posts: 26801

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    "id": "wp-26801",
    "slug": "untitled-reusable-block-106",
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                        "text": "The first widely-used rotavirus vaccine was approved in the United States in 2006. Today, there are four oral rotavirus vaccines recommended for use by the World Health Organisation (WHO): Rotarix, RotaTeq, RotaSiil, and Rotavac.{ref}World Health Organization. (2019). ",
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                                "text": "Rotavirus",
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                        "text": ". [online] Available at: ",
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                    {
                        "url": "https://www.who.int/immunization/diseases/rotavirus/en/",
                        "children": [
                            {
                                "text": "https://www.who.int/immunization/diseases/rotavirus/en/",
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                        "text": " [Accessed 14 Aug. 2019].{/ref}",
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                        "text": " Rotarix and RotaTeq are the most widely used and both have shown good efficacy against rotavirus infections in clinical trials.{ref}Ruiz-Palacios, G. M., P\u00e9rez-Schael, I., Vel\u00e1zquez, F. R., Abate, H., Breuer, T., Clemens, S. C., \u2026 & Cervantes, Y. (2006). ",
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                    {
                        "url": "https://www.nejm.org/doi/full/10.1056/nejmoa052434",
                        "children": [
                            {
                                "text": "Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis",
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                    {
                        "text": ". ",
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                        "children": [
                            {
                                "text": "New England Journal of Medicine",
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                        "text": ", ",
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                                "text": "354",
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                        "text": "(1), 11-22.{/ref}{ref}Vesikari, T., Matson, D. O., Dennehy, P., Van Damme, P., Santosham, M., Rodriguez, Z., \u2026 & Shinefield, H. R. (2006). ",
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                    },
                    {
                        "url": "https://www.nejm.org/doi/full/10.1056/nejmoa052664",
                        "children": [
                            {
                                "text": "Safety and efficacy of a pentavalent human\u2013bovine (WC3) reassortant rotavirus vaccine",
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                            }
                        ],
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                        "text": ". ",
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                        "children": [
                            {
                                "text": "New England Journal of Medicine",
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                        "text": ", ",
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                        "children": [
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                                "text": "354",
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                        "text": "(1), 23-33.{/ref}",
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                        "text": "Since the use of rotavirus vaccines have been approved, they have had a notable impact on the reduction of rotavirus-related deaths. According to a study published in 2018, the use of rotavirus vaccines prevented approximately 28,900 child deaths globally in 2016. However, as the chart shows, full vaccine use \u2013 that is a 100% coverage globally \u2013 could have prevented an additional 83,200 deaths.{ref}Troeger, C., Khalil, I. A., Rao, P. C., Cao, S., Blacker, B. F., Ahmed, T., \u2026 & Kang, G. (2018). ",
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                        "url": "https://jamanetwork.com/journals/jamapediatrics/fullarticle/2696431",
                        "children": [
                            {
                                "text": "Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years",
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                        ],
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                    },
                    {
                        "text": ". ",
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                        "children": [
                            {
                                "text": "JAMA Pediatrics",
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                        "spanType": "span-italic"
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                        "text": ", ",
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                                "text": "172",
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                        "text": "(10), 958-965.{/ref} This means that, even at the current rates of efficacy, 53% of all deaths in children under-5 from rotavirus in 2016 could have been avoided by full vaccine coverage. ",
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                        "text": "In addition to saving lives, the rotavirus vaccine also reduces the burden on healthcare systems. Between 2008 and 2016 the introduction of the rotavirus vaccine has reduced the number of diarrhea-related hospital admissions on average by 40%.{ref}Aliabadi, Negar, et al. ",
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                    {
                        "url": "https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30207-4/fulltext",
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                            {
                                "text": "\"Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008\u201316: findings from the Global Rotavirus Surveillance Network.\"",
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                            }
                        ],
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                        "children": [
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                                "text": "The Lancet Global Health",
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                    {
                        "text": "7.7 (2019): e893-e903.{/ref}",
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                "url": "https://ourworldindata.org/grapher/avertable-deaths-from-rotavirus-with-full-vaccine-coverage",
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                "text": [
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                        "text": "Rotavirus vaccine could save the lives of even more children",
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                        "text": "If there is so much scope for saving more children\u2019s lives, what is the reason that these children are still dying?",
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                        "text": "There are two key barriers to achieving the full potential of the rotavirus vaccine: immunization rates, and the efficacy of the vaccine in specific regions.",
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                "text": [
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                        "text": "Immunisation rates are still too low",
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                        "text": "According to the WHO, by the end of 2018, 101 countries were using the rotavirus vaccine. The major drivers for the introduction of the vaccine are the burden of diarrheal diseases, the availability of funding, and a favourable political climate for vaccines.{ref}",
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                        "text": "The cost of rotavirus vaccines varies by country. For example, countries with a gross national income per capita of less than US$1,000 receive subsidies from the Global Alliance for Vaccines and Immunisation, and there the cost per dose is ",
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                        "url": "https://www.unicef.org/supply/files/Rotavaccine.pdf",
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                                "text": "set between US$2.10 - 3.20",
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                        "text": ". With additional co-financing options can reduce the costs ",
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                    {
                        "url": "https://www.sabin.org/sites/sabin.org/files/frederic_debellut.pdf",
                        "children": [
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                                "text": "down to US$0.13",
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                        "text": ". In high-income countries, such as the US, the cost per dose is between ",
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                        "url": "https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html",
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                                "text": "US$70 and 95",
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                        "text": "Countries are more likely to introduce the vaccine if the political environment is favourably disposed towards them. For example, if a country has set a high priority on achieving the Millennium Development Goal targets or the introduction of vaccines is seen as a positive news story, especially during election years.",
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                        "text": "Burchett, H. E. D., Mounier-Jack, S., Griffiths, U. K., Biellik, R., Ongolo-Zogo, P., Chavez, E., \u2026 & Molla, M. (2012). ",
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                    {
                        "url": "https://academic.oup.com/heapol/article/27/suppl_2/ii5/594662",
                        "children": [
                            {
                                "text": "New vaccine adoption: qualitative study of national decision-making processes in seven low-and middle-income countries",
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                        "text": ". ",
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                        "children": [
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                                "text": "Health policy and planning",
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                        "text": ", ",
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                                "text": "27",
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                        "text": "(suppl_2), ii5-ii16.{/ref}",
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                        "text": " The vaccine is only given to children \u2013 it\u2019s recommended that the vaccination should be initiated 15 weeks after birth and finished by the 32nd week. However, the global coverage is still very low: it is estimated that just 35% of under one-year-olds were vaccinated in 2018.{ref}World Health Organization (2019). ",
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                        "children": [
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                                "text": "Immunization coverage",
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                        "text": ". [online] Available at: ",
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                    {
                        "url": "https://www.who.int/news-room/fact-sheets/detail/immunization-coverage",
                        "children": [
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                                "text": "https://www.who.int/news-room/fact-sheets/detail/immunization-coverage",
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                        "text": " [Accessed 14 Aug. 2019].{/ref}",
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                        "text": "The map shows the WHO estimates on the share of one-year olds who received the full recommended dosage of the vaccine (two immunizations for Rotarix vaccine or three immunizations for RotaTeq vaccine). For many countries where data coverage is low, it\u2019s expected that the share of infants receiving the vaccine is very low. Some countries however did see rapid increases in rates of immunization. In a period of only a few years countries including ",
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                        "url": "https://ourworldindata.org/grapher/share-of-one-year-olds-who-received-the-rotavirus-vaccine?tab=chart&time=2011..2018&country=SDN+GMB+MWI",
                        "children": [
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                                "text": "Sudan, Malawi and Gambia",
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                    {
                        "text": " have increased immunisation rates from below 10% to 80-95% \u2013 click on the country to see the change over time.",
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                "text": [
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                        "text": "Vaccine efficacy differs by region",
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                        "text": "Since most ",
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                        "url": "https://ourworldindata.org/grapher/child-deaths-from-rotavirus",
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                                "text": "rotavirus cases",
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                        "text": " occur in Sub-Saharan Africa where ",
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                        "url": "https://ourworldindata.org/grapher/child-mortality-rate-from-rotavirus?tab=chart",
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                                "text": "mortality from rotavirus infection is also the highest",
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                        "text": ", it is essential to increase and maintain high immunisation coverage in this region. However, in addition to delivering the vaccine for those who need it, we also need to work on improving its efficacy.",
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                        "text": "Vaccine efficacy for the rotavirus vaccine is defined as the percentage reduction of the rate of diarrhea incidences in vaccinated versus unvaccinated groups of children. It is well established that the efficacy of the rotavirus vaccine is not the same across all countries \u2014 in countries with high child mortality rates the vaccine shows much lower efficacy.{ref}Clark, Andrew, et al. ",
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                        "url": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30126-4/fulltext",
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                                "text": "\"Efficacy of live oral rotavirus vaccines by duration of follow-up: a meta-regression of randomised controlled trials.\"",
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                        "children": [
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                                "text": "The Lancet Infectious Diseases",
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                    {
                        "text": " (2019).{/ref}",
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                        "text": "The chart is from a recent study by Clark et ",
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                        "children": [
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                                "text": "al.",
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                        "text": ", which looked at how the efficacy of live oral rotavirus vaccines changes in different countries following vaccination. The chart shows that in countries with high child mortality rates, not only is the immediate vaccine efficacy lower \u2013 98% in low child mortality countries versus 66% in high child mortality countries \u2013 but also the vaccine efficacy decreases faster in high child mortality countries over time.{ref}The ",
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                        "url": "https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30126-4/fulltext",
                        "children": [
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                                "text": "Clark et al.",
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                    {
                        "text": " (2019) study defined low child mortality rate as less than 1.3% of newborns; medium mortality rate as between 1.35% and 2.81%; and high mortality rate as more than 2.81%{/ref}",
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                        "text": " Five years after vaccination, the rotavirus vaccine reduces the chances of getting diarrhea by 90% in low child mortality countries and only by 30% in high mortality countries.",
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                        "text": "The table shows how good the rotavirus vaccine is at preventing severe diarrhea and reducing hospitalization due to diarrhea in children under-5 in different regions.{ref}Lamberti, L. M., Ashraf, S., Walker, C. L. F., & Black, R. E. (2016). ",
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                    },
                    {
                        "url": "https://www.ingentaconnect.com/content/wk/inf/2016/00000035/00000009/art00016",
                        "children": [
                            {
                                "text": "A systematic review of the effect of rotavirus vaccination on diarrhea outcomes among children younger than 5 years",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                        "children": [
                            {
                                "text": "The Pediatric Infectious Disease Journal",
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                        "spanType": "span-italic"
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                        "text": ", ",
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                        "children": [
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                                "text": "35",
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                        "text": "(9), 992-998.{/ref}",
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                        "text": " In high-income countries, rotavirus vaccination has been shown to reduce the cases of severe rotavirus diarrhea by 91% and hospitalization by 94%. In Eastern Asia and Latin America, the effectiveness rates are lower but still high \u2013 preventing 88% and 80% of severe diarrhea cases, respectively. However, effectiveness in South Asia and Sub-Saharan Africa is significantly lower, only reducing severe diarrhea in around half of the cases.",
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                "value": "<div class=\"raw-html-table__container\"><table><thead><tr><th scope=\"col\" colspan=\"1\">Outcome </th><th scope=\"col\" colspan=\"1\">Region</th><th scope=\"col\" colspan=\"1\">Vaccine effectivness</th></tr></thead><tbody><tr><td colspan=\"1\" rowspan=\"5\">Severe rotavirus diarrhea</td><td colspan=\"1\" rowspan=\"1\">Developed</td><td colspan=\"1\" rowspan=\"1\">91%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Eastern Asia and Southeast Asia</td><td colspan=\"1\" rowspan=\"1\">88%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Latin America and Caribbean</td><td colspan=\"1\" rowspan=\"1\">80%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Southern Asia</td><td colspan=\"1\" rowspan=\"1\">50%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Sub-Saharan Africa</td><td colspan=\"1\" rowspan=\"1\">46%</td></tr><tr><td colspan=\"1\" rowspan=\"4\">Hospitalization due to rotavirus infection</td><td colspan=\"1\" rowspan=\"1\">Developed</td><td colspan=\"1\" rowspan=\"1\">94%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Eastern Asia and Southeast Asia</td><td colspan=\"1\" rowspan=\"1\">94%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Latin America and Caribbean</td><td colspan=\"1\" rowspan=\"1\">84%</td></tr><tr><td colspan=\"1\" rowspan=\"1\">Sub-Saharan Africa</td><td colspan=\"1\" rowspan=\"1\">58%</td></tr></tbody></table></div>",
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                        "text": "The reasons for different responses to the vaccine are not entirely clear.{ref}Patel, M., Shane, A. L., Parashar, U. D., Jiang, B., Gentsch, J. R., & Glass, R. I. (2009). ",
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                        "url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673012/#R3",
                        "children": [
                            {
                                "text": "Oral rotavirus vaccines: how well will they work where they are needed most?",
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                        "text": ". ",
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                        "children": [
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                                "text": "The Journal of Infectious Diseases",
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                        "text": ", ",
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                                "text": "200",
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                        "text": ", S39-S48.{/ref} {ref}Parker, E. P., Ramani, S., Lopman, B. A., Church, J. A., Iturriza-Gomara, M., Prendergast, A. J., & Grassly, N. C. (2018). ",
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                    {
                        "url": "https://www.futuremedicine.com/doi/10.2217/fmb-2017-0128?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov&",
                        "children": [
                            {
                                "text": "Causes of impaired oral vaccine efficacy in developing countries",
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                        "text": ". ",
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                        "children": [
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                                "text": "Future microbiology",
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                        "text": ", ",
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                                "text": "13",
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                        "text": "(1), 97-118.{/ref}",
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                        "text": " It is likely that the gut responses to the oral rotavirus vaccines in children in lower-income countries are different. This may be due to a variety of causes, including ",
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                    },
                    {
                        "url": "https://ourworldindata.org/micronutrient-deficiency",
                        "children": [
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                                "text": "micronutrient deficiencies",
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                        ],
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                    {
                        "text": ", pre-vaccination exposure to certain pathogens, and the presence of chronic conditions such as ",
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                        "url": "https://ourworldindata.org/malaria",
                        "children": [
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                                "text": "malaria",
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                        "text": " or ",
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                        "url": "https://ourworldindata.org/hiv-aids",
                        "children": [
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                                "text": "HIV",
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                        "text": ". Overall, the poor gut response to the live vaccine means the efficacy of the vaccine is reduced. Taking all of the above mentioned points into account, there are several interventions that could increase the benefits of the rotavirus vaccine even further. In addition to increasing the vaccine coverage, improving nutritional health (of both infants and mothers) and improving hygiene and sanitation conditions (to lower the prevalence of damaging pathogens) could have positive effects on the vaccine\u2019s efficacy.",
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                        "text": "We are still at quite an early stage of the rotavirus vaccine use. Although the vaccine has brought huge benefits already, it could go even further. Improving vaccination coverage, particularly across Sub-Saharan Africa and South Asia is key to continued reduction of childhood deaths from diarrhea. Even at moderate levels of vaccine efficacy, a significant number of additional additional child deaths could be prevented every year. The bar chart above that shows the number of preventable deaths illustrates the potential for extended vaccine coverage to save many more lives. And this is already taking into account the regional differences in the vaccine\u2019s effectiveness.",
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                "value": [
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                        "text": "In addition to increased coverage, improving the effectiveness of the vaccine would go even further in tackling one of the leading causes of death.",
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        "type": "article",
        "title": "Rotavirus vaccine",
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        "dateline": "November 1, 2019",
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    "createdAt": "2019-11-01T14:45:39.000Z",
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    "updatedAt": "2020-04-30T14:00:12.000Z",
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    "publishedAt": "2019-11-01T14:45:32.000Z",
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}