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Wu ZW, Jin F, Li QL, Gao JM, Zhou HS, Duan K, Gao Z, Liu Y, Hao ZY, Chen W, Liu YY, Xu GL, Yang B, Dong B, Zhang JW, Zhao YL, Yang XM. Immunogenicity and safety of a new hexavalent rotavirus vaccine in Chinese infants: A randomized, double-blind, placebo-controlled phase 2 clinical trial. Hum Vaccin Immunother 2023; 19:2263228. [PMID: 37843437 PMCID: PMC10580834 DOI: 10.1080/21645515.2023.2263228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
Rotavirus remains a major cause of diarrhea among 5-y-old children, and vaccination is currently the most effective and economical measure. We conducted a randomized, double-blind, placebo-controlled phase II clinical trial designed to determine the dosage, immunogenicity, and safety profile of a novel hexavalent rotavirus vaccine. In total, 480 eligible healthy infants, who were 6-12 weeks of age at the time of randomization were randomly allocated (1:1:1) to receive 105.5 focus-forming unit (FFU) or 106.5FFU of vaccine or placebo on a 0, 28 and 56-d schedule. Blood samples were collected 28 d after the third dose to assess rotavirus immunoglobulin A (IgA) antibody levels. Adverse events (AEs) up to 28 d after each dose and serious adverse events (SAEs) up to 6 months after the third dose were recorded as safety measurements. The anti-rotavirus IgA seroconversion rate of the vaccine groups reached more than 70.00%, ranging from 74.63% to 76.87%. The postdose 3 (PD3) geometric mean concentrations (GMCs) of anti-rotavirus IgA among vaccine recipients ranged from 76.97 U/ml to 84.46 U/ml. At least one solicited AE was recorded in 114 infants (71.25%) in the high-dose vaccine group, 106 infants (66.25%) in the low-dose vaccine group and 104 infants (65.00%) in the placebo group. The most frequently solicited AE was fever. The novel oral hexavalent rotavirus vaccine was safe and immunogenic in infants support the conclusion to advance the candidate vaccine for phase 3 efficacy trials.
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Affiliation(s)
- Zhi-Wei Wu
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People’s Republic of China
| | - Fei Jin
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People’s Republic of China
| | - Qing-Liang Li
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Jia-Mei Gao
- National Institutes for Food and Drug Control, Beijing, China
| | - Hai-Song Zhou
- Zhengding County Center for Disease Control and Prevention, Zhengding, People’s Republic of China
| | - Kai Duan
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Zhao Gao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People’s Republic of China
| | - Yan Liu
- National Institutes for Food and Drug Control, Beijing, China
| | - Zhi-Yong Hao
- Zhengding County Center for Disease Control and Prevention, Zhengding, People’s Republic of China
| | - Wei Chen
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Yue-Yue Liu
- National Institutes for Food and Drug Control, Beijing, China
| | - Ge-Lin Xu
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Biao Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Ben Dong
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Jiu-Wei Zhang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
| | - Yu-Liang Zhao
- Institute for Vaccine Clinical Research, Hebei Province Center for Disease Control and Prevention, Shijiazhuang, People’s Republic of China
| | - Xiao-Ming Yang
- National Engineering Technology Research Center for Combined Vaccines, Wuhan Institute of Biological Products Co., Ltd, Wuhan, People’s Republic of China
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Wang G, Zhang K, Zhang R, Kong X, Guo C. Impact of vaccination with different types of rotavirus vaccines on the incidence of intussusception: a randomized controlled meta-analysis. Front Pediatr 2023; 11:1239423. [PMID: 37583623 PMCID: PMC10424850 DOI: 10.3389/fped.2023.1239423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
Background Intussusception is a prevalent pediatric issue causing acute abdominal pain, with potential links to rotavirus vaccines. The variety of these vaccines has grown in recent years. This meta-analysis study aims to evaluate the impact of various rotavirus vaccines on intussusception incidence. Methods We executed a thorough search across databases like PubMed, Cochrane Library, Embase, and Web of Science, leading to the selection of 15 credible randomized controlled trials (RCTs) that encompass various types of rotavirus vaccines. From each study, we extracted essential details such as vaccine types and intussusception occurrences. We assessed the risk of bias using the Cochrane Collaboration's tool, conducted statistical analysis with R (version 4.2.3), determined relative risk (RR) using a random effects model, and performed a subgroup analysis for vaccines of differing brands and types. Results We included 15 randomized controlled studies from various countries. While intussusception incidence differed between vaccinated and control groups, this difference was not statistically significant. The overall risk ratio (RR), calculated using a random effects model, was 0.81, with a 95% confidence interval of [0.53, 1.23]. This crossing 1 shows that vaccination didn't notably change disease risk. Additionally, the 0% group heterogeneity suggests consistency across studies, strengthening our conclusions. Subgroup analysis for different vaccine brands and types (RV1 (Rotarix, Rotavac, RV3-BB), RV3 (LLR3), RV5 (RotasiiL, RotaTeq), and RV6) showed no significant variation in intussusception incidence. Despite variations in RR among subgroups, these differences were not statistically significant (P > 0.05). Conclusions Our study indicates that rotavirus vaccination does not significantly increase the incidence of intussusception. Despite varying impacts across different vaccine brands and types, these variations are insignificant. Given the substantial benefits outweighing the risks, promoting the use of newly developed rotavirus vaccines remains highly valuable. Systematic Review Registration www.crd.york.ac.uk/prospero/, Identifier CRD42023425279.
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Affiliation(s)
- Guoyong Wang
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics,Chongqing Medical University, Chongqing, China
| | - Kaijun Zhang
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics,Chongqing Medical University, Chongqing, China
| | - Rensen Zhang
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiangru Kong
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics,Chongqing Medical University, Chongqing, China
| | - Chunbao Guo
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics,Chongqing Medical University, Chongqing, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing, China
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Debellut F, Tang K, Clark A, Pecenka C, Assao B, Guindo O, Grais RF, Isanaka S. Impact and cost-effectiveness of rotavirus vaccination in Niger: a modelling study evaluating alternative rotavirus vaccines. BMJ Open 2022; 12:e061673. [PMID: 36198460 PMCID: PMC9535195 DOI: 10.1136/bmjopen-2022-061673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the cost-effectiveness of alternative rotavirus vaccines in Niger, using UNIVAC, a proportionate outcomes model. SETTING The study leverages global, regional and local data to inform cost-effectiveness modelling. Local data were collected as part of a clinical trial taking place in the Madarounfa district, Maradi region, Niger. PARTICIPANTS The study models impact of infants vaccination on rotavirus gastroenteritis in children under 5 years of age. INTERVENTIONS We compared the use of ROTARIX (GlaxoSmithKline, Belgium), ROTAVAC (Bharat Biotech, India) and ROTASIIL (Serum Institute, India) to no vaccination and to each other over a 10-year period starting in 2021. RESULTS We estimated that ROTARIX, ROTAVAC and ROTASIIL would each prevent 13 million cases and 20 000 deaths of children under 5 years over a 10-year period in Niger. Compared with no vaccination, the cost to avert a disability-adjusted life-year was US$146 with ROTARIX, US$107 with ROTASIIL and US$76 with ROTAVAC from the government perspective. ROTAVAC dominated ROTARIX and ROTASIIL (eg, provided similar or higher benefits at a lower cost) and had 90% chance to be cost-effective at a US$100 willingness-to-pay threshold. CONCLUSIONS This study can inform decision-making around rotavirus vaccination policy in Niger, demonstrating that ROTAVAC is likely the most cost-effective option. Alternative products (ROTASIIL and ROTARIX) may also be considered by decision-makers if they are priced more competitively, or if their cold chain requirements could bring additional economic benefits.
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Affiliation(s)
| | - Kevin Tang
- Epicentre, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Clark
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Clint Pecenka
- Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA
| | | | | | | | - Sheila Isanaka
- Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Mijatovic-Rustempasic S, Jaimes J, Perkins C, Ward ML, Esona MD, Gautam R, Lewis J, Sturgeon M, Panjwani J, Bloom GA, Miller S, Reisdorf E, Riley AM, Pence MA, Dunn J, Selvarangan R, Jerris RC, DeGroat D, Parashar UD, Cortese MM, Bowen MD. Rotavirus Strain Trends in United States, 2009-2016: Results from the National Rotavirus Strain Surveillance System (NRSSS). Viruses 2022; 14:1775. [PMID: 36016397 PMCID: PMC9414880 DOI: 10.3390/v14081775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Before the introduction of vaccines, group A rotaviruses (RVA) were the leading cause of acute gastroenteritis in children worldwide. The National Rotavirus Strain Surveillance System (NRSSS) was established in 1996 by the Centers for Disease Control and Prevention (CDC) to perform passive RVA surveillance in the USA. We report the distribution of RVA genotypes collected through NRSSS during the 2009-2016 RVA seasons and retrospectively examine the genotypes detected through the NRSSS since 1996. During the 2009-2016 RVA seasons, 2134 RVA-positive fecal specimens were sent to the CDC for analysis of the VP7 and VP4 genes by RT-PCR genotyping assays and sequencing. During 2009-2011, RVA genotype G3P[8] dominated, while G12P[8] was the dominant genotype during 2012-2016. Vaccine strains were detected in 1.7% of specimens and uncommon/unusual strains, including equine-like G3P[8] strains, were found in 1.9%. Phylogenetic analyses showed limited VP7 and VP4 sequence variation within the common genotypes with 1-3 alleles/lineages identified per genotype. A review of 20 years of NRSSS surveillance showed two changes in genotype dominance, from G1P[8] to G3P[8] and then G3P[8] to G12P[8]. A better understanding of the long-term effects of vaccine use on epidemiological and evolutionary dynamics of circulating RVA strains requires continued surveillance.
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Affiliation(s)
- Slavica Mijatovic-Rustempasic
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Jose Jaimes
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Charity Perkins
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - M. Leanne Ward
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Mathew D. Esona
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Rashi Gautam
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Jamie Lewis
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Michele Sturgeon
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Junaid Panjwani
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Gail A. Bloom
- Indiana University Health Pathology Laboratory, Indiana University, 350 West 11th Street, Indianapolis, IN 46202, USA
| | - Steve Miller
- UCSF Clinical Microbiology Laboratory, 185 Berry St, Suite 290, San Francisco, CA 94107, USA
| | - Erik Reisdorf
- Wisconsin State Laboratory of Hygiene, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Ann Marie Riley
- Infectious Disease Diagnostic Laboratory, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA
| | - Morgan A. Pence
- Cook Children’s Medical Center, 801 Seventh Ave., Fort Worth, TX 76104, USA
| | - James Dunn
- Medical Microbiology and Virology, Department of Pathology, Texas Children’s Hospital, 6621 Fannin Street, Suite AB1195, Houston, TX 77030, USA
| | | | - Robert C. Jerris
- Children’s Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329, USA
| | - Dona DeGroat
- Seattle Children’s Hospital, 5801 Sand Point Way NE, Seattle, WA 98105, USA
| | - Umesh D. Parashar
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Margaret M. Cortese
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
| | - Michael D. Bowen
- Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mail Stop G-04, Atlanta, GA 30329, USA
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Sadiq A, Bostan N, Aziz A. Effect of rotavirus genetic diversity on vaccine impact. Rev Med Virol 2022; 32:e2259. [PMID: 34997676 DOI: 10.1002/rmv.2259] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/05/2021] [Indexed: 11/07/2022]
Abstract
Group A rotaviruses (RVAs) are the leading cause of gastroenteritis, causing 0.2 million deaths and several million hospitalisations globally each year. Four rotavirus vaccines (RotarixTM , RotaTeqTM , Rotavac® and ROTASIIL® ) have been pre-qualified by the World Health Organization (WHO), but the two newly pre-qualified vaccines (Rotavac® and ROTASIIL® ) are currently only in use in Palestine and India, respectively. In 2009, WHO strongly proposed that rotavirus vaccines be included in the routine vaccination schedule of all countries around the world. By the end of 2019, a total of 108 countries had administered rotavirus vaccines, and 10 countries have currently been approved by Gavi for the introduction of rotavirus vaccine in the near future. With 39% of global coverage, rotavirus vaccines have had a substantial effect on diarrhoeal morbidity and mortality in different geographical areas, although efficacy appears to be higher in high income settings. Due to the segmented RNA genome, the pattern of RVA genotypes in the human population is evolving through interspecies transmission and/or reassortment events for which the vaccine might be less effective in the future. However, despite the relative increase in some particular genotypes after rotavirus vaccine use, the overall efficacy of rotavirus mass vaccination worldwide has not been affected. Some of the challenges to improve the effect of current rotavirus vaccines can be solved in the future by new rotavirus vaccines and by vaccines currently in progress.
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Affiliation(s)
- Asma Sadiq
- Department of Biosciences, Molecular Virology Laboratory, COMSATS University, Islamabad, Pakistan
| | - Nazish Bostan
- Department of Biosciences, Molecular Virology Laboratory, COMSATS University, Islamabad, Pakistan
| | - Aamir Aziz
- Sarhad University of Science and Information Technology, Institute of Biological Sciences, Sarhad University, Peshawar, Pakistan
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Bergman H, Henschke N, Hungerford D, Pitan F, Ndwandwe D, Cunliffe N, Soares-Weiser K. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev 2021; 11:CD008521. [PMID: 34788488 PMCID: PMC8597890 DOI: 10.1002/14651858.cd008521.pub6] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Rotavirus is a common cause of diarrhoea, diarrhoea-related hospital admissions, and diarrhoea-related deaths worldwide. Rotavirus vaccines prequalified by the World Health Organization (WHO) include Rotarix (GlaxoSmithKline), RotaTeq (Merck), and, more recently, Rotasiil (Serum Institute of India Ltd.), and Rotavac (Bharat Biotech Ltd.). OBJECTIVES To evaluate rotavirus vaccines prequalified by the WHO for their efficacy and safety in children. SEARCH METHODS On 30 November 2020, we searched PubMed, the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (published in the Cochrane Library), Embase, LILACS, Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index-Science, Conference Proceedings Citation Index-Social Science & Humanities. We also searched the WHO ICTRP, ClinicalTrials.gov, clinical trial reports from manufacturers' websites, and reference lists of included studies, and relevant systematic reviews. SELECTION CRITERIA We selected randomized controlled trials (RCTs) conducted in children that compared rotavirus vaccines prequalified for use by the WHO with either placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and assessed risk of bias. One author extracted data and a second author cross-checked them. We combined dichotomous data using the risk ratio (RR) and 95% confidence interval (CI). We stratified the analyses by under-five country mortality rate and used GRADE to evaluate evidence certainty. MAIN RESULTS Sixty trials met the inclusion criteria and enrolled a total of 228,233 participants. Thirty-six trials (119,114 participants) assessed Rotarix, 15 trials RotaTeq (88,934 participants), five trials Rotasiil (11,753 participants), and four trials Rotavac (8432 participants). Rotarix Infants vaccinated and followed up for the first year of life In low-mortality countries, Rotarix prevented 93% of severe rotavirus diarrhoea cases (14,976 participants, 4 trials; high-certainty evidence), and 52% of severe all-cause diarrhoea cases (3874 participants, 1 trial; moderate-certainty evidence). In medium-mortality countries, Rotarix prevented 79% of severe rotavirus diarrhoea cases (31,671 participants, 4 trials; high-certainty evidence), and 36% of severe all-cause diarrhoea cases (26,479 participants, 2 trials; high-certainty evidence). In high-mortality countries, Rotarix prevented 58% of severe rotavirus diarrhoea cases (15,882 participants, 4 trials; high-certainty evidence), and 27% of severe all-cause diarrhoea cases (5639 participants, 2 trials; high-certainty evidence). Children vaccinated and followed up for two years In low-mortality countries, Rotarix prevented 90% of severe rotavirus diarrhoea cases (18,145 participants, 6 trials; high-certainty evidence), and 51% of severe all-cause diarrhoea episodes (6269 participants, 2 trials; moderate-certainty evidence). In medium-mortality countries, Rotarix prevented 77% of severe rotavirus diarrhoea cases (28,834 participants, 3 trials; high-certainty evidence), and 26% of severe all-cause diarrhoea cases (23,317 participants, 2 trials; moderate-certainty evidence). In high-mortality countries, Rotarix prevented 35% of severe rotavirus diarrhoea cases (13,768 participants, 2 trials; moderate-certainty evidence), and 17% of severe all-cause diarrhoea cases (2764 participants, 1 trial; high-certainty evidence). RotaTeq Infants vaccinated and followed up for the first year of life In low-mortality countries, RotaTeq prevented 97% of severe rotavirus diarrhoea cases (5442 participants, 2 trials; high-certainty evidence). In medium-mortality countries, RotaTeq prevented 79% of severe rotavirus diarrhoea cases (3863 participants, 1 trial; low-certainty evidence). In high-mortality countries, RotaTeq prevented 57% of severe rotavirus diarrhoea cases (6775 participants, 2 trials; high-certainty evidence), but there is probably little or no difference between vaccine and placebo for severe all-cause diarrhoea (1 trial, 4085 participants; moderate-certainty evidence). Children vaccinated and followed up for two years In low-mortality countries, RotaTeq prevented 96% of severe rotavirus diarrhoea cases (5442 participants, 2 trials; high-certainty evidence). In medium-mortality countries, RotaTeq prevented 79% of severe rotavirus diarrhoea cases (3863 participants, 1 trial; low-certainty evidence). In high-mortality countries, RotaTeq prevented 44% of severe rotavirus diarrhoea cases (6744 participants, 2 trials; high-certainty evidence), and 15% of severe all-cause diarrhoea cases (5977 participants, 2 trials; high-certainty evidence). We did not identify RotaTeq studies reporting on severe all-cause diarrhoea in low- or medium-mortality countries. Rotasiil Rotasiil has not been assessed in any RCT in countries with low or medium child mortality. Infants vaccinated and followed up for the first year of life In high-mortality countries, Rotasiil prevented 48% of severe rotavirus diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence), and resulted in little to no difference in severe all-cause diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence). Children vaccinated and followed up for two years In high-mortality countries, Rotasiil prevented 44% of severe rotavirus diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence), and resulted in little to no difference in severe all-cause diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence). Rotavac Rotavac has not been assessed in any RCT in countries with low or medium child mortality. Infants vaccinated and followed up for the first year of life In high-mortality countries, Rotavac prevented 57% of severe rotavirus diarrhoea cases (6799 participants, 1 trial; moderate-certainty evidence), and 16% of severe all-cause diarrhoea cases (6799 participants, 1 trial; moderate-certainty evidence). Children vaccinated and followed up for two years In high-mortality countries, Rotavac prevented 54% of severe rotavirus diarrhoea cases (6541 participants, 1 trial; moderate-certainty evidence); no Rotavac studies have reported on severe all-cause diarrhoea at two-years follow-up. Safety No increased risk of serious adverse events (SAEs) was detected with Rotarix (103,714 participants, 31 trials; high-certainty evidence), RotaTeq (82,502 participants, 14 trials; moderate to high-certainty evidence), Rotasiil (11,646 participants, 3 trials; high-certainty evidence), or Rotavac (8210 participants, 3 trials; moderate-certainty evidence). Deaths were infrequent and the analysis had insufficient evidence to show an effect on all-cause mortality. Intussusception was rare. AUTHORS' CONCLUSIONS: Rotarix, RotaTeq, Rotasiil, and Rotavac prevent episodes of rotavirus diarrhoea. The relative effect estimate is smaller in high-mortality than in low-mortality countries, but more episodes are prevented in high-mortality settings as the baseline risk is higher. In high-mortality countries some results suggest lower efficacy in the second year. We found no increased risk of serious adverse events, including intussusception, from any of the prequalified rotavirus vaccines.
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Affiliation(s)
| | | | - Daniel Hungerford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | | | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa
| | - Nigel Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
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Tsolenyanu E, Akakpo-Numado K, Akolly DE, Mwenda J, Tate J, Boko A, Landoh D, Gnassingne K, Atakouma Y, Parashar U. Epidemiology of intussusception among infants in Togo, 2015-2018. Pan Afr Med J 2021; 39:7. [PMID: 34548899 PMCID: PMC8437427 DOI: 10.11604/pamj.supp.2021.39.1.21343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction intussusception is the leading cause of bowel obstruction in infants and young children. We describe the epidemiology and diagnostic and treatment characteristics of intussusception among Togolese infants over a 4-year period. Methods we implemented active surveillance among infants younger than 1 year of age admitted with intussusception from 2015 to 2018 at Sylvanus Olympio Teaching Hospital and in 2018 at Campus Teaching Hospital. Brighton Collaboration Level 1 case definition criteria were used to confirm the diagnosis of intussusception. Results during four years, 41 cases of intussusception, with an annual range of 8 to 14 cases (median: 10) were reported; and the highest number of cases (89%) was enrolled at Sylvanus Olympio teaching hospital. Intussusception was uncommon in the first 2 months of life, peaked from 5 to 7 months old (63%), with male predominance (63%), and showed no significant seasonality. One third of cases (34%) were transferred to the sentinel surveillance site from another health facility; and the median delay in seeking care was 4 days (range: 0-11) with ≥ 48-hour delay in 59% of cases. Clinical symptoms, ultrasound and surgery were combined to diagnose intussusception in all the cases (100%). The treatment was exclusively surgical, and intestinal resection was common (28/41, 68%). A high case fatality rate (23%) was observed and the average length of hospital stay was 10 days (range: 1-23). Conclusion active surveillance for intussusception in Togo has highlighted exclusive use of surgical therapy; often associated to an intestinal resection with a very high case fatality rate.
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Affiliation(s)
- Enyonam Tsolenyanu
- Department of Paediatrics, Medical School of Lome, Togo, West Africa.,Ministry of Health, Togo
| | | | | | - Jason Mwenda
- The World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Jacqueline Tate
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Dadja Landoh
- The World Health Organization, Country Office, Togo
| | - Komlan Gnassingne
- Department of Paediatrics Surgery, Medical School of Lome, Togo, West Africa
| | - Yawo Atakouma
- Department of Paediatrics, Medical School of Lome, Togo, West Africa
| | - Umesh Parashar
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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8
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Abstract
Rotavirus is a major cause of severe pediatric diarrhea worldwide. In 2006, two live, oral rotavirus vaccines, Rotarix and RotaTeq, were licensed for use in infants and were rapidly adopted in many high- and middle-income settings where efficacy had been demonstrated in clinical trials. Following completion of additional successful trials in low-income settings, the World Health Organization (WHO) recommended rotavirus vaccination for all infants globally in 2009. In 2018, two new rotavirus vaccines, Rotasiil and Rotavac, were prequalified by WHO, further expanding global availability. As of March 2021, rotavirus vaccines have been introduced nationally in 106 countries. Since introduction, rotavirus vaccines have demonstrated effectiveness against severe disease and mortality, even among age groups not eligible for vaccination. Cross-genotypic protection has also been demonstrated, and the favorable benefit-risk profile of these vaccines continues to be confirmed via post-marketing surveillance. Ongoing research seeks to better understand reasons for the lower effectiveness observed in lower-resource settings, and to use these findings to optimize vaccine strategies worldwide.
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Affiliation(s)
- Rachel M Burke
- Viral Gastroenteritis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E Tate
- Viral Gastroenteritis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- Viral Gastroenteritis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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Sun ZW, Fu Y, Lu HL, Yang RX, Goyal H, Jiang Y, Xu HG. Association of Rotavirus Vaccines With Reduction in Rotavirus Gastroenteritis in Children Younger Than 5 Years: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Observational Studies. JAMA Pediatr 2021; 175:e210347. [PMID: 33970192 PMCID: PMC8111566 DOI: 10.1001/jamapediatrics.2021.0347] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Rotavirus vaccines have been introduced worldwide, and the clinical association of different rotavirus vaccines with reduction in rotavirus gastroenteritis (RVGE) after introduction are noteworthy. OBJECTIVE To evaluate the comparative benefit, risk, and immunogenicity of different rotavirus vaccines by synthesizing randomized clinical trials (RCTs) and observational studies. DATA SOURCES Relevant studies published in 4 databases: Embase, PubMed, the Cochrane Library, and Web of Science were searched until July 1, 2020, using search terms including "rotavirus" and "vaccin*." STUDY SELECTION Randomized clinical trials and cohort and case-control studies involving more than 100 children younger than 5 years that reported the effectiveness, safety, or immunogenicity of rotavirus vaccines were included. DATA EXTRACTION AND SYNTHESIS A random-effects model was used to calculate relative risks (RRs), odds ratios (ORs), risk differences, and 95% CIs. Adjusted indirect treatment comparison was performed to assess the differences in the protection of Rotarix and RotaTeq. MAIN OUTCOMES AND MEASURES The primary outcomes were RVGE, severe RVGE, and RVGE hospitalization. Safety-associated outcomes involved serious adverse events, intussusception, and mortality. RESULTS A meta-analysis of 20 RCTs and 38 case-control studies revealed that Rotarix (RV1) significantly reduced RVGE (RR, 0.316 [95% CI, 0.224-0.345]) and RVGE hospitalization risk (OR, 0.347 [95% CI, 0.279-0.432]) among children fully vaccinated; RotaTeq (RV5) had similar outcomes (RVGE: RR, 0.350 [95% CI, 0.275-0.445]; RVGE hospitalization risk: OR, 0.272 [95% CI, 0.197-0.376]). Rotavirus vaccines also demonstrated higher protection against severe RVGE. Additionally, no significant differences in the protection of RV1 and RV5 against rotavirus disease were noted in adjusted indirect comparisons. Moderate associations were found between reduced RVGE risk and Rotavac (RR, 0.664 [95% CI, 0.548-0.804]), Rotasiil (RR, 0.705 [95% CI, 0.605-0.821]), and Lanzhou lamb rotavirus vaccine (RR, 0.407 [95% CI, 0.332-0.499]). All rotavirus vaccines demonstrated no risk of serious adverse events. A positive correlation was also found between immunogenicity and vaccine protection (eg, association of RVGE with RV1: coefficient, -1.599; adjusted R2, 99.7%). CONCLUSIONS AND RELEVANCE The high protection and low risk of serious adverse events for rotavirus vaccines in children who were fully vaccinated emphasized the importance of worldwide introduction of rotavirus vaccination. Similar protection provided by Rotarix and RotaTeq relieves the pressure of vaccines selection for health care authorities.
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Affiliation(s)
- Zi-Wei Sun
- Department of Laboratory Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Fu
- Department of Pathology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hai-Ling Lu
- Department of Laboratory Medicine, Yancheng Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Yancheng, China
| | - Rui-Xia Yang
- Department of Laboratory Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hemant Goyal
- The Wright Center of Graduate Medical Education, Scranton, Pennsylvania
| | - Ye Jiang
- Department of Laboratory Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hua-Guo Xu
- Department of Laboratory Medicine, the First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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10
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Isanaka S, Langendorf C, McNeal MM, Meyer N, Plikaytis B, Garba S, Sayinzoga-Makombe N, Soumana I, Guindo O, Makarimi R, Scherrer MF, Adehossi E, Ciglenecki I, Grais RF. Rotavirus vaccine efficacy up to 2 years of age and against diverse circulating rotavirus strains in Niger: Extended follow-up of a randomized controlled trial. PLoS Med 2021; 18:e1003655. [PMID: 34214095 PMCID: PMC8253401 DOI: 10.1371/journal.pmed.1003655] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rotavirus vaccination is recommended in all countries to reduce the burden of diarrhea-related morbidity and mortality in children. In resource-limited settings, rotavirus vaccination in the national immunization program has important cost implications, and evidence for protection beyond the first year of life and against the evolving variety of rotavirus strains is important. We assessed the extended and strain-specific vaccine efficacy of a heat-stable, affordable oral rotavirus vaccine (Rotasiil, Serum Institute of India, Pune, India) against severe rotavirus gastroenteritis (SRVGE) among healthy infants in Niger. METHODS AND FINDINGS From August 2014 to November 2015, infants were randomized in a 1:1 ratio to receive 3 doses of Rotasiil or placebo at approximately 6, 10, and 14 weeks of age. Episodes of gastroenteritis were assessed through active and passive surveillance and graded using the Vesikari score. The primary endpoint was vaccine efficacy of 3 doses of vaccine versus placebo against a first episode of laboratory-confirmed SRVGE (Vesikari score ≥ 11) from 28 days after dose 3, as previously reported. At the time of the primary analysis, median age was 9.8 months. In the present paper, analyses of extended efficacy were undertaken for 3 periods (28 days after dose 3 to 1 year of age, 1 to 2 years of age, and the combined period 28 days after dose 3 to 2 years of age) and by individual rotavirus G type. Among the 3,508 infants included in the per-protocol efficacy analysis (mean age at first dose 6.5 weeks; 49% male), the vaccine provided significant protection against SRVGE through the first year of life (3.96 and 9.98 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 60.3%, 95% CI 43.6% to 72.1%) and over the entire efficacy follow-up period up to 2 years of age (2.13 and 4.69 cases per 100 person-years for vaccine and placebo, respectively; vaccine efficacy 54.7%, 95% CI 38.1% to 66.8%), but the difference was not statistically significant in the second year of life. Up to 2 years of age, rotavirus vaccination prevented 2.56 episodes of SRVGE per 100 child-years. Estimates of efficacy against SRVGE by individual rotavirus genotype were consistent with the overall protective efficacy. Study limitations include limited generalizability to settings with administration of oral polio virus due to low concomitant administration, limited power to assess vaccine efficacy in the second year of life owing to a low number of events among older children, potential bias due to censoring of placebo children at the time of study vaccine receipt, and suboptimal adapted severity scoring based on the Vesikari score, which was designed for use in settings with high parental literacy. CONCLUSIONS Rotasiil provided protection against SRVGE in infants through an extended follow-up period of approximately 2 years. Protection was significant in the first year of life, when the disease burden and risk of death are highest, and against a changing pattern of rotavirus strains during the 2-year efficacy period. Rotavirus vaccines that are safe, effective, and protective against multiple strains represent the best hope for preventing the severe consequences of rotavirus infection, especially in resource-limited settings, where access to care may be limited. Studies such as this provide valuable information for the planning of national immunization programs and future vaccine development. TRIAL REGISTRATION ClinicalTrials.gov NCT02145000.
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Affiliation(s)
- Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Monica Malone McNeal
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Nicole Meyer
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Brian Plikaytis
- BioStat Consulting, Jasper, Georgia, United States of America
| | | | | | | | | | | | | | | | - Iza Ciglenecki
- Operational Center Geneva, Médecins Sans Frontières, Geneva, Switzerland
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11
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Wang Y, Li J, Liu P, Zhu F. The performance of licensed rotavirus vaccines and the development of a new generation of rotavirus vaccines: a review. Hum Vaccin Immunother 2021; 17:880-896. [PMID: 32966134 DOI: 10.1080/21645515.2020.1801071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rotavirus, which causes acute gastroenteritis and severe diarrhea, has posed a great threat to children worldwide over the last 30 y. Since no specific drugs and therapies against rotavirus are available, vaccination is considered the most effective method of decreasing the morbidity and mortality related to rotavirus-associated gastroenteritis. To date, six rotavirus vaccines have been developed and licensed by local governments. Notably, Rotarix™ and RotaTeq™ have been recommended as universal agents against rotavirus infection by the World Health Organization; however, lower efficacies were found in less-developed and developing regions with medium and high child mortality than well-developed ones with low child mortality. For now, two promising novel vaccines, Rotavac™ and RotaSiil™ were pre-qualified by the World Health Organization in 2018. Other rotavirus vaccines in the pipeline including neonatal strain (RV3-BB) and several non-replicating rotavirus vaccines with a parenteral delivery strategy are currently undergoing investigation, with the potential to improve the performance of, and eliminate the safety concerns associated with, previous live oral rotavirus vaccines. This paper reviews the important developments in rotavirus vaccines in the last 20 y and discusses problems and challenges that require investigation in the future.
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Affiliation(s)
- Yuxiao Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Jingxin Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Pei Liu
- School of Public Health, Southeast University, Nanjing, China
| | - Fengcai Zhu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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12
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Avoka JA, Dun-Dery EJ, Seidu I, Abou ANE, Twene P, Tandoh IO, Dun-Dery F. Time series analysis of the relationship between diarrhea in children and Rota 2 vaccine in the Fanteakwa District of the eastern region of Ghana. BMC Pediatr 2021; 21:88. [PMID: 33607970 PMCID: PMC7893935 DOI: 10.1186/s12887-021-02540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Rotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana. METHODS The study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases. RESULTS The study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt - 1),0.346 to 0.735), two months ago ((Xt - 2),0.383 to 0.746), three months ago ((Xt - 3), 0.330 to 0.737) and four months ago ((Xt - 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month's Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36. CONCLUSION Seasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.
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Affiliation(s)
- James Atampiiga Avoka
- Ghana Health Service, Birim Central Municipal Health Directorate, Box 429, Akim Oda, Ghana
| | - Elvis J. Dun-Dery
- Department of Population and Health Research, Research Web Africa, Box 233, Sunyani, Ghana
| | - Issah Seidu
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Armel N. E. Abou
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Paul Twene
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Isaac Obeng Tandoh
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Frederick Dun-Dery
- Disease Control in Disadvantaged Populations, Heidelberg Institute of Global Health, Medical Faculty, Ruprecht-Karls Universität, Heidelberg, Germany
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13
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Dadari IK, Zgibor JC. How the use of vaccines outside the cold chain or in controlled temperature chain contributes to improving immunization coverage in low- and middle-income countries (LMICs): A scoping review of the literature. J Glob Health 2021; 11:04004. [PMID: 33692889 PMCID: PMC7915947 DOI: 10.7189/jogh.11.04004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Most vaccines are recommended for storage at temperatures of +2°C to +8°C to maintain potency. Immunization supply chain bottlenecks constraints reaching populations with life-saving vaccines. The World Health Organization permits the use of vaccines outside the cold chain as "controlled temperature chain (CTC)" upon meeting certain conditions and has set targets to license more vaccines CTC by 2020. Objectives This scoping review aims to explore and synthesize the evidence in the literature on how the use of vaccines outside the cold chain or in a controlled temperature chain increases immunization coverage in low and middle-income countries (LMICs), with a focus on the timelines of the Global Vaccine Action Plan (2011-2020). Methods A systematic search of three online databases (PubMed, Embase, and Web of Science) due to their broad coverage of global health sciences retrieved 173 original peer-reviewed articles, of which 13 were included in the review having met our inclusion criteria. Results The majority of the studies were conducted in Africa (n = 9), followed by Asia (n = 3), and the least in the Pacific (n = 1). The different study designs captured included four non-randomized trials, three randomized trials, two simulation models, two cross-sectional studies, and one cohort study. Reported benefits included increased coverage, logistical ease, cost savings while vaccines remain potent. Conclusion Currently, only two vaccines have been licensed to be stored CTC. More needs to be done to get additional vaccines licensed for CTC and disseminate operational guidance to operationalize its use in low- and middle-income countries.
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Affiliation(s)
- Ibrahim K Dadari
- College of Public Health, University of South Florida, Tampa, Florida, USA.,United Nations Children's Fund, Pacific Office, Solomon Islands
| | - Janice C Zgibor
- College of Public Health, University of South Florida, Tampa, Florida, USA
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14
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Skansberg A, Sauer M, Tan M, Santosham M, Jennings MC. Product review of the rotavirus vaccines ROTASIIL, ROTAVAC, and Rotavin-M1. Hum Vaccin Immunother 2020; 17:1223-1234. [PMID: 33121329 DOI: 10.1080/21645515.2020.1804245] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Rotavirus is the leading cause of severe dehydrating gastroenteritis and death due to diarrhea among children under 5, causing over 180,000 under-5 deaths annually. Safe, effective rotavirus vaccines have been available for over a decade and are used in over 98 countries. In addition to the globally available, WHO-prequalified ROTARIX (GSK) and RotaTeq (Merck), several new rotavirus vaccines have attained national licensure - ROTAVAC (Bharat Biotech) and ROTASIIL (Serum Institute of India), licensed and manufactured in India and now WHO-prequalified, and Rotavin-M1 (PolyVac), licensed and manufactured in Vietnam. In this review, we summarize the available clinical trial and post-introduction evidence for these three new orally administered rotavirus vaccines. All three vaccines have demonstrated safety and efficacy against rotavirus diarrhea, although publicly available preclinical data are limited in some cases. This expanding product landscape presents a range of options to optimize immunization programs, and new presentations of each vaccine are currently under development.
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Affiliation(s)
- Annika Skansberg
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Molly Sauer
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marissa Tan
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mathuram Santosham
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Carol Jennings
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, MD, USA.,International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Abstract
As of 2019, four rotavirus vaccines have been prequalified by the WHO for use worldwide. This review highlights current knowledge regarding rotavirus vaccines available, and provides a brief summary of the rotavirus vaccine pipeline.
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16
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Burnett E, Van Trang N, Rayamajhi A, Yousafzai MT, Satter SM, Anh DD, Thapa A, Qazi SH, Heffelfinger JD, Hung PH, Rayamajhi AK, Saddal N, Flora MS, Canh TM, Ali SA, Gurley ES, Tate JE, Yen C, Parashar UD. Preparing for safety monitoring after rotavirus vaccine introduction - Assessment of baseline epidemiology of intussusception among children <2 years of age in four Asian countries. Vaccine 2018; 36:7593-7598. [PMID: 30414781 PMCID: PMC10983083 DOI: 10.1016/j.vaccine.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 11/23/2022]
Abstract
Intussusception is the invagination of one segment of the bowel into a distal segment, characterized by symptoms of bloody stool, vomiting, and abdominal pain. Previous studies have found regional differences in incidence but the etiology of most intussusception cases is unknown. Rotavirus vaccines were associated with a slightly of increased risk of intussusception in post-licensure evaluations in high- and middle-income countries, but not in low income African countries. To describe the baseline epidemiology of intussusception in young children prior to rotavirus vaccine implementation, active sentinel hospital surveillance for intussusception in children < 2 years of age was conducted in 4 low income Asian countries (Bangladesh, Nepal, Pakistan and Vietnam). Over a 24-month period, 15 sites enrolled 1,415 intussusception cases, of which 70% were enrolled in Vietnam. Overall, 61% of cases were male and 1% (n = 16) died, ranging from 8% in Pakistan to 0% in Vietnam. The median age of cases enrolled ranged from 6 months in Bangladesh and Pakistan to 12 months in Vietnam. The proportion of cases receiving surgical management was 100% in Bangladesh, 88% in Pakistan, 61% in Nepal, and 1% in Vietnam. The high proportion of males and median age of cases around 6 months of age found in this regional surveillance network are consistent with previous descriptions of the epidemiology of intussusception in these countries and elsewhere. Differences in management and the fatality rate of cases between the countries likely reflect differences in access to healthcare and availability of diagnostic modalities. These baseline data will be useful for post-rotavirus vaccine introduction safety monitoring.
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Affiliation(s)
- Eleanor Burnett
- CDC Foundation for the US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Nguyen Van Trang
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | - Ajit Rayamajhi
- Janek Medical and Research Center, Kathmandu, Nepal; Kanthi Children's Hospital, Kathmandu, Nepal
| | | | | | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam
| | | | - Saqib Hamid Qazi
- Department of Pediatric Surgery, Aga Khan University, Karachi, Pakistan
| | | | | | | | - Nasir Saddal
- Department of Surgery, National Institute of Child Health, Karachi, Pakistan
| | - Meerjady S Flora
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Syed Asad Ali
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | - Catherine Yen
- Centers for Disease Control and Prevention, Atlanta, USA
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