Population effectiveness of the pentavalent and monovalent rotavirus vaccines: a systematic review and meta-analysis of observational studies

Abstract

BackgroundRotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination. Since 2006 there have been two licensed vaccines available; with successful clinical trials leading the World Health Organization to recommend rotavirus vaccination for all children worldwide. In order to inform immunisation policy we have conducted a systematic review and meta-analysis of observation studies to assess population effectiveness against acute gastroenteritis.MethodsWe systematically searched PubMed, Medline, Web of Science, Cinhal and Academic Search Premier and grey literature sources for studies published between January 2006 and April 2014. Studies were eligible for inclusion if they were observational measuring population effectiveness of rotavirus vaccination against health care attendances for rotavirus gastroenteritis or AGE. To evaluate study quality we use used the Newcastle-Ottawa Scale for non-randomised studies, categorising studies by risk of bias. Publication bias was assessed using funnel plots. If two or more studies reported a measure of vaccine effectiveness (VE), we conducted a random effects meta-analysis. We stratified analyses by World Bank country income level and used study quality in sensitivity analyses.ResultsWe identified 30 studies, 19 were from high-income countries and 11 from middle-income countries. Vaccine effectiveness against hospitalization for laboratory confirmed rotavirus gastroenteritis was highest in high-income countries (89% VE; 95% CI 84-92%) compared to middle-income countries (74% VE; 95% CI 67-80%). Vaccine effectiveness was higher for those receiving the complete vaccine schedule (81% VE; 95% CI 75-86%) compared to partial schedule (62% VE; 95% CI 55-69%). Two studies from high-income countries measured VE against community consultations for AGE with a pooled estimate of 40% (95% CI 13-58%; 2 studies).ConclusionsWe found strong evidence to further support the continued use of rotavirus vaccines. Vaccine effectiveness was similar to that reported in clinical trials for both high and middle-income countries. There is limited data from Low income settings at present. There was lower effectiveness against milder disease. Further studies, should continue to report effectiveness against AGE and less-severe rotavirus disease because as evidenced by pre-vaccine introduction studies this is likely to contribute the greatest burden on healthcare resources, particularly in high-income countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2613-4) contains supplementary material, which is available to authorized users.

Epidemiologic characteristics and clinical course of children with acute gastroenteritis hospitalized in the Department of Pediatric Infectious Diseases and Hepatology at John Paul II Hospital in Krakow

“…Rotavirus is the leading cause of AGE in infants and young children and the major contributor to hospitalization for diarrhea in countries that have no rotavirus vaccines in their national immunization schedules (3,4,5). With the continuing decline in cases of rotavirus-associated AGE, since the implementation of routine childhood vaccination against rotavirus, norovirus infection has become the most common cause of medically treated AGE (6,7). However, rotavirus is still responsible for most cases of AGE and overall childhood mortality from diarrhea.…”

“…W krajach niemających w obowiązku szczepień przeciwko rotawirusom, wirus ten jest najczęstszą przyczyną AGE u niemowląt i małych dzieci oraz głównym powodem hospitalizacji dzieci z biegunką (3,4,5). W państwach, gdzie szczepienia przeciwko rotawirusom zostały włączone do narodowego programu szczepień, zaobserwowano zmniejszenie liczby hospitalizacji dzieci z powodu infekcji rotawirusowej oraz znaczne zwiększenie udziału norowirusa w etiologii AGE (6,7). Niemiej jednak rotawirus nadal odpowiada za znaczną większość zachorowań oraz znaczny odsetek zgonów dziecięcych na całym świecie.…”

Association between rotavirus vaccination and intussusception in Australian children: A record linkage study

“…19 A systematic review estimated rotavirus effectiveness against hospitalisation for laboratory confirmed rotavirus gastroenteritis to be 89% (95% CI 84, 92) in high-income countries and 74% (95% CI 75, 86) in middle-income countries. 20 In Australia, declines in rotavirus-associated hospitalisations among children aged <5 years have been observed following the implementation of the universal rotavirus vaccination programme, and studies have shown moderate-high vaccine effectiveness depending upon the study setting. [21][22][23][24][25] Several post-licensure studies have identified a small increased risk of intussusception following the first dose of rotavirus vaccine.…”

Rotavirus detection and typing in the rotavirus vaccine era

“…The rotavirus hospitalization rates in children aged younger than 5-years have declined by 63-94% in the United States (Leshem et al, 2015), 65-84% in Europe (Karafillakis et al, 2015), and by 73% in Latin America (Santos et al, 2016). While much is now known about the impact of rotavirus vaccines on moderate to severe rotavirus diarrhoea and healthcare utilisation, much less is known about their impact on mild disease managed in the community where clinical trial data suggest they may be less effective (Hungerford et al, 2017;Gentsch et al, 2005). Territory.…”

“…In contrast with hospital-based data, little is known about the impact of rotavirus vaccines on mild gastroenteritis episodes managed within the community where clinical trial data suggest vaccines are less efficacious (Hungerford et al, 2017). Changes in diagnostic testing practices have also occurred recently and may impinge upon monitoring vaccine effectiveness.…”