Rotavirus vaccine cuts deaths of Mexican babies from diarrhoea by 40%BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c511 (Published 28 January 2010) Cite this as: BMJ 2010;340:c511
The worldwide campaign to introduce the rotavirus vaccine has been given an important boost with the publication of two papers, one showing a drop in deaths from diarrhoeal disease in Mexico after the vaccine was introduced and the other proving its effectiveness among babies in Africa.
The findings from the two studies, published in the New England Journal of Medicine, informed the World Health Organization’s recent recommendation that rotavirus vaccine be included in every nation’s vaccination programme.
In an editorial accompanying the papers, Mathuram Santosham, professor of international health and paediatrics at Johns Hopkins University, Baltimore, said that the vaccine had the potential to prevent about two million deaths over the next decade.
Rotavirus, the leading cause of diarrhoea worldwide, kills more than 500 000 children under 5 years old every year and puts many more in hospital.
Researchers in Mexico, one of the first countries to introduce the rotavirus vaccine among children aged under 11 months, compared data on diarrhoea related mortality from 2008 and 2009 with that from 2003 to 2006, the year when the vaccine was introduced in Mexico (New England Journal of Medicine 2010;362:299-305, doi:10.1056/NEJMoa0905211). By December 2007 an estimated 74% of children aged 11 months or younger had received one dose of the rotavirus vaccine. In this age group diarrhoea related mortality fell by 41%, from 61.5 deaths per 100 000 to 36 per 100 000.
Among children aged between 12 and 23 months—just 10% to 15% of whom had been vaccinated—the number of diarrhoea related deaths fell by 29%. This indicates that the vaccine may have reduced transmission of rotavirus disease and provided some herd protection.
The second study was a randomised controlled trial in South Africa and Malawi (New England Journal of Medicine 2010;362:289-98, doi:10.1056/NEJMoa0904797). A total of 4939 children under the age of 12 months were enrolled and assigned to three groups: 1647 children received two doses of the vaccine, 1651 children received three doses, and 1641 were given a placebo. Severe rotavirus gastroenteritis occurred in 4.9% of the children in the placebo group and in 1.9% of those in the vaccine groups, giving a vaccine efficacy of 61.2%.
Poorer countries face major barriers to the vaccine’s widespread introduction, partly because the first dose should be given between 6 and 15 weeks of age and the third dose no later than 32 weeks. However, the Global Alliance for Vaccines and Immunisation hopes to introduce the vaccination to at least 44 poor countries by 2015.
The alliance says that the vaccine is an important part of a coordinated approach to reducing mortality and morbidity from diarrhoeal disease that includes oral rehydration therapy, breast feeding, zinc supplementation, and improved sanitation.
Cite this as: BMJ 2010;340:c511