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.

Cochrane meets controversy: Vaccines for measles, mumps, and rubella

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A lot has already been written on the subject of the measles-mumps-rubella (MMR) vaccine in children. A lot, a lot, a lot. But many countries around the world are currently experiencing another measles outbreak, and public opinion on the safety and necessity of the MMR vaccine continues to be divided by strongly-held, opposing beliefs.

So, we turned to a Cochrane review on the safety and effectiveness of the MMR vaccine for an exhaustive look at the evidence from 64 studies involving approximately 14,700,000 children (Demicheli, 2012), and according to the review authors,

“Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication and in order to reduce morbidity and mortality associated with mumps and rubella.”

These conclusions are based on the ≥95% effectiveness of the vaccine in preventing clinical and laboratory-confirmed measles cases in preschool children, school-aged children, and adolescents; 92% and 95% prevention of secondary measles cases with one and two doses, respectively; and 64-88% prevention of mumps cases, depending on the strain of vaccine used. No studies of the effectiveness of the MMR vaccine in protecting against rubella were found.

There are rare harms associated with the MMR vaccine, including aseptic meningitis (Urabe and Leningrad-Zagreb mumps strains), febrile seizure (Moraten, Jeryl Lynn, Wistar RA, and RIT 4385 strains), and fever, convulsions, and acute or idiopathic thrombocytopenic purpura (vaccine composition not described). However, there is no scientific evidence to suggest that MMR is associated with: autism, asthma, leukemia, hay fever, type 1 diabetes, gait disturbance, Crohn’s disease, demyelinating diseases, or bacterial or viral infections.

These results probably don’t come as much of a surprise to those on the front lines, caring for children. But in the face of controversy, being armed with the evidence can’t hurt.

According to Dr. Joan Robinson, Divisional Director of Pediatric Infectious Disease at the University of Alberta, “Most people under 50 have never seen a case of measles and are not aware that it is a miserable disease with about 5 to 10% of infected children requiring hospitalization and 1 in 1,500 children having brain involvement. The harms that have been linked to the vaccine are all much more common with measles infection than they are with vaccine. Until recently, parents thought that they could rely upon “herd immunity,” meaning that if most other children were immunized, their unimmunized child would not be exposed to measles. However, this has changed as the number of unimmunized children has increased. The recent US outbreak that started in Disneyland demonstrates how very infectious the measles virus is and proves that “It’s a Small World After All.”

Reference:

Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004407. DOI: 10.1002/14651858.CD004407.pub3. See summary here.