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

Cases prevented in LIC vs MIC

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 Recommendation

Funding 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

COUNTRYINTRODUCTION YEARREDUCTION IN ALL-CAUSE GASTROENTERITIS DEATHS < 5 FOLLOWING INTRODUCTION
Bolivia200836-43%
Brazil200622%
El Salvador20060-36%
Honduras200916-20%
Mexico200743-55%*
Panama200650%**
Venezuela200657-64%
*Measured from 2009-2011. While methodologies differ, and some studies aren’t directly comparable, it is clear the vaccine has had a significant impact.
**Among children age 0-4 years

 

Table: Following the introduction of rotavirus vaccines, rotavirus hospitalizations in high-income countries dropped by half or more.

COUNTRYREDUCTION IN ROTAVIRUS HOSPITALIZATIONS*
Australia45-88%
Austria74-79%
Belgium50-80%
Finland78%
United States of America55-94%
*Studies vary in time period and age group and therefore are not directly comparable. However, when taken together, they demonstrate the significant impact of the vaccine. 

 

ROTA Council Recommendation

Given 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.

COUNTRYINTRODUCTION YEARREDUCTION IN ROTAVIRUS DIARRHEA HOSPITALIZATIONS AMONG CHILDREN <5 YEARS FOLLOWING INTRODUCTION
Ghana [32]201249%
Rwanda [25]201261-70%
South Africa [30]200954-58%
Togo [29]201432%

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.

COUNTRYINTRODUCTION YEARREDUCTION IN ALL-CAUSE DIARRHEA HOSPITALIZATIONS AMONG CHILDREN <12 MONTHS FOLLOWING INTRODUCTION
Botswana[27]201243%
Ghana [32]201252%
Malawi [28]201248.2%
Rwanda [33]201251-55%
South Africa [31]200944.9-65.4%
Zambia [26]201318-29%

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15. Hanlon, P., et al., Trial of an attenuated bovine rotavirus vaccine (RIT 4237) in Gambian infants. Lancet, 1987. 1(8546): p. 1342-5.

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18. Georges-Courbot, M.C., et al., Evaluation of the efficacy of a low-passage bovine rotavirus (strain WC3) vaccine in children in Central Africa. Res Virol, 1991. 142(5): p. 405-11.

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20. Patel, M., et al., Oral rotavirus vaccines: how well will they work where they are needed most? J Infect Dis, 2009. 200 Suppl 1: p. S39-48.

21. do Carmo, G.M., et al., Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. PLoS Med, 2011. 8(4): p. e1001024.

22. Gastanaduy, P.A., et al., Effect of rotavirus vaccine on diarrhea mortality in different socioeconomic regions of Mexico. Pediatrics, 2013. 131(4): p. e1115-20.

23. Bayard, V., et al., Impact of rotavirus vaccination on childhood gastroenteritis-related mortality and hospital discharges in Panama. Int J Infect Dis, 2012. 16(2): p. e94-8.

24. De Oliveira, L.H., et al., Temporal trends in diarrhea-related hospitalizations and deaths in children under age 5 before and after the introduction of the rotavirus vaccine in four Latin American countries. Vaccine, 2013. 31(Suppl 3): p. C99-C108.

25. Ngabo, F., et al., Effect of pentavalent rotavirus vaccine introduction on hospital admissions for diarrhoea and rotavirus in children in Rwanda: a time-series analysis. The Lancet Global Health. 4(2): p. e129-e136.

26. Mpabalwani, E.M., et al., Impact of Rotavirus Vaccination on Diarrheal Hospitalizations in Children Aged <5 Years in Lusaka, Zambia. Clin Infect Dis, 2016. 62 Suppl 2: p. S183-7.

27. Enane, L.A., et al., Impact of Rotavirus Vaccination on Hospitalizations and Deaths From Childhood Gastroenteritis in Botswana. Clin Infect Dis, 2016. 62 Suppl 2: p. S168-74.

28. Bar-Zeev, N., et al., Cost-Effectiveness of Monovalent Rotavirus Vaccination of Infants in Malawi: A Postintroduction Analysis Using Individual Patient-Level Costing Data. Clin Infect Dis, 2016. 62 Suppl 2: p. S220-8.

29. Tsolenyanu, E., et al., Early Evidence of Impact of Monovalent Rotavirus Vaccine in Togo. Clin Infect Dis, 2016. 62 Suppl 2: p. S196-9.

30. Msimang, V.M., et al., Impact of rotavirus vaccine on childhood diarrheal hospitalization after introduction into the South African public immunization program. Pediatr Infect Dis J, 2013. 32(12): p. 1359-64.

31. Groome, M.J., et al., Temporal Association of Rotavirus Vaccine Introduction and Reduction in All-Cause Childhood Diarrheal Hospitalizations in South Africa. Clin Infect Dis, 2016. 62 Suppl 2: p. S188-95.

32. Armah, G., et al., Impact and Effectiveness of Monovalent Rotavirus Vaccine Against Severe Rotavirus Diarrhea in Ghana. Clin Infect Dis, 2016. 62 Suppl 2: p. S200-7.

33. Tate, J.E., et al., Effectiveness of Pentavalent Rotavirus Vaccine Under Conditions of Routine Use in Rwanda. Clin Infect Dis, 2016. 62 Suppl 2: p. S208-12.