Rotavirus vaccine significantly reduces diarrhea-associated deaths in young children

Issue: September 2018

Rotavirus vaccination reduced diarrhea-associated deaths due to rotavirus infection in infants and young children in Africa, according to the results of two recently published studies.

In a study published in JAMA Pediatrics, Christopher Troeger, MPH, of the Institute for Health Metrics and Evaluation in Seattle, Washington, and colleagues expanded upon the Global Burden of Disease Study 2016, a cross-sectional study that measured rotavirus as one of 13 diarrheal etiological agents to estimate disease burden for each age, sex and geographic location from 1990 to 2016.

The researchers found that there were an estimated 128,500 deaths (95% uncertainty interval [UI], 104,500-155,600) among children aged younger than 5 years worldwide attributable to rotavirus in 2016; 28.8% of deaths from diarrhea were attributed to rotavirus. The deaths included 104,733 in sub-Saharan Africa (95% UI, 83,406-128,842). More than 258 million episodes of diarrhea among children aged younger than 5 years were associated with rotavirus infection in 2016 (95% UI, 193 million-341 million) — an incidence of 0.42 cases per child-year.

Troeger and colleagues estimated that 27.8% of children aged younger than 5 years were vaccinated against rotavirus, with the vaccine estimated to avert more than 28,000 deaths (95% UI, 14,600-46,700) among children in that age group. They also estimated that expanded use of the vaccine could have prevented approximately 20% of all deaths attributable to diarrhea among children aged younger than 5 years, particularly in sub-Saharan Africa.

“These results suggest that rotavirus is still a highly prevalent cause of diarrhea worldwide and is responsible for a substantial nonfatal burden of diarrhea globally,” the researchers concluded. “These findings call for renewed efforts to prevent rotavirus infection through increased efforts to improve vaccination coverage, water and sanitation, and access to and quality of medical care.”

In a study published in The Lancet Global Health, Naor Bar-Zeev, PhD, MBBS(Hons), MPH, MBiostat. a professor at the International Vaccine Access Center of the Johns Hopkins Bloomberg School of Public Health, and colleagues reported that a monovalent rotavirus vaccine cut infant diarrhea deaths by more than a third in rural Malawi.

Bar-Zeev and colleagues included infants born from Jan. 1, 2012, to June 1, 2015, in Mchinji, Central Malawi, and conducted an analysis of those who survived 10 weeks in a population-based cohort study. The researchers determined the infants’ vaccination status using caregiver records or reports at home visits at 4 months and 1 year of age. Home visits determined survival to 1 year.

The researchers registered 48,672 live births during the study, including 38,518 who were vaccine eligible and 37,507 who survived at 10 weeks. They compared the effectiveness of two doses of vaccine vs. zero doses in 28,141 infants, including 101 infants aged younger than 1 year who had diarrhea-associated death. They found a 31% decline in diarrhea-associated deaths after the introduction of the rotavirus vaccine at 6 and 10 weeks (95% CI, 1%-52%), and that the vaccine had an effectiveness against diarrhea-related mortality of 35% (95% CI, –28% to 66%).

“We already knew that rotavirus vaccine reduces hospital admissions and is highly cost-effective in low-income countries with a high burden of diarrheal disease, and now we have been able to demonstrate that it saves lives,” Bar-Zeev said in a press release. “However, not all countries are vaccinating against rotavirus yet, including some very populous countries. The key message of this paper is that to do the best by all our children and to help them survive, all countries should introduce rotavirus vaccination.” – by Bruce Thiel

Reference:

Bar-Zeev N, et al. Lancet Glob Health. 2018;doi:10.1016/S2214-109X(18)30314-0.

Troeger C, et al. JAMA Pediatr. 2018;doi:101001/jamapediatrics.2018.1960.

Disclosures: Troeger and colleagues report no relevant financial disclosures. Bar-Zeev reports receiving an investigator-initiated research grant from GlaxoSmithKline to support work represented in the study. Please see the study for all other authors’ relevant financial disclosures.