New studies highlight tremendous health and economic benefits of rotavirus vaccination

Data from a new journal supplement reveal the widespread impact of rotavirus vaccines in preventing death and disease from rotavirus diarrhea in low-income countries around the world, while also highlighting the need for continued rollout of rotavirus vaccines given the burden of rotavirus that still remains. Additionally, a study from Rwanda shows a reduction in the economic burden of diarrhea following rotavirus vaccine introduction, and a new white paper serves as an advocacy tool in countries considering the introduction of rotavirus vaccine.

Studies confirm rotavirus vaccine impact in developing countries and provide new rotavirus mortality estimates

A supplementary issue recently published in Clinical Infectious DiseasesHealth Benefits of Rotavirus Vaccination in Developing Countries, contains 17 studies that add to the existing wealth of evidence showing the impact and effectiveness of vaccines against deaths and illness from rotavirus diarrhea in low- and lower-middle-income countries, spanning from Latin America, to Eastern Europe, to Africa. Across evaluations, rotavirus vaccines’ role in reducing disease is supported by sharp declines in diarrheal deaths and hospitalizations after vaccine introduction, greater declines during seasonal peaks of rotavirus disease, and greater initial declines in younger age groups that received the vaccine early in the vaccination program.

In addition, one article provides updated global rotavirus mortality statistics using data from 2013 – updating earlier estimates from 2008. The authors found that 37 percent of the 578,000 childhood diarrheal deaths in 2013 were due to rotavirus, for a total of 215,000 rotavirus deaths globally. This represents a 60 percent decrease from the 528,000 rotavirus deaths estimated in 2000.

Click to see Figure 1. Number of worldwide rotavirus deaths by region, 2000-2013.

While the decline in global rotavirus deaths is certainly cause for celebration, it also highlights the work left to be done. More than 90 percent of rotavirus deaths in 2013 occurred in 72 low- and lower-middle-income countries eligible for rotavirus vaccine support from Gavi, the Vaccine Alliance, and 56 percent occurred in sub-Saharan Africa. Over the 14-year study period, rotavirus deaths decreased at a slower rate in sub-Saharan Africa than in other regions, resulting in an increasing proportion of all rotavirus deaths occurring in this region (see Figure 1). And, consistently throughout the time period, the largest number of rotavirus deaths occurred in India—a fact that underscores the potential impact of India’s recent introduction of ROTAVAC®, an indigenously developed rotavirus vaccine, into its national immunization program.

Given the remaining burden of rotavirus and the demonstrated widespread health benefits of rotavirus vaccines, the supplement editors emphasize the urgency of introducing rotavirus vaccines in more countries, especially high-burden countries in sub-Saharan Africa and Asia, as well as continuing to find ways to improve vaccine performance. Watch this video to hear from Dr. Umesh Parashar, leader of the Enteric Viruses Epidemiology Team at the US Centers for Disease Control and Prevention and an editor of the supplement, on the remarkable data and real-world impacts of rotavirus vaccine introduction.

Rotavirus vaccines reduce economic burden of diarrhea in Rwanda

A recent article in PLOS ONE provides strong evidence that rotavirus vaccines help reduce the economic burden of diarrhea on families and the national health system. The authors estimated that, in the years prior to rotavirus vaccine introduction, diarrhea admissions in public health centers and district hospitals in Rwanda amounted to an estimated annual total economic burden of approximately US$1.3 to $1.7 million or $101 per hospitalization, 65 percent of which was borne by households. For low-income households, the economic costs of diarrhea amounted to 110 percent of their monthly income (see Figure 2).

Click to see Figure 2. Household costs for diarrheal hospitalizations in Rwanda as a percentage of household monthly income.

After rotavirus vaccine introduction, however, reductions in diarrhea hospitalizations in Rwanda (see RotaFlash) resulted in an estimated 20 to 40 percent reduction of the total economic burden of diarrhea, representing savings for both families and the health system. The authors expect this evidence to help confirm the value of the rotavirus vaccination program for Rwandan policymakers.

ROTA Council provides recommendations for scaling up coverage of rotavirus vaccination

The Rotavirus Organization of Technical Allies (ROTA) Council, a coalition of leading scientists and advocates that promotes the introduction of rotavirus vaccines in high-burden countries, recently published a white paper entitled Rotavirus: Common, Severe, Devastating, Preventable. The paper summarizes the latest evidence on rotavirus disease and vaccines and contains 21 recommendations from the ROTA Council for stakeholders to scale coverage of rotavirus vaccines to all children.

These articles were first published in the RotaFlash Rotavirus Vaccine Update e-Newsletter on 13 April 2016. View it online here.

For information on rotavirus disease and vaccines and to access the RotaFlash archives, please visit our Rotavirus Vaccine Access and Delivery website. For information on diarrheal disease, please visit our DefeatDD website. For information on support for rotavirus vaccine introduction, please visit Gavi, the Vaccine Alliance’s website.

Figure 1: Taken from Figure 2a in Tate JE, Burton AH, Boschi-Pinto C, Parashar UD. Global, regional, and national estimates of rotavirus mortality in children <5 years of age, 2000-2013. Clinical Infectious Diseases. 2016;62(S2):S96-S105.

Figure 2: Taken from Figure 1 in Ngabo F, Mvundura M, Gazley L, et al. The economic burden attributable to a child’s inpatient admission for diarrheal disease in Rwanda. PLoS ONE. 2016;11(2):e0149805.