Key result
Full-dose Rotarix vaccine cuts rotavirus-associated hospitalizations by ~58% in African children.
Why the study?
Randomized controlled trials of licensed oral rotavirus group A vaccines showed lower efficacy in developing countries, prompting evaluation of pooled Rotarix effectiveness in Africa across a decade of progressive introduction.
Does the Rotarix (RV1) vaccine reduce rotavirus group A associated hospitalizations in African children?
Meta-Analysis (n=9,987)
Yes
Does the Rotarix (RV1) vaccine reduce rotavirus group A associated hospitalizations in African children?
Effect estimate: VE 58% (95% CI 50-65)
The Rotarix vaccine significantly reduces severe rotavirus diarrhea hospitalizations in African children, with the full dose providing greater protection than a partial dose.
Supports full-dose Rotarix vaccination in African children to reduce RVA hospitalizations; challenges prior low-certainty evidence against benefit.
<ns4:p> <ns4:bold>Background:</ns4:bold> Randomized controlled trials of licensed oral rotavirus group A (RVA) vaccines, indicated lower efficacy in developing countries compared to developed countries. We investigated the pooled effectiveness of Rotarix <ns4:sup>®</ns4:sup> in Africa in 2019, a decade since progressive introduction began in 2009. </ns4:p> <ns4:p> <ns4:bold>Methods:</ns4:bold> A systematic search was conducted in PubMed to identify studies that investigated the effectiveness of routine RVA vaccination in an African country between 2009 and 2019. A meta-analysis was undertaken to estimate pooled effectiveness of the full-dose versus partial-dose of Rotarix <ns4:sup>®</ns4:sup> (RV1) vaccine and in different age groups. Pooled odds ratios were estimated using random effects model and the risk of bias assessed using Newcastle-Ottawa scale. The quality of the evidence was assessed using GRADE. </ns4:p> <ns4:p> <ns4:bold>Results:</ns4:bold> By December 2019, 39 (72%) countries in Africa had introduced RVA vaccination, of which 34 were using RV1. Thirteen eligible studies from eight countries were included in meta-analysis for vaccine effectiveness (VE) of RVA by vaccine dosage (full or partial) and age categories. Pooled RV1 VE against RVA associated hospitalizations was 44% (95% confidence interval (CI) 28-57%) for partial dose versus 58% (95% CI 50-65%) for full dose. VE was 61% (95% CI 50-69%), 55% (95% CI 32-71%), 56% (95% CI 43-67%), and 61% (95% CI 42-73%) for children aged <12 months, 12-23 months, <24 months and 12-59 months, respectively. </ns4:p> <ns4:p> <ns4:bold>Conclusion:</ns4:bold> RV1 vaccine use has resulted in a significant reduction in severe diarrhoea in African children and its VE is close to the efficacy findings observed in clinical trials. RV1 VE point estimate was higher for children who received full dose than those who received partial dose, and its protection lasted beyond the first year of life. </ns4:p>
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Murunga et al. (2020) conducted a meta-analysis in Rotavirus gastroenteritis (n=9,987). Rotarix (RV1) vaccine vs. Unvaccinated was evaluated on Vaccine effectiveness against rotavirus-associated hospitalization (VE 58%, 95% CI 50-65). A full dose of the Rotarix vaccine demonstrated a pooled vaccine effectiveness of 58% against rotavirus-associated hospitalizations in African children.
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