Vaccine Health Impact
Thousands of Lives Saved
To date, about 90 countries have introduced rotavirus vaccines into their national immunization program. More than 45 million children now have access to rotavirus vaccines through national immunization programs1. As a result there is a large and growing body of evidence demonstrating the impact of vaccines following introduction into countries’ national immunization programs.Learn more about Vaccine Introductions
Thanks to rotavirus vaccination, in 2010 there were:
Lives saved in 2010
million outpatient cases averted
million hospitalizations averted in 2010
hundred million US$ of treatment costs averted (2)
Swift and significant declines in hospitalizations and deaths due to rotavirus and all-cause diarrhea have been observed in many countries now routinely using rotavirus vaccines.
- Research from countries that have included rotavirus vaccines in their national immunization programs has found that vaccination reduced rotavirus-related hospitalizations by up to 92% (49-92%) and hospitalizations related to all causes of diarrhea by up to 55% (17-55%)3.
- Furthermore, in some countries, deaths from all causes of diarrhea declined by up to 50% (20-50%) following rotavirus vaccine introduction3.
- Studies have shown that the greatest potential benefit of rotavirus vaccination in 25 Gavi countries would be in the poorest quintiles4.
- Because of high disease burden in low-income countries, the absolute number of severe rotavirus cases prevented by vaccination is also greater in low-income countries, despite the lower efficacy as compared to high- and middle-income countries5-8.
Rotavirus Vaccine Efficacy
Efficacy is the measure of how a vaccine performs under ideal conditions, such as a clinical study. This is different from effectiveness, which measures how a vaccine performs in real-world conditions, and impact, which measures the number of lives saved or hospitalizations averted.
Figure: Cases of severe rotavirus diarrhea prevented per 100 vaccinated children6, 7
Even moderate efficacy can translate to significant public health impact:
- In Bangladesh, a low-income country, rotavirus vaccination reduced the risk of severe disease by nearly half (46%) during the first year of life. In Vietnam, a middle-income country, vaccine efficacy was 72%6.
- Rotavirus vaccines were, however, shown to have a greater public health impact in Bangladesh, where four cases of severe rotavirus diarrhea per 100 vaccinated children were prevented, than in Vietnam, where two cases of severe rotavirus diarrhea per 100 vaccinated children were prevented6.
- More research is needed to better understand why lower efficacy is typical of orally administered vaccines—including cholera, typhoid and polio vaccines—in impoverished, high-mortality settings such as those found in low-income countries9-19.
- Higher levels of maternal antibody, the prevalence of other intestinal infections and incidence of other causes of death and diseases like HIV, malaria, tuberculosis and malnutrition may influence the vaccine’s efficacy20.
- When the oral polio vaccine is given at the same time as the rotavirus vaccine, it may affect rotavirus vaccine performance in low-income countries.
ROTA Council RecommendationFunding agencies should continue to support the evaluation of rotavirus vaccine programs in Gavi-eligible countries, as well as countries that have recently graduated from Gavi support, including the evaluation of: operational aspects, safety, public health impact, economic impact and effectiveness.
Table: Impact in Early Adopter Countries21-24
|COUNTRY||INTRODUCTION YEAR||REDUCTION IN ALL-CAUSE GASTROENTERITIS DEATHS < 5 FOLLOWING INTRODUCTION|
**Among children age 0-4 years
Table: Following the introduction of rotavirus vaccines, rotavirus hospitalizations in high-income countries dropped by half or more.
|COUNTRY||REDUCTION IN ROTAVIRUS HOSPITALIZATIONS*|
|United States of America||55-94%|
ROTA Council RecommendationGiven the consistent, high public health impact and cost-effectiveness of rotavirus vaccines in high-income countries, WHO, UNICEF and NGOs should collect data to better understand the reasons why a number of high-income countries have not yet included rotavirus vaccines in their national immunization programs.
Vaccine Impact: Africa
Rotavirus vaccines demonstrate substantial impact in Africa. Since South Africa became the first African country to introduce rotavirus vaccines in 2009, over 30 countries in Africa (shaded purple at right) have introduced rotavirus vaccines into their national immunization programs.Download Factsheet: ROTAVIRUS IN AFRICA (English or French)
- After Rwanda became the first low-income country in the world to introduce the pentavalent rotavirus vaccine in 2012, hospital admissions for acute gastroenteritis decreased by about half25. Researchers also noted a decrease in rotavirus diarrhea hospitalizations in almost every age group, suggesting herd immunity25.
- Within two years of vaccine introduction, Zambia experienced 51% and 31% reductions in rotavirus hospitalizations for infants and 1-year olds, respectively26.
- In Botswana, there has been a 43% and 48% reduction in gastroenteritis-related hospitalizations and deaths in infants during the rotavirus season, respectively27.
- In Malawi, a low-income country where health expenditures have substantially increased in the last decade, rotavirus vaccine is highly cost-effective28.
- Togo’s June 2014 introduction of monovalent rotavirus vaccine has already demonstrated impressive results in the first rotavirus season post-introduction: 43% reduction in rotavirus hospitalizations for infants29.
- In the first two years following the introduction in South Africa, all-cause diarrhea hospitalizations declined by one-third for children under 530; a recent study in urban Soweto observed a 34- 57% reduction in the overall incidence of all-cause diarrhea hospitalizations in children under 531. The vaccine has been effective in reducing the incidence of diarrhea for both HIV-infected and uninfected children31.
Drop in rotavirus hospitalizations measured across Africa
Despite the lower vaccine efficacy of rotavirus vaccines observed in Africa, vaccines have reduced mortality and morbidity given the high rotavirus disease burden in Sub-Saharan Africa.
|COUNTRY||INTRODUCTION YEAR||REDUCTION IN ROTAVIRUS DIARRHEA HOSPITALIZATIONS AMONG CHILDREN <5 YEARS FOLLOWING INTRODUCTION|
|South Africa ||2009||54-58%|
Sharp reduction in hospitalizations for pediatric diarrheal disease in Africa
Rotavirus vaccine introductions have led to sharp, significant reductions in hospitalizations for pediatric diarrheal disease in general, reducing the load on pediatric wards.
|COUNTRY||INTRODUCTION YEAR||REDUCTION IN ALL-CAUSE DIARRHEA HOSPITALIZATIONS AMONG CHILDREN <12 MONTHS FOLLOWING INTRODUCTION|
|South Africa ||2009||44.9-65.4%|
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