Related Experiment Video
Updated: May 3, 2026
Assays for the Specific Growth Rate and Cell-binding Ability of Rotavirus
Published on: January 28, 2019
Oral rotavirus vaccine effectiveness among malnourished children in 19 countries: Findings from the MNSSTER-V project
Eleanor Burnett1, Ismail Ticklay2, Jazmina Umana3
1Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Atlanta, Georgia, USA.
Insights
Rotavirus vaccine effectiveness is lower in malnourished children, particularly those with stunting. Addressing malnutrition may improve vaccine protection and reduce rotavirus disease burden.
Area of Science:
- Global Health
- Vaccinology
- Pediatric Nutrition
Background:
- Rotavirus vaccines are crucial for preventing severe diarrhea in children.
- Malnourished children may exhibit reduced immune responses to vaccines.
- Previous studies suggest lower rotavirus vaccine effectiveness (VE) in malnourished populations.
Purpose of the Study:
- To evaluate rotavirus VE in malnourished versus well-nourished children using anthropometric indicators.
- To assess the impact of different malnutrition severities on rotavirus vaccine protection.
- To analyze VE data from medium to high child mortality countries.
Main Methods:
- Analysis of the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V) dataset.
- Categorization of children based on four anthropometric indicators, birthweight, and reported malnutrition.
- Calculation of VE using logistic regression, comparing vaccinated cases and controls.
Main Results:
- Complete series VE was 59% in children without stunting, 42% in moderate-to-severe stunting, and 31% in severe stunting.
- VE estimates varied based on the anthropometric indicator used for malnutrition assessment.
- No significant differences in VE were observed between malnourished and well-nourished children using other indicators.
Conclusions:
- Chronic malnutrition, especially stunting, negatively impacts rotavirus vaccine effectiveness.
- Interventions to combat malnutrition could enhance rotavirus vaccine performance.
- Reducing malnutrition may decrease rotavirus-related illness and deaths globally.
Objectives:
Rotavirus vaccine clinical trials and post-licensure evaluations found malnourished children may have lower protection against rotavirus diarrhea hospitalizations than well-nourished children. On a population level, rotavirus vaccines are less protective in high child mortality settings.
Methods:
We analyzed rotavirus vaccine effectiveness (VE) among malnourished and well-nourished children categorized using four anthropometric malnutrition indicators, birthweight, and reported malnutrition from medium to high child mortality countries in the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V) dataset. We calculated child-level z-scores for weight-for-age, length-for-age, weight-for-length, and mid-upper arm circumference (MUAC), and the site-level proportion implausible z-scores. Sites with published VE estimates by nutritional status or those with <3% implausible values were included in the final analysis. Z-scores <-2 were considered moderate-to-severe malnutrition and <-3 were considered severe malnutrition. We calculated complete series rotavirus VE in each malnourished and well-nourished group using an unconditional adjusted logistic regression model, where VE = (1 - odds ratio of vaccination among cases and controls) × 100, where cases and controls were children who tested rotavirus positive and negative, respectively.
Results:
Complete series VE was more protective among children without stunting (normal length-for-age) (59%; 95% confidence interval [CI]: 49-67) compared to children with moderate-to-severe stunting (42%; 95% CI: 19-58) and severe stunting (31%; 95%CI: -14 to 58). Adjusted VE point estimates were similar among malnourished and well-nourished children using the other anthropometric and birthweight indicators.
Conclusions:
Our findings clearly show that chronic malnutrition negatively impacted rotavirus VE. Efforts to address and prevent malnutrition generally may further reduce the burden of rotavirus morbidity and mortality.
Related Concept Videos
01:51Vaccinations
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:18Bacterial Gastroenteritis