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The Journal of Infectious Diseases May 2024Even moderate differences in rotavirus vaccine effectiveness against nonvaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Even moderate differences in rotavirus vaccine effectiveness against nonvaccine genotypes may exert selective pressures on circulating rotaviruses. Whether this vaccine effect or natural temporal fluctuations underlie observed changes in genotype distributions is unclear.
METHODS
We systematically reviewed studies reporting rotavirus genotypes from children <5 years of age globally between 2005 and 2023. We compared rotavirus genotypes between vaccine-introducing and nonintroducing settings globally and by World Health Organization (WHO) region, calendar time, and time since vaccine introduction.
RESULTS
Crude pooling of genotype data from 361 studies indicated higher G2P[4], a nonvaccine genotype, prevalence in vaccine-introducing settings, both globally and by WHO region. This difference did not emerge when examining genotypes over time in the Americas, the only region with robust longitudinal data. Relative to nonintroducing settings, G2P[4] detections were more likely in settings with recent introduction (eg, 1-2 years postintroduction adjusted odds ratio [aOR], 4.39; 95% confidence interval [CI], 2.87-6.72) but were similarly likely in settings with more time elapsed since introduction, (eg, 7 or more years aOR, 1.62; 95% CI, .49-5.37).
CONCLUSIONS
When accounting for both regional and temporal trends, there was no substantial evidence of long-term vaccine-related selective pressures on circulating genotypes. Increased prevalence of G2P[4] may be transient after rotavirus vaccine introduction.
Topics: Rotavirus Vaccines; Humans; Rotavirus; Rotavirus Infections; Genotype; Child, Preschool; Infant; Global Health; Vaccination
PubMed: 37738554
DOI: 10.1093/infdis/jiad403 -
EClinicalMedicine Dec 2022Oral rotavirus vaccines have lower effectiveness in high child mortality settings. We evaluated the impact of additional dose(s) schedules of rotavirus vaccine on...
BACKGROUND
Oral rotavirus vaccines have lower effectiveness in high child mortality settings. We evaluated the impact of additional dose(s) schedules of rotavirus vaccine on vaccine immunogenicity and reduction in episodes of gastroenteritis.
METHODS
We searched Medline (via PubMed), Cochrane databases and ClinicalTrials.gov for randomised controlled trials from 1973 to February 2022, evaluating the immunological and clinical impact of additional dose vs standard dose oral rotavirus vaccine schedules. We extracted immunogenicity - proportion of children with evidence of anti-rotavirus IgA seroresponse, and clinical - proportion of children with at least one episode of severe rotavirus gastroenteritis, outcome data and used random effects meta-analysis where appropriate. We assessed the methodological quality of the studies using the Cochrane risk of bias tool. The study protocol was registered in PROSPERO (CRD42021261058).
FINDINGS
We screened 536 items and included 7 clinical trials. Our results suggest moderate to high level evidence that an additional dose rotavirus vaccine schedule improves IgA vaccine immune response, including additional doses administered as a booster dose schedule >6 months old; IgA vaccine seroresponse 74·3% additional dose schedule vs 56·1% standard dose schedule RR 1·3 (95%CI, 1·15 - 1·48), and when administered to children who were seronegative at baseline; IgA vaccine seroresponse 48.2% additional dose schedule vs 29.6% standard dose schedule RR 1.86 (95%CI 1.27 to 2.72). Only one study evaluated reduction in gastroenteritis episodes and found little benefit in first year of life, 1·8% vs 2·0% RR 0·88 (95% CI, 0·52 to 1·48), or second year of life, 1·7% vs 2·9% RR 0·62 (95%CI, 0·31 - 1·23).
INTERPRETATION
Administering an additional dose of oral rotavirus vaccines is likely to result in an improved vaccine immune response, including when administered as a booster dose to older children. Evidence of an impact on diarrhoeal disease is needed before additional dose rotavirus vaccine schedules can be recommended as vaccine policy.
FUNDING
BM was funded by the National Health and Medical Research Council, the Royal Australasian College of Physicians Paediatrics and Child Health Division, and the Australian Academy of Science.
PubMed: 36247922
DOI: 10.1016/j.eclinm.2022.101687 -
Human Vaccines & Immunotherapeutics 2014To assess the comparative effectiveness of a monovalent and a pentavalent rotavirus vaccine (RV1 and RV5), a Bayesian network meta-analysis was conducted. Data of... (Comparative Study)
Comparative Study Meta-Analysis Review
Bayesian network meta-analysis suggests a similar effectiveness between a monovalent and a pentavalent rotavirus vaccine: a preliminary report of re-analyses of data from a Cochrane Database Systematic Review.
To assess the comparative effectiveness of a monovalent and a pentavalent rotavirus vaccine (RV1 and RV5), a Bayesian network meta-analysis was conducted. Data of randomized trials from the Cochrane Review in 2012 were extracted and synthesized. For the prevention of severe rotavirus disease up to 2 years, no statistical difference was found in the effectiveness between the 2 types of vaccine (odds ratio: 2.23, 95% credible interval: 0.71-5.20). Similarly, the comparative effectiveness of RV1 and RV5 appeared equivalent for other rotavirus-associated outcome measures, such as prevention of severe disease up to 1 year and all severity of rotavirus infections for up to both 1- and 2-year follow-ups. These results indicates that, overall, RV1 and RV5 offer similar benefits to prevent rotavirus diseases; nonetheless, credible intervals are generally wide, highlighting the necessity of further meta-analyses including updated information or, ideally, controlled trials comparing both vaccines directly.
Topics: Bayes Theorem; Databases, Factual; Humans; Research Report; Rotavirus Infections; Rotavirus Vaccines; Treatment Outcome; Vaccines, Attenuated
PubMed: 24608099
DOI: 10.4161/hv.28284 -
The American Journal of Tropical... Apr 2018Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects... (Meta-Analysis)
Meta-Analysis
Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects remains unknown. We systematically reviewed the literature and quantified indirect rotavirus vaccine effectiveness (VE) for preventing rotavirus hospitalization in children aged less than 5 years. From 148 identified abstracts, 14 studies met our eligibility criteria. In our main analysis using a random-effects model, indirect rotavirus VE was 48% (95% confidence interval [CI]: 39-55%). In a subgroup analysis by country income level, indirect VE was greater in high-income countries (52%; 95% CI: 43-60%) than in low- and middle-income countries (LMICs) (25%; 95% CI: 5-41%). In a sensitivity analysis using a quality-effects model, the indirect VE in LMICs was not statistically significant (25%; 95% CI: 0-44%). Our findings highlight the importance of increasing rotavirus vaccine coverage, particularly in LMICs where evidence for indirect VE is limited and rotavirus burden is high.
Topics: Child, Preschool; Hospitalization; Humans; Income; Infant; Infant, Newborn; Rotavirus Infections; Rotavirus Vaccines
PubMed: 29436336
DOI: 10.4269/ajtmh.17-0705 -
Frontiers in Pharmacology 2019The vaccine against the rotavirus is an effective measure in reducing hospitalizations and mortality caused by the virus. However, its use can result in serious adverse...
The vaccine against the rotavirus is an effective measure in reducing hospitalizations and mortality caused by the virus. However, its use can result in serious adverse effects. The available evidence on Kawasaki disease has not yet been reported in the literature. This study investigated the risk of developing Kawasaki disease with the use of rotavirus vaccines in children. This is a systematic review of data collected from studies retrieved on the following databases: Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, HealthSTAR, Lilacs, Clinical trial.gov, and International Clinical Trials Registry Platform, up to the 15 of August 2018, with no restrictions on language or date of publication. The outcomes measured were incidence of Kawasaki disease, risk of developing the disease, and rate of discontinuation of the vaccination schedule. Four reviewers independently selected the studies, performed data extraction, and assessed the quality of evidence. A meta-analysis of random effects was performed. A total of 13 publications were included, with a population of 164,434 children included in the meta-analysis. The incidence of Kawasaki disease (24 cases per 100,000, 95% CI = 11.98-48.26) in the vaccinated children was low. No difference between the vaccines was found in the prevalence rate of adverse effects (RR = 1.55, 95% CI = 0.41-5.93). Use of the vaccines was not associated with risk of developing Kawasaki disease (low-quality evidence). None of the studies reported the rate of discontinuation of the vaccination schedule. The vaccines were associated with a low incidence of developing Kawasaki disease, showing no association with this serious adverse effect.
PubMed: 31616298
DOI: 10.3389/fphar.2019.01075 -
Human Vaccines & Immunotherapeutics 2018We performed a systematic review to evaluate factors affecting uptake of rotavirus vaccine amongst physicians, parents and health system. We identified 15 studies that...
We performed a systematic review to evaluate factors affecting uptake of rotavirus vaccine amongst physicians, parents and health system. We identified 15 studies that met the inclusion criteria from 790 screened studies published between Jan 2005 to Jan 2016. Perceived severity of rotavirus disease, efficacy of vaccine and recommendation by health authorities positively influenced uptake of vaccine amongst health care providers. Routine and timely vaccination with routine vaccines and availability of rotavirus vaccine in public health programme facilitated uptake. Family income, parental education and employment status positively influenced the decision to vaccinate by parents. Concerns about safety, high cost, additional workload and logistic problems in acquiring vaccine stocks were perceived as barriers. Improved awareness regarding the rotavirus vaccination amongst public and scientific community and strengthening of public health system for better and timely immunisation coverage are important factors to maximize uptake of rotavirus vaccine in India.
PubMed: 29913110
DOI: 10.1080/21645515.2018.1489190 -
Human Vaccines & Immunotherapeutics 2018An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and...
An estimated 215,000 children died of rotavirus infections in 2013, accounting for 37% of diarrhea-related deaths worldwide, 92% of which occurred in low and lower-middle income countries. Since 2009 the World Health Organization (WHO) recommends the use of rotavirus vaccines in all national immunization programs. This review compares rotavirus vaccine (RV) introductions and vaccine coverage by region, country income status and Gavi-eligibility from 2006-2016. Gross National Income data from the World Bank and surviving infant population from United Nations Population Division was obtained for 2016. Data from WHO were collected on rotavirus vaccine coverage, national immunization schedules, and new vaccine introductions for 2016 while estimated rotavirus deaths were collected for 2013, the last year of available WHO data. As of December 2016, the majority of countries (57%, 110/194) had not introduced universal rotavirus vaccine despite WHO's 2009 recommendation to do so. Countries in the WHO African region had the greatest proportion of introductions (37%, 31/84) by December 2016 and a great majority of these (77%, 24/31) were supported by new vaccine introduction (NVI) grants from Gavi. Almost half (48%) of global introductions were in low and lower-middle income Gavi-eligible and Gavi-graduating countries. Conversely, countries in the Southeast Asia WHO region and those not eligible for Gavi NVI support have been slow to introduce rotavirus vaccine. High-income countries, on average, had poorer rotavirus vaccine coverage compared to low and lower-middle income countries. The over-representation of African countries within the Gavi subset and high estimated rotavirus deaths in these African countries, likely explains why introduction efforts have been focused in this region. While much progress has been made with the integration and implementation of rotavirus vaccine into national immunization programs, 110 countries representing 69% of the global birth cohort had yet to introduce the vaccine by December 2016.
Topics: Capital Financing; Disease Transmission, Infectious; Global Health; Humans; Immunization Programs; Infant; Rotavirus Infections; Rotavirus Vaccines; Vaccination Coverage
PubMed: 29787334
DOI: 10.1080/21645515.2018.1470725 -
Infectious Diseases of Poverty Aug 2016Rotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Rotavirus was the leading cause of childhood diarrhoea-related hospitalisations and death before the introduction of rotavirus vaccines.
METHODS
We describe the effectiveness of rotavirus vaccines to prevent rotavirus infections and hospitalizations and the main rotavirus strains circulating before and after vaccine introduction through a systematic review and meta-analysis of studies published between 1990 and 2014. 203 studies were included to estimate the proportion of infections due to rotavirus and 10 to assess the impact of the vaccines. 41 of 46 studies in the post-vaccination period were used for meta-analysis of genotypes, 20 to calculate VE against infection, eight for VE against hospitalisation and seven for VE against severe rotavirus-diarrhoea.
RESULTS
24.3 % (95 % CI 22.1-26.5) and 16.1 % (95 % CI 13.2-19.3) of cases of diarrhoea were due to rotavirus before and after vaccine introduction, respectively. The most prevalent G types after vaccine introduction were G2 (51.6 %, 95 % CI 38-65), G9 (14.5 %, 95 % CI 7-23) and G1 (14.2 %, 95 % CI 7-23); while the most prevalent P types were P[4] (54.1 %, 95 % CI 41-67) and P[8] (33 %, 95 % CI 22-46). G2P[4] was the most frequent genotype combination after vaccine introduction. Effectiveness was 53 % (95 % CI 46-60) against infection, 73 % (95 % CI, 66-78) against hospitalisation and 74 % (95 % CI, 68.0-78.0) against severe diarrhoea. Reductions in hospitalisations and mortality due to diarrhoea were observed in countries that adopted universal rotavirus vaccination.
CONCLUSIONS
Rotavirus vaccines are effective in preventing rotavirus-diarrhoea in children in Latin America. The vaccines were associated with changes in genotype distribution.
Topics: Child, Preschool; Diarrhea; Genotype; Hospitalization; Humans; Infant; Infant, Newborn; Latin America; Prevalence; Rotavirus; Rotavirus Infections; Rotavirus Vaccines
PubMed: 27514855
DOI: 10.1186/s40249-016-0173-2 -
Infectious Diseases of Poverty Dec 2023Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are... (Review)
Review
BACKGROUND
Non-National Immunization Program (NIP) vaccines have played an important role in controlling vaccine-preventable diseases (VPDs) in China. However, these vaccines are paid out of pocket and there is room to increase their coverage. We focused on four selected non-NIP vaccines in this study, namely Haemophilus influenzae type b (Hib) vaccine, human papillomavirus (HPV) vaccine, pneumococcal conjugate vaccine (PCV), and rotavirus vaccine. We aimed to conduct a scoping review of their vaccination rates and the major barriers faced by health systems, providers, and caregivers to increase coverage.
METHODS
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We searched five English databases (PubMed, Web of Science, EMBASE, Scopus, and WHO IRIS) and four Chinese databases using the search strategy developed by the study team. Two independent reviewers screened, selected studies, and examined their quality. We summarized the non-NIP vaccine coverage data by vaccine and applied the 5A framework (Access, Affordability, Acceptance, Awareness, Activation) to chart and analyze barriers to increasing coverage.
RESULTS
A total of 28 articles were included in the analysis (nine pertaining to vaccine coverage, and another 19 reporting challenges of increasing uptake). Among the four selected vaccines, coverage for the Hib vaccine was the highest (54.9-55.9% for 1 dose or more from two meta-analyses) in 2016, while the coverage of the other three vaccines was lower than 30%. Eight of the nine included articles mentioned the regional disparity of coverage, which was lower in under-developing regions. For example, the three-dose Hib vaccination rate in eastern provinces was 38.1%, whereas the rate in central and western provinces was 34.3% and 26.2%, respectively in 2017. Within the 5A framework, acceptance, awareness, and affordability stood out as the most prominent themes. Among the 12 identified sub-themes, high prices, low vaccine awareness, concerns about vaccine safety and efficacy were the most cited barriers to increasing the uptake.
CONCLUSIONS
There is an urgent need to increase coverage of non-NIP vaccines and reduce disparities in access to these vaccines across regions. Concerted efforts from the government, the public, and society are required to tackle the barriers and challenges identified in this study, both on the demand and supply side, to ensure everybody has equal access to life-saving vaccines in China. Particularly, the government should take a prudent approach to gradually incorporate non-NIP vaccines into the NIP step by step, and make a prioritizing strategy based on key factors such as disease burden, financial resources, and market readiness, with special attention to high-risk populations and underdeveloped regions.
Topics: Humans; Vaccines; Vaccination; Immunization Programs; China; Cost of Illness
PubMed: 38062480
DOI: 10.1186/s40249-023-01150-8 -
Frontiers in Pediatrics 2022Rotavirus vaccination has been proven to effectively protect against rotavirus gastroenteritis. However, there are concerns about the relationship between rotavirus...
BACKGROUND
Rotavirus vaccination has been proven to effectively protect against rotavirus gastroenteritis. However, there are concerns about the relationship between rotavirus vaccination and the risk of autoimmune disorders. Thus, we conducted a systematic review and meta-analysis to comprehensively assess the association between rotavirus vaccination and type 1 diabetes (T1D) or celiac disease (CD) risk.
METHODS
A systematic review and meta-analysis were conducted to evaluate the type 1 diabetes or celiac disease associated with rotavirus vaccination. The following journal databases were searched to identify potential studies for inclusion: PubMed, Embase, and Cochrane Library databases.
RESULTS
Seven articles involving more than 5,793,055 children were included. Our results showed that rotavirus vaccination does not alter the subsequent risk of T1D (RR 0.94, 95% CI: 0.82-1.09) or CD (RR 0.86, 95% CI: 0.64-1.17) after vaccination. Furthermore, the risk of T1D was not increased or decreased for children fully exposed to rotavirus vaccination (RR 0.86, 95% CI, 0.54-1.36) and for children partially exposed to rotavirus vaccination (RR 1.05, 95% CI, 0.87-1.26). However, younger (<5 years) vaccinated children at the end of study (RR 0.84, 95% CI = 0.75-0.95) may be at a lower risk for T1D than older (≥5 years) vaccinated children (RR 0.93, 95% CI, 0.81-1.07).
CONCLUSION
The findings of this study suggest that rotavirus vaccination does not appear to be associated with T1D or CD in children. The protective effect of rotavirus vaccination on T1D may be presented by time dependent.
PubMed: 36090563
DOI: 10.3389/fped.2022.951127