Rotavirus vaccine introduction in the Americas: progress and lessons learned

Abstract

In Latin America and the Caribbean, rotavirus causes approximately 15,000 deaths, 75,000 hospitalizations, 2 million clinic visits and 10 million cases of rotavirus diarrhea annually. Two safe vaccines are available that are effective in preventing severe illness. To date, seven countries in Latin America (Brazil, Ecuador, El Salvador, Panama, Mexico, Nicaragua and Venezuela) have introduced the vaccine. For successful rotavirus vaccine introduction, the lessons learned re-emphasize the critical need for countries to have precise plans that will ensure technical, programmatic and financial sustainability of vaccine introduction. Of these lessons learned, programmatic feasibility and financial sustainability were particularly challenging for countries that were the first to introduce a rotavirus vaccine.

Características epidemiológicas y clínicas de las gastroenteritis agudas según su etiología por rotavirus u otra en niños menores de 5 años atendidos en una institución privada de la Ciudad Autónoma de Buenos Aires

“…2 En Latinoamérica y el Caribe, causa el 25% (2 millones) de todas las visitas médicas por diarrea, 40% de las diarreas que requieren hospitalización (190 000) y 5000 muertes anuales. 3,4 Se estima que es responsable del 39% de las consultas por gastroenteritis (130 000) y del 42% de las internaciones (20 000) [5][6][7] en la Argentina, con un costo directo que alcanzaría anualmente l o s 2 7 , 7 m i l l o n e s d e d ó l a r e s . 6 La morbimortalidad asociada a la diarrea está determinada por el nivel socioeconómico y cultural de la población, y la cercanía a los centros asistenciales.…”

Rotavirus vaccines: Opportunities and challenges

“…The vaccine is administered orally in two doses, at least 4 weeks apart, with the first dose given between age 6-14 weeks and the course completed by 6 months of age. 9,111 The HRV strain replicates well in the gut, is immunogenic (anti-rotavirus IgA seroconversion rates of 73-96%) and is commonly shed in stools. 2,112,113 At least six major randomized double-blind, placebo controlled trials have been conducted with HRV to evaluate its safety and efficacy (Table 4).…”

“…[116][117][118] At present OPV is administered simultaneously with rotavirus and other routine childhood vaccines to Latin American children. 9 In addition to the aforementioned trials, the information gained from postmarketing surveillance of Latin America programs will help further clarify whether OPV and rotavirus vaccines significantly interfere with one another.…”

“…150 Already, important lessons have been learnt in Latin America from implementing rotavirus vaccine programs. 9 Public health officials must understand that unlike other enteric pathogens, improvements in water quality and sanitation will not materially decrease rates of rotavirus gastroenteritis. Evidence for a significant public health benefit, including favorable cost effectiveness, feasibility and financial sustainability must be established at the onset.…”

Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old treated in a private institution in the City of Buenos Aires

“…2 In Latin America and the Caribbean, rotavirus causes 25% (2 millions) of all diarrhea related medical consultations, 40% of children with diarrhea require hospitalization (190 000), and there are 5000 deaths every year. 3,4 It is estimated that rotavirus is accountable for 39% of consultations due to gastroenteritis (130 000) and 42% of hospitalizations (20 000) [5][6][7] in Argentina, with a direct annual cost that would be equivalent to 27.7 million dollars. 6 Mortality and morbidity associated with diarrhea are determined by the population's socioeconomic and cultural level, and their closeness to health care centers.…”