Incidence of rotavirus gastroenteritis by age in African, Asian and European children: Relevance for timing of rotavirus vaccination

ABSTRACT Variability in rotavirus gastroenteritis (RVGE) epidemiology can influence the optimal vaccination schedule. We evaluated regional trends in the age of RVGE episodes in low- to middle- versus high-income countries in three continents. We undertook a post-hoc analysis based on efficacy trials of a human rotavirus vaccine (HRV; Rotarix™, GSK Vaccines), in which 1348, 1641, and 5250 healthy infants received a placebo in Europe (NCT00140686), Africa (NCT00241644), and Asia (NCT00197210, NCT00329745). Incidence of any/severe RVGE by age at onset was evaluated by active surveillance over the first two years of life. Severity of RVGE episodes was assessed using the Vesikari-scale. The incidence of any RVGE in Africa was higher than in Europe during the first year of life (≤2.78% vs. ≤2.03% per month), but much lower during the second one (≤0.86% versus ≤2.00% per month). The incidence of severe RVGE in Africa was slightly lower than in Europe during the first year of life. Nevertheless, temporal profiles for the incidence of severe RVGE in Africa and Europe during the first (≤1.00% and ≤1.23% per month) and second (≤0.53% and ≤1.13% per month) years of life were similar to those of any RVGE. Any/severe RVGE incidences peaked at younger ages in Africa vs. Europe. In high-income Asian regions, severe RVGE incidence (≤0.31% per month) remained low during the study. The burden of any RVGE was higher earlier in life in children from low- to middle- compared with high-income countries. Differing rotavirus vaccine schedules are likely warranted to maximize protection in different settings.

[1]  S. Madhi,et al.  Effect of human rotavirus vaccine on severe diarrhea in African infants. , 2010, The New England journal of medicine.

[2]  Naveen Karkada,et al.  Human rotavirus vaccine ( RIX 4414 ) efficacy in the first two years of life A randomized , placebo-controlled trial in China , 2014 .

[3]  N. Tee,et al.  A Hospital-based Surveillance of Rotavirus Gastroenteritis in Children <5 Years of Age in Singapore , 2013, The Pediatric infectious disease journal.

[4]  R. Jacobson,et al.  Efficacy, immunogenicity, and safety of two doses of a tetravalent rotavirus vaccine RRV-TV in Ghana with the first dose administered during the neonatal period. , 2013, The Journal of infectious diseases.

[5]  Katherine Lee,et al.  Phase I trial of RV3-BB rotavirus vaccine: a human neonatal rotavirus vaccine. , 2013, Vaccine.

[6]  Y. Lau,et al.  Efficacy, safety and immunogenicity of a human rotavirus vaccine (RIX4414) in Hong Kong children up to three years of age: a randomized, controlled trial. , 2013, Vaccine.

[7]  S. Madhi,et al.  Human rotavirus vaccine Rotarix™ provides protection against diverse circulating rotavirus strains in African infants: a randomized controlled trial , 2012, BMC Infectious Diseases.

[8]  Y. Lau,et al.  Rotavirus vaccine RIX4414 efficacy sustained during the third year of life: a randomized clinical trial in an Asian population. , 2012, Vaccine.

[9]  K. Neuzil,et al.  Efficacy of human rotavirus vaccine against severe gastroenteritis in Malawian children in the first two years of life: a randomized, double-blind, placebo controlled trial. , 2012, Vaccine.

[10]  Jacqueline E Tate,et al.  2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. , 2011, The Lancet. Infectious diseases.

[11]  G. Kang,et al.  Protective effect of natural rotavirus infection in an Indian birth cohort. , 2011, The New England journal of medicine.

[12]  M. Molyneux,et al.  Epidemiology of rotavirus infection in children in Blantyre, Malawi, 1997-2007. , 2010, The Journal of infectious diseases.

[13]  C. Giaquinto,et al.  Age distribution of paediatric rotavirus gastroenteritis cases in Europe: the REVEAL† study , 2010, Scandinavian journal of infectious diseases.

[14]  Y. Lau,et al.  Safety and efficacy of human rotavirus vaccine during the first 2 years of life in Asian infants: randomised, double-blind, controlled study. , 2009, Vaccine.

[15]  C. Sanderson,et al.  Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data , 2009, The Lancet.

[16]  Felix Espinoza,et al.  Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomised, double-blind, placebo-controlled phase III study , 2008, The Lancet.

[17]  T. Vesikari,et al.  Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study , 2007, The Lancet.

[18]  R. Chanock,et al.  Neonatal Administration of Rhesus Rotavirus Tetravalent Vaccine , 2006, The Pediatric infectious disease journal.

[19]  T. Vesikari,et al.  Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. , 2006, The New England journal of medicine.

[20]  D. Bernstein,et al.  A rotavirus vaccine for infants: the Asian experience. , 2006, Annals of the Academy of Medicine, Singapore.

[21]  A. Linhares,et al.  Evaluation of Safety, Immunogenicity and Efficacy of an Attenuated Rotavirus Vaccine, RIX4414: A Randomized, Placebo-Controlled Trial in Latin American Infants , 2005, The Pediatric infectious disease journal.

[22]  R. Glass,et al.  Rotavirus in Asia: the value of surveillance for informing decisions about the introduction of new vaccines. , 2005, The Journal of infectious diseases.

[23]  R. Ward,et al.  Comparative Evaluation of Safety and Immunogenicity of Two Dosages of an Oral Live Attenuated Human Rotavirus Vaccine , 2005, The Pediatric infectious disease journal.

[24]  T. Vesikari,et al.  Efficacy of RIX4414 Live Attenuated Human Rotavirus Vaccine in Finnish Infants , 2004, The Pediatric infectious disease journal.

[25]  T. Vesikari,et al.  Safety and immunogenicity of RIX4414 live attenuated human rotavirus vaccine in adults, toddlers and previously uninfected infants. , 2004, Vaccine.

[26]  J. Alexander,et al.  Anticipating rotavirus vaccines: epidemiology and surveillance of rotavirus in South Africa. , 2003, Vaccine.

[27]  K. Mølbak,et al.  Protective immunity after natural rotavirus infection: a community cohort study of newborn children in Guinea-Bissau, west Africa. , 2002, The Journal of infectious diseases.

[28]  R. Glass,et al.  Rotavirus infection in infants as protection against subsequent infections. , 1996, The New England journal of medicine.

[29]  T. Vesikari,et al.  Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. , 1990, Scandinavian journal of infectious diseases.

[30]  G. Beards,et al.  Evaluation of RIT 4237 bovine rotavirus vaccine in newborn infants: correlation of vaccine efficacy to season of birth in relation to rotavirus epidemic period. , 1990, Scandinavian journal of infectious diseases.

[31]  J. Alexander,et al.  Rotavirus-associated gastroenteritis in black infants in South Africa , 1986, Journal of clinical microbiology.