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Rotavirus vaccines: progress and new developments
Jordan E Cates1,2, Jacqueline E Tate1, Umesh Parashar1
1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
Insights
Rotavirus vaccines significantly reduce severe gastroenteritis and deaths in young children globally. Ongoing research aims to improve vaccine effectiveness, especially in low-resource settings.
Area of Science:
- Vaccinology
- Pediatric Infectious Diseases
- Public Health
Background:
- Rotavirus is a leading cause of severe gastroenteritis in children under five, responsible for substantial annual mortality.
- Six oral, live-attenuated rotavirus vaccines are available, with four WHO-pre-qualified for global use.
- Widespread vaccination has decreased rotavirus hospitalizations and diarrhea deaths in countries with vaccine introduction.
Purpose of the Study:
- To review current rotavirus vaccines, their global coverage, and efficacy/effectiveness.
- To summarize vaccine safety data, including intussusception risk.
- To provide an overview of rotavirus vaccines in development.
Main Methods:
- Comprehensive literature review of clinical trials and post-licensure evaluations.
- Analysis of global vaccine coverage data.
- Synthesis of safety data, focusing on intussusception risk.
Main Results:
- Rotavirus vaccines demonstrate high effectiveness (80-90%) in high-income countries.
- Effectiveness is lower (40-70%) in low-to-middle-income countries.
- Ongoing surveillance and research are crucial for understanding and improving vaccine performance.
Conclusions:
- Rotavirus vaccines are highly effective but show variable performance across different economic settings.
- Further research is needed to identify factors influencing effectiveness and to develop next-generation vaccines.
- Continued surveillance and data strengthening are essential for optimizing rotavirus vaccine impact.
Introduction:
Rotavirus is the primary cause of severe acute gastroenteritis among children under the age of five globally, leading to 128,500 to 215,000 vaccine-preventable deaths annually. There are six licensed oral, live-attenuated rotavirus vaccines: four vaccines pre-qualified for global use by WHO, and two country-specific vaccines. Expansion of rotavirus vaccines into national immunization programs worldwide has led to a 59% decrease in rotavirus hospitalizations and 36% decrease in diarrhea deaths due to rotavirus in vaccine-introducing countries.
Areas Covered:
This review describes the current rotavirus vaccines in use, global coverage, vaccine efficacy from clinical trials, and vaccine effectiveness and impact from post-licensure evaluations. Vaccine safety, particularly as it relates to the risk of intussusception, is also summarized. Additionally, an overview of candidate vaccines in the pipeline is provided.
Expert Opinion:
Considerable evidence over the past decade has demonstrated high effectiveness (80-90%) of rotavirus vaccines at preventing severe rotavirus disease in high-income countries, although the effectiveness has been lower (40-70%) in low-to-middle-income countries. Surveillance and research should continue to explore modifiable factors that influence vaccine effectiveness, strengthen data to better evaluate newer rotavirus vaccines, and aid in the development of future vaccines that can overcome the limitations of current vaccines.
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