Understanding Reduced Rotavirus Vaccine Efficacy in Low Socio-Economic Settings

Lopman, Benjamin A.; Pitzer, Virginia E.; Sarkar, Rajiv; Gladstone, Beryl Primrose; Patel, Manish; Glasser, John W.; Gambhir, Manoj; Atchison, Christina; Grenfell, Bryan T.; Edmunds, W. John; Kang, Gagandeep; Parashar, Umesh D.

doi:10.1371/journal.pone.0041720

Cited by 122 publications

(129 citation statements)

References 39 publications

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“…[2] estimated that rotavirus vaccine could result in 2.46 million childhood deaths between 2011-2030. Of course, uncertainty in the seroconversion rate [24] and achievable vaccination coverage means that the true benefit of these vaccines is unknown.…”

Section: Discussionmentioning

confidence: 99%

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An ensemble approach to predicting the impact of vaccination on rotavirus disease in Niger

Park

Goldstein

Haran

et al. 2017

Vaccine

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Recently developed vaccines provide a new way of controlling rotavirus in sub-Saharan Africa.Models for the transmission dynamics of rotavirus are critical both for estimating current burden from imperfect surveillance and for assessing potential effects of vaccine intervention strategies.We examine rotavirus infection in the Maradi area in southern Niger using hospital surveillance data provided by Epicentre collected over two years. Additionally, a cluster survey of households in the region allows us to estimate the proportion of children with diarrhea who consulted at a health structure. Model fit and future projections are necessarily particular to a given model; thus, where there are competing models for the underlying epidemiology an ensemble approach can account for that uncertainty. We compare our results across several variants of Susceptible-Infectious-Recovered (SIR) compartmental models to quantify the impact of modeling assumptions on our estimates. Model-specific parameters are estimated by Bayesian inference using Markov chain Monte Carlo. We then use Bayesian model averaging to generate ensemble estimates of the current dynamics, including estimates of R0, the burden of infection in the region, as well as the impact of vaccination on both the short-term dynamics and the long-term reduction of rotavirus incidence under varying levels of coverage. The ensemble of models predicts that the current burden of severe rotavirus disease is 2.9 to 4.1% of the population each year and that a 2-dose vaccine schedule achieving 70% coverage could reduce burden by 37-43%.

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Section: Discussionmentioning

confidence: 99%

“…To reflect this uncertainty, we investigate the impact of vaccination using the value of efficacy from two different studies. First based on the results of [24], for low income countries, we assume a seroconversion rate of 63%. Second, a recent study of a 3-dose vaccination strategy in Niger [20] estimated efficacy of 66.7% with all doses.…”

Section: Vaccinationmentioning

confidence: 99%

An ensemble approach to predicting the impact of vaccination on rotavirus disease in Niger

Park

Goldstein

Haran

et al. 2017

Vaccine

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“…17,48,73,74 Increasing the number of rotavirus vaccine doses Waning vaccine efficacy from one year post-immunisation may be addressed through the administration of additional vaccine doses. 75 Lopman et al proposed that extra vaccine doses later in the EPI schedule may target the severe symptomatic nature of higher-order infections in low-income countries, estimating a 9% improvement in RV1 vaccine efficacy with a 3-dose course at 6, 10 and 14 weeks. 75 This is supported by a previous study that demonstrated that the same 3-dose RV1 course was efficacious against severe rotavirus gastroenteritis, without an increased risk of intussusception following the third dose.…”

Section: Changes To Rotavirus Immunisation Schedulesmentioning

confidence: 99%

“…75 Lopman et al proposed that extra vaccine doses later in the EPI schedule may target the severe symptomatic nature of higher-order infections in low-income countries, estimating a 9% improvement in RV1 vaccine efficacy with a 3-dose course at 6, 10 and 14 weeks. 75 This is supported by a previous study that demonstrated that the same 3-dose RV1 course was efficacious against severe rotavirus gastroenteritis, without an increased risk of intussusception following the third dose. 29 The administration of an additional dose at a later age, such as concomitantly with measles-containing vaccines at 9 months of age, may pose a potential solution to the observed decreased efficacy in the 2 nd year of life.…”

Section: Changes To Rotavirus Immunisation Schedulesmentioning

confidence: 99%

Options for improving effectiveness of rotavirus vaccines in developing countries

Tissera

Cowley

Bogdanovic-Sakran

et al. 2017

Human Vaccines & Immunotherapeutics

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Rotavirus gastroenteritis is a leading global cause of mortality and morbidity in young children due to diarrhea and dehydration. Over 85% of deaths occur in developing countries. In industrialised countries, 2 live oral rotavirus vaccines licensed in 2006 quickly demonstrated high effectiveness, dramatically reducing severe rotavirus gastroenteritis admissions in many settings by more than 90%. In contrast, the same vaccines reduced severe rotavirus gastroenteritis by only 30-60% in developing countries, but have been proven life-saving. Bridging this "efficacy gap" offers the possibility to save many more lives of children under the age of 5. The reduced efficacy of rotavirus vaccines in developing settings may be related to differences in transmission dynamics, as well as host luminal, mucosal and immune factors. This review will examine strategies currently under study to target the issue of reduced efficacy and effectiveness of oral rotavirus vaccines in developing settings.

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“…A growing body of evidence now suggests that gut microbiota may also play an important role in determining vaccine efficacy. Studies have demonstrated that immunogenicity of oral vaccines against cholera [2,3], rotavirus [4] and polio [5] is lower in populations from regions with poor sanitation who have a higher occurrence of fecal-oral bacterial exposure. While this observation may be confounded by factors such as socioeconomic status, genetics or malnutrition, the prevailing hypothesis is that exposure to harmful microbes could alter the composition of bacteria in the gut [6], and the composition of the gut may influence vaccine immunogenicity.…”

mentioning

confidence: 99%