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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

Re: Should India launch a national immunisation programme against rotavirus? No

We thank Batik for responding to our paper on the rotavirus vaccines, and raising two distinct issues. The first relates to the efficacy of rotavirus vaccines. We would like to reiterate that the Cochrane review clearly shows that both RV1 and RV5 vaccines did not have any impact on mortality as compared to placebo, in WHO-defined low-mortality as well as high-mortality countries.(1) In fact, the authors of the review state this in the text of the review itself.

Further, we have not left out any relevant information that is important for decision-making in India and other developing countries. All actors (including international organization) who are insisting that the rotavirus vaccines should be used in developing countries, repeatedly state that the vaccines reduce severe rotavirus diarrhea, severe diarrhea and severe all-cause diarrhea, exactly as Batik has done. What they omit to mention is that there is no evidence of a reduction in mortality (the most important outcome), which is the point that we are highlighting. This is especially important because the same actors emphasize that diarrhea (including rotaviral) is a leading cause of childhood mortality (in fact, the opening sentence in the Cochrane review also does likewise), thereby indirectly leading decision-makers to believe that the vaccines reduce mortality. This is perhaps why Batik felt that the rotavirus vaccines reduce mortality. The GAVI Alliance, explicitly promotes rotavirus vaccination as a key step towards lowering child mortality and achieving the millennium development goal for reduction of deaths among children under 5 years of age.(2) We feel that it is misleading to promote the vaccine in this manner when the evidence does not support mortality reduction.

References
1. Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev 2012;2:CD008521.

2. GAVI Alliance. Rotavirus vaccine support. www.gavialliance.org/support/nvs/rotavirus/.

Competing interests: No competing interests
03 January 2013
Joseph L. Mathew
Pediatrician
Jacob Puliyel
Post Graduate Institute
Chandigarh
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