The status of rotavirus vaccines in 1990

Rotavirus disease and its prevention in infants and children

Rotavirus disease causes immense morbidity and mortality in developing countries. In the United States, mortality is very rare, but the health care and societal costs of rotavirus-related morbidity exceed one billion dollars annually A new vaccine that prevents the illness recently was marketed in the United States. Economic issues surround national recommendations for its use. Economic, safety, and effectiveness issues will be resolved only with surveillance systems that document the effectiveness of immunization programs and their cost-effectiveness.

New strategies for using mucosal vaccination to achieve more effective immunization

Future progress in vaccination will be significantly advanced by application of emerging technologies for immunization of mucosal surfaces. It should now be possible to maximize the antigenicity of many vaccines and facilitate their interaction with appropriate lymphoid tissues to induce protective cellular and humoral responses. Mucosal vaccines requiring no more than two doses are achievable with current technologies. Living vaccines have been among the most promising candidates for mucosal vaccination, but with few exceptions their promise is still to be realized. Development of new microencapsulated delivery systems and adjuvants has made non-living vaccines reasonable options for mucosal immunization. To be practical, such vaccines should be developed as combined agent vaccines, possibly deliverable by multiple mucosal routes. Although strategies to be used for specific mucosal vaccines will depend upon a number of factors pertinent to the disease agent, in concept an adjuvant administered with inactivated but maximally antigenic pathogens or their recombinant adhesive subcomponents could prove to be among the more practical mucosal vaccine options for use globally.