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Should India launch a national immunisation programme against rotavirus? No

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7832 (Published 30 November 2012) Cite this as: BMJ 2012;345:e7832
  1. Jacob M Puliyel, consultant paediatrician1,
  2. Joseph L Mathew, associate professor2
  1. 1St Stephen’s Hospital, Tis Hazari, Delhi 110054, India
  2. 2Advanced Paediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to: J M Puliyel puliyel{at}gmail.com

India is considering including rotavirus vaccine in its national childhood immunisation programme. Johnie Rose and Umesh Parashar (doi:10.1136/bmj.e7818) support the move, but Jacob Puliyel and Joseph Mathew question the evidence used to support vaccination

The programme to immunise all the world’s children with the rotavirus vaccine is based on mistaken assumptions. Careful evaluation of available evidence does not support the launch of the programme in India. It will divert funds from more life saving interventions and could cause harm.

Inappropriate extrapolations

The World Health Organization recommended universal rotavirus vaccination well before regional evidence of its effectiveness was collected. This is a distortion of the standard procedure whereby recommendations are made based on local evidence. The distortion came about in two stages. In 2007, the WHO committee looking at rotavirus vaccination for developing countries decided that efficacy data from one population can be extrapolated to other populations that are in an “equivalent child mortality strata.”1 This presumes that the prevalent virus strains are the same in different regions with similar socioeconomic status and mortality rates. There is no scientific evidence to support this assumption. Following this in 2009, using data from Malawi (one of the poorest regions in the world),2 Nicaragua, and a handful of developed countries, WHO recommended rotavirus vaccine for all regions of the world.3

Rationale

According to the GAVI Alliance, which funds vaccination for children in poor countries, rotavirus …

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