vaccine introduction. ► Indirect benefits (i.e. herd immunity) have been conferred to unvaccinated children as well as older age groups.
Section snippets
Vaccine effectiveness and impact
A number of assessments of vaccine effectiveness against severe rotavirus disease have been undertaken using observational methods (e.g. case-control and cohort studies), and these studies have confirmed good vaccine performance in routine use (for a thorough review, see [8, 9, 10, 11]). In high income countries such as the United States [12], Australia [13••], Austria [14] and Israel [15], vaccine effectiveness was on par with estimates from the clinical trials (>85%) and was sustained through
Strain-specific vaccine effectiveness and potential evolutionary pressure of vaccination
Based on the pre-licensure clinical trial data, there was some controversy as to whether RV1 provided a high level of protection against the completely heterotypic G2P[4] genotype. In the Latin American trials, VE against G2P[4] was estimated at 41% (95% CI −79% to 82%) [38]; although the number of cases from this strain was small and the trial was not powered to measure VE against G2P[4]. In Europe, VE was measured to >85% against severe rotavirus gastroenteritis caused all G types through the
Intussusception
While pre-licensure trials of RV5 and RV1 did not show a risk of intussusception (in a 42 or 31 day window after vaccination, respectively), they were only able to evaluate a level of risk similar to that observed with the Rotashield vaccine (1 in 10 000 vaccinees) [43, 48]; thus, on-going monitoring is important to assess the possibility of a smaller risk or risk in small time-windows. Indeed, post-licensure evaluations in Mexico (RV1) and in Australia (RV5 and RV1) have both detected a lower
Future directions
Below we outline a number of the key remaining issues for middle and high income settings and highlight where these overlap with challenges in low-income settings. [Developing country-specific challenges will be discussed in detail by Babji and Kang, in this issue [61].
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While both vaccines have provided good protection against a broad range of circulating homotypic and heterotypic rotavirus strains, the question of whether vaccination will exert a selective pressure and promote the emergence of
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
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Cited by (0)
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Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.