Impact of the indigenous rotavirus vaccine Rotavac in the Universal Immunization Program in India during 2016–2020

Figures

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  Fig. 1. Data flow of enrolled children and identification of age-eligible children based on the date of introduction of rotavirus vaccine in the UIP. A flow diagram outlining the data collection process for study surveillance, presenting the layout of participants from initial screening to eligibility assessment and inclusion in final analysis and providing details of exclusion stepwise.

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  Fig. 2. Impact of rotavirus vaccine after its introduction in the UIP in India shown by comparing the pre- and postvaccination introduction surveillance periods. A comparison of rotavirus positivity during prevaccination period and postvaccination period from five selected study sites. The bars indicate the number of rotavirus-positive cases (N = 2,530) and rotavirus-negative cases (N = 5,744) among children under 5 years admitted with AGE in the study settings by month and year of surveillance. The blue colored solid line shows the percentage of rotavirus-positives among children enrolled in the surveillance by month and year of surveillance. The blue dotted line shows the percentage of children who had received at least a single dose of rotavirus vaccine at the time of enrollment into the study surveillance. The orange straight line shows the time of rotavirus vaccine introduction into the UIP in India. The data during the prevaccine period from 2012 to 2016 were collected as a part of National Rotavirus Surveillance Network5,35. The postvaccine data were collected as a part of present study during the time period 2016–202036.

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  Fig. 3. Reduction in proportions of rotaviral diarrheal disease among children under 5 years during the rotavirus vaccine postintroduction period in the study sites. The percentage reduction in rotavirus positivity among children under 5 years after the introduction of rotavirus vaccination. The green bars show the percentage of children under 5 years of age who tested positive for rotavirus gastroenteritis during the prevaccination period stratified by their age groups (N = 4,163). The blue bars show the percentage of children under 5 years of age who tested positive for rotavirus gastroenteritis during the postvaccination period stratified by their age groups (N = 4,336). The dotted line shows the coverage of rotavirus vaccine during the study period of 2016–2020 for each age group. The data during the prevaccine period were collected as a part of National Rotavirus Surveillance Network (2012–2016) using similar protocol5,35. Postvaccine data were collected as a part of present study (2016–2020)36. The details are further elaborated in Extended Data Table 6.

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  Extended Data Fig. 1. Map of India showing the phased introduction by states of RotavacTM vaccine in the Universal Immunization Program in India from 2016 to 2018. This map was generated using licensed version of ArcGIS® software to demonstrate the states in India that were part of the surveillance and introduction times of rotavirus vaccine in each of the participating states. Vaccine effectiveness surveillance data were collected from all nine states from January 2016 to January 2020. Data for assessing the impact of the vaccine were obtained from four states with pre-vaccination data from September 2012 to April 2016, post-vaccination data from May 2016 to June 2020, and from Tamil Nadu from 2018 to January 2020. A uniform protocol was followed throughout the surveillance period.

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  Extended Data Fig. 2. Study flow diagram. Shows the protocol followed at all the study sites for enrolment and collection of data. EIA- enzyme immunoassay; MoHFW- Ministry of Health and Family Welfare, Government of India.

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  Extended Data Fig. 3. Timeliness of rotavirus and pentavalent vaccines among age-eligible children in the Universal Immunization Program in India. Rotavirus vaccines and pentavalent vaccines are administered to children at 6, 10, and 14 weeks of age in the Universal Immunization Program in India. This figure shows the comparison between cumulative percentages of vaccinated children across timelines during the surveillance. A delay is observed in the completion of the series of both vaccines.