Age restrictions on rotavirus vaccination cost livesBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7283 (Published 31 October 2012) Cite this as: BMJ 2012;345:e7283
Earlier this year, the World Health Organization changed its mind about restricting rotavirus vaccination to babies aged 15-32 weeks. WHO was responding to revised figures, just published, that balanced lives saved by rotavirus vaccination with lives lost from intussusception, a rare complication linked to early formulations of the vaccine.
After modelling data from 158 low and middle income countries, researchers estimate that allowing babies to start their vaccine schedule beyond 15 weeks of age would prevent an extra 154 deaths from rotavirus diarrhoea for every extra death caused by intussusception (5th-95th centile (uncertainty range) 55 to 318). The ratio of lives saved to lives lost rose to 220 (116 to 407) in the most optimistic sensitivity analysis, and fell to 24 (9 to 51) in the most pessimistic one.
These figures are best guesses that apply to deaths only in children under 5 years in low and middle income countries. Roughly 450 000 children die here each year from rotavirus diarrhoea. The estimates reflect assumptions about efficacy and coverage of vaccinations, and about incidence and fatality rates of both rotavirus infections and intussusception. The researchers also had to assume that deaths caused by a vaccine are morally and ethically equivalent to deaths caused by failing to vaccinate.
WHO recommended age restriction as a safety precaution because the risk of naturally occurring intussusception rises with age. The policy change should help those African countries planning to introduce rotavirus vaccination in the next two years, say the authors.
Cite this as: BMJ 2012;345:e7283