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Understanding the Challenges of Oral Live Attenuated Rotavirus Vaccines Performance in Low- and Middle-Income
Mahtab Mir-Hosseinian1, Farzane Behnezhad2, Somayeh-Sadat Hosseini-Fakhr1
1Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Rotavirus vaccines significantly reduce severe gastroenteritis in children. However, their effectiveness varies globally, prompting a review of host, pathogen, and environmental factors influencing vaccine performance.
Area of Science:
- * Virology and Immunology
- * Pediatric Infectious Diseases
- * Global Public Health
Background:
- * Rotaviruses are a leading cause of severe gastroenteritis in children under five worldwide.
- * Oral live-attenuated rotavirus vaccines have reduced hospitalizations and deaths globally.
- * Significant disparities exist in rotavirus vaccine efficacy between high-income and low- and middle-income countries.
Purpose of the Study:
- * To comprehensively review factors influencing rotavirus vaccine efficacy.
- * To analyze the interplay of host, pathogen, and environmental elements.
- * To identify strategies for improving rotavirus vaccine performance in diverse settings.
Main Methods:
- * Systematic literature review.
- * Analysis of host-related factors (e.g., nutrition, immunity).
- * Evaluation of pathogen characteristics and environmental influences.
Main Results:
- * Vaccine efficacy is demonstrably lower in low- and middle-income countries.
- * Factors such as malnutrition, co-infections, and viral strain variations impact vaccine response.
- * Environmental conditions play a role in vaccine effectiveness.
Conclusions:
- * Understanding the triad of host, pathogen, and environment is crucial for addressing rotavirus vaccine efficacy gaps.
- * Tailored strategies are needed to optimize rotavirus vaccination programs globally.
- * Further research is essential to enhance vaccine performance in vulnerable populations.
Abstract:
Rotaviruses have been the foremost cause of acute gastroenteritis in children <5 years old since their discovery in the 1970s. After the introduction of oral live-attenuated rotavirus vaccines nearly two decades ago, rotavirus vaccination programs have been established in over half of the countries in the world, as they have demonstrated a remarkable impact on reducing disease-associated hospitalizations and mortality rates. Nevertheless, rotavirus continues to claim thousands of children's lives globally each year, with the majority of these fatalities occurring in sub-Saharan Africa and Southeast Asia. Furthermore, while rotavirus vaccines have proven highly effective in high-income settings, their efficacy has been noticeably stunted in low- and middle-income countries. The present study will provide a comprehensive review of a wide range of factors in the triad of host, pathogen, and environment that have been identified or proposed as contributing to these discrepancies in rotavirus vaccine efficacy to better understand and subsequently, improve rotavirus vaccine performance.
