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Confirmation: rotavirus vaccination programmes save children’s lives in poor countries

1 Feb 2010

Paul Chinnock

Source: PATH (see original article)

Diarrhoeal disease is (after pneumonia) the biggest infectious killer of children in poor countries and rotavirus is the most common cause of diarrhoea. Studies in Africa [1] and Mexico [2], published in the New England Journal of Medicine, have now demonstrated the effectiveness of rotavirus vaccination in developing nations.

In a trial involving nearly 500 children in Malawi and South Africa, rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among infants during their first year of life. And in Mexico, where a national vaccination programme has been phased in, researchers found a significant decline in diarrhoea-related deaths in children.

Both studies underscore the importance of vaccination in achieving major reductions in severe rotavirus infections among children in the developing world, where disease impact is greatest. Rotavirus is believed to take the lives of more than 500,000 children under five every year – with almost half of these deaths occurring in Africa – and causes the hospitalization of millions more.

While the full reports of the two studies have only now been published, their findings have already led to the World Health Organization’s recommendation (last June) that rotavirus vaccines should be included in every nation’s immunization programme. (Unusually for the New Journal of Medicine, both studies and an accompanying editorial [3] are freely accessible online).

The WHO recommendation is important for Africa, which is hit particularly hard by diarrhoeal disease. It places rotavirus vaccines among a comprehensive set of other interventions key to stopping diarrhoeal disease deaths, including access to clean water, proper sanitation and oral rehydration therapies (ORT), breastfeeding, and vitamin A and zinc supplementation.

In the editorial [3] accompanying the studies, Mathuram Santosham, Professor of International Health and Pediatrics at Johns Hopkins University, Baltimore, welcomed the studies for supporting the use of rotavirus vaccines in the poorest countries of the world. “We now have another powerful weapon to add to our armamentarium to combat diarrhoeal deaths – rotavirus vaccines,” wrote Santosham. “Rotavirus vaccine should be introduced immediately in high mortality areas and it should be used as a trigger to energize diarrhoea control programs and improve coverage for all the proven interventions for diarrhoea.”

In Mexico, which in 2006 was among the first countries in the world to introduce rotavirus vaccine, diarrhoeal disease death rates dropped during the 2009 rotavirus season by more than 65 percent among children age two and under. This demonstrates real-world impact that is crucial as other countries consider rotavirus vaccine introduction. The Mexican study examined the impact of vaccination on diarrhoeal deaths in Mexican children between 2008 and 2009 following a phased introduction of the orally administered RotarixRotarixTM, manufactured by GlaxoSmithKline Biologicals (GSK).

Diarrhoeal disease, once seen as a top priority in health efforts, has been neglected in recent years. Activists are seeking to re-invigorate diarrhoeal control programmes. They point out that, with the availability of a safe, effective rotavirus vaccine, there are now more opportunities for progress than ever before – see PATH’s website Resources for Diarrheal Control. Nevertheless, the provision of safe water and sanitation for all who need it must remain at the centre of efforts to reduce diarrhoea morbidity and mortality.
 

References

1. Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, Ngwira B, Victor JC, Gillard PH, Cheuvart BB, Han HH, Neuzil KM (2010). Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med; 362(4):289-298. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20107214

2. Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, Esparza-Aguilar M, Johnson B, Gomez-Altamirano CM, Parashar U, Patel M (2010). Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. N Engl J Med; 362(4):299-305. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20107215

3. Santosham M (2010). Rotavirus vaccine – a powerful tool to combat deaths from diarrhea. N Engl J Med; 362(4):358-360. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20107222

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