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Should India launch a national immunisation programme against rotavirus? Yes

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7818 (Published 30 November 2012) Cite this as: BMJ 2012;345:e7818
  1. Johnie Rose, senior instructor 1,
  2. Umesh D Parashar, medical epidemiologist2
  1. 1Preventive Medicine Residency, Department of Family Medicine and Community Health, Division of Research, Case Western Reserve University, Cleveland, Ohio, USA
  2. 2Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to: J Rose johnie.rose{at}case.edu

India is considering including rotavirus vaccine in its national childhood immunisation programme. Johnie Rose and Umesh Parashar support the move, but Jacob Puliyel and Joseph Mathew (doi:10.1136/bmj.e7832) question the evidence used to support vaccination

The World Health Organization recommends inclusion of rotavirus vaccination of infants into all national immunisation programmes, with a strong recommendation for introduction of vaccine in countries like India where diarrhoeal deaths account for ≥10% of child mortality.1 The health burden of rotavirus in India is well established. WHO estimated that 98 621 Indian children died from rotavirus gastroenteritis in 2008, representing about one third of deaths from diarrhoeal disease and 4% of all child deaths in India.2 More recent data from the Million Death Study, a nationally representative survey of 1.1 million Indian households, estimated that the virus causes 113 000 deaths a year.3 Both of these figures are conservative compared with an estimate of 147 000 annual rotavirus deaths obtained by directly extrapolating rates of laboratory confirmed rotavirus mortality from a contemporary community based birth cohort study in India.4

Non-fatal rotavirus gastroenteritis results in around 880 000 hospital admissions and 1.26 million …

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