Prospects for vaccines against rotaviruses

Candidate vaccines against rotavirus-caused diarrhoea have been under development for more than ten years. Recent research has helped to identify virological and immunological parameters which are most likely to be correlates of protection from rotavirus infection and disease. Large double-blind, placebo-controlled trials in the United States and Venezuela have resulted in successful protection from severe disease and dehydration after immunisation with live-attenuated rhesus rotavirus-based monovalent and tetravalent vaccine candidates. The tetravalent vaccine is now submitted for regulatory approval in the United States. The anticipated widespread use of such a vaccine will need careful safety and effectiveness surveillance as the enormous diversity of rotavirus antigenicity may affect efficacy in different geographical regions. To proceed from licensure to reduction of disease a series of goals must be achieved: the vaccine must be recommended by major immunisation advisory committees, be financed in both the public and private sectors, be integrated into existing vaccination schedules, be promoted, find parental acceptance and achieve a high level of coverage.