Vaccines for Preventing Rotavirus Diarrhoea: Vaccines in Use

Today marks the beginning of National Infection Control Week in Canada and the US. As part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on vaccines approved for the prevention of rotavirus diarrhoea. This review was selected for the TREKK Evidence Repository on intussusception.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Vaccines for preventing rotavirus diarrhoea: vaccines in use

Rotavirus infection is a common cause of diarrhoea in infants and young children, and can cause mild illness, hospitalization, and death. Rotavirus infections result in approximately half a million deaths per year in children aged under five years, mainly in low- and middle-income countries. Since 2009, the World Health Organization (WHO) has recommended that a rotavirus vaccine be included in all national immunization programmes.

This review evaluates a monovalent rotavirus vaccine (RV1; Rotarix, GlaxoSmithKline Biologicals) and a pentavalent rotavirus vaccine (RV5; RotaTeq, Merck & Co., Inc.). These vaccines have been evaluated in several large trials and are approved for use in many countries. No trials of the Lanzhou lamb rotavirus vaccine (LLR; Lanzhou Institute of Biomedical Products) were found; this vaccine is used in China only. The review includes 41 trials with 186,263 participants; all trials compared a rotavirus vaccine with placebo. The vaccines tested were RV1 (29 trials with 101,671 participants) and RV5 (12 trials with 84,592 participants). The trials took place in a number of worldwide locations.

In the first two years of life, RV1 prevented more than 80% of severe cases of rotavirus diarrhoea in low-mortality countries, and at least 40% of severe rotavirus diarrhoea in high-mortality countries. Severe cases of diarrhoea from all causes (such as any viral infection, bacterial infections, toxins, or allergies) were reduced after vaccination with RV1 by 35 to 40% in low-mortality countries, and 15 to 30% in high-mortality countries.

In the first two years of life, RV5 reduced severe cases of rotavirus diarrhoea by more than 80% in low-mortality countries, and by 40 to 57% in high-mortality countries. Severe cases of diarrhoea from all causes were reduced by 73% to 96% in low-mortality countries, and 15% in high-mortality countries, after vaccination with RV5. Diarrhoea is more common in high-mortality countries, so even modest relative effects prevent more episodes in this population. The vaccines when tested against placebo gave similar numbers of adverse events such as reactions to the vaccine, and other events that required discontinuation of the vaccination schedule.

Authors’ Conclusions:

RV1 and RV5 prevent episodes of rotavirus diarrhoea. The vaccine efficacy is lower in high-mortality countries; however, due to the higher burden of disease, the absolute benefit is higher in these settings. No increased risk of serious adverse events including intussusception was detected, but post-introduction surveillance studies are required to detect rare events associated with vaccination.

Check Out the Full Cochrane Systematic Review Below:

Soares-Weiser, K., Maclehose, H., Bergman, H., Ben-Aharon, I., Nagpal, S., Goldberg, E., Pitan, F., Cunliffe, N. (2012). Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev, 11, CD008521. doi: 10.1002/14651858.CD008521.pub3

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.