Prevention of rotavirus gastroenteritis in infants and children: rotavirus vaccine safety, efficacy, and potential impact of vaccines

Abstract

Rotavirus infection is the most common cause of severe gastroenteritis globally, with greater than 86% of deaths occurring in low-income and middle-income countries. There are two rotavirus vaccines currently licensed in the United States and prequalified by the World Health Organization. RV1 is a monovalent attenuated human rotavirus strain, given orally in two doses. RV5 is a pentavalent human-bovine reassortant rotavirus vaccine, given orally in three doses. A third rotavirus vaccine, LLV, is a lamb rotavirus strain given orally as a single dose, which is currently available only in China. RV1 and RV5 have been shown to be highly efficacious in developed countries, and initial results from trials in Africa and Asia are promising as well. At least three other vaccines are in development, which are being developed by manufacturers of developing countries. Further studies are needed to clarify issues including administration of oral rotavirus vaccines with breastfeeding and other oral vaccines, and alterations in dosing schedule. Using new data on global diarrheal burden, rotavirus is estimated to cause 390,000 deaths in children younger than 5 years. Should rotavirus vaccines be introduced in the routine immunization programs of all countries, a potential of 170,000 deaths could be prevented annually. The largest impact on mortality would be seen in low-income and middle-income countries, despite poor immunization coverage and lower efficacy. Therefore, international efforts are needed to ensure that rotavirus vaccines reach the populations with highest burden of rotavirus disease.

Prevalence of rotavirus infection in children below two years presenting with diarrhea

“…Rotavirus was also significantly associated with vomiting, coryza, fever and severe dehydration which is similar to data from other studies. 20 Our study had a few limitations. This was a hospital based study and hence the results are unlikely to be a true reflection of the disease burden in the community.…”

Cranberry and Grape Juices Affect Tight Junction Function and Structural Integrity of Rotavirus-Infected Monkey Kidney Epithelial Cell Monolayers

“…For example, the breaching or viral-induced disruption of intercellular TJ glycoproteins after infection of intestinal epithelium by enteric viruses usually leads to tissue damage, an inflammatory response, and symptoms characteristic of gastroenteritis (e.g., diarrhea) (Guttman and Finlay 2009). Infection by rotavirus is a leading cause of morbidity and mortality in children world-wide, most significantly in developing countries (Chandran et al 2010). The pathophysiology of infection by rotavirus has been shown to impact, for example, on monolayer TJ function and structural integrity of the host cell (Obert et al 2000).…”

“…Pathologies of TJs commonly result in dehydration, electrolyte imbalance, and other clinical manifestations. If untreated, these effects, especially in the young, elderly, and immunocompromised, could be fatal (Chandran et al 2010;Okada et al 2006). Cranberry (CJ; V. macrocarpon) and grape (V. labrusca) juices (GJ), and/or secondary plant metabolites of these species (e.g., PACs) possess antiviral activity both in cell culture and in the animal model (Lipson et al 2007a(Lipson et al , b, 2010Su et al 2010a).…”

Tandem truncated rotavirus VP8* subunit protein with T cell epitope as non-replicating parenteral vaccine is highly immunogenic

“…[6][7][8] However, the immunogenicity and efficacy of these vaccines are substantially reduced in low-income countries of Africa, Asia and Central America, [9][10][11] where the high mortality due to rotavirus infections occurs. 12,13 In addition, formation of reassortant rotaviruses between vaccine strains and circulating wild-type strains or among vaccine strains can potentially increase virulence as reported recently. [14][15][16][17] PATH (Program for Appropriate Technology in Health, an international nonprofit organization) has launched a non-replicating rotavirus vaccine (NRRV) program (including the P2-P [8] DVP8* recombinant protein vaccine we reported previously) 18 aiming to develop next generation, nonoral rotavirus vaccines.…”