Effectiveness of universal rotavirus vaccination: a literature review

Abstract

Objectives This study focuses on the evaluation of the use of vaccine in the prevention of severe acute gastroenteritis in the community in the literature. The objectives of this project report include an in depth review of the effectiveness and cost effectiveness of rotavirus vaccination for severe acute gastroenteritis in low and middle income countries (developing countries).

Methods Publications were identified using computerized bibliographic searches in PubMed (for the period from October 1994 to July 2012). The keywords “effective*”, “vaccin*”, “rotavirus” , “Randomized controlled trial” were used to search for relevant information. Also the keywords “轮状病毒”, “疫苗” , “随机对照试验” were used to search for relevant information in China Journals Full-text Database(中国期刊全文数据库). Selection criteria: SSRandomized controlled trials (RCT) in children (<5 years old) comparing rotavirus RV1/RV5/LLR vaccines for use with (1) placebo, (2) no intervention, or (3) another RV1/RV5/LLR vaccine.

Once the identified articles had been screened by the inclusion and exclusion criteria, the content of each was evaluated in relation to the two research questions. International guidelines: CONSORT (for RCT) was also followed in the quality assessment process.

Results In our review, there were 9 studies included and 2 of them were graded A(i.e. good quality), 5 graded B(i.e. medium quality) and 2 graded C(i.e. poor quality). For the two Grade A studies, vaccine effectiveness was estimated to be 39.3% and 48.3%. For 5 Grade B studies, vaccine effectiveness was estimated to be 19.2% to 63.9%. For 2 Grade C studies, vaccine effectiveness was estimated to be 10.6% and 74.3%. There is a smaller range in vaccine effectiveness in grade A studies. In contrast, there is a greater range in vaccine effectiveness in grade B and C studies. Many low and middle income countries may not have enough training in conducting RCT. However, the Grade A studies showed that rotavirus vaccine is effective. Our review also showed that authors from most of the low income countries suggested that rotavirus vaccine is cost effective to very cost effective, while those from middle income countries suggested that the cost of the vaccine is the key factor.

Conclusion This review showed evidence of effectiveness of rotavirus vaccine and cost-effectiveness in low and middle income countries (developing countries). China has a huge population and similar situation with other developing countries, hence it is useful to conduct a study on cost-effectiveness on universal vaccination in the near future.