Rotavirus vaccine: a cost effective control measure for India.
ABSTRACT Globally, rotavirus diarrhea results in 453,000 deaths in children younger than 5 y—37% of deaths attributable to diarrhea and 5% of all deaths in children younger than 5 y. India alone accounts for 22% (~100,000 deaths) of all deaths attributable to rotavirus infection. Two oral rotavirus vaccines are available: Rotarix, a monovalent P1A G1 vaccine (GlaxoSmithKline), and RotaTeq, a pentavalent bovine-human reassortant vaccine (Merck). Rotarix is administered in a 2-dose schedule with the first and second doses of DTP (DTP1, DTP2). RotaTeq requires a 3-dose schedule with DTP1, DTP2 and DTP3 with an interval of 4–10 weeks between doses. The first dose of either vaccine should be administered to infants aged 6–15 weeks irrespective of the history of previous rotavirus infection, and the maximum age for administering the last dose of either vaccine should be 32 weeks. Although India would require funding from international health organizations/GAVI until new indigenous rotavirus vaccine candidates are developed at a cheaper price, introduction of vaccination into the national immunization program would be a cost-effective step toward control of the rotavirus diarrhea-related morbidity and mortality in India.
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ABSTRACT: Background More than half of the over 18 million incompletely vaccinated children worldwide in 2011 lived in India (32%), Nigeria (14%) and Indonesia (7%). Overall immunization coverage in India was 61% in 2009. Few studies have explored the role of parental attitudes in children's vaccination. Objectives To explore the correlates of completion of routine vaccination among children in Mysore City, India. Methods A two-stage probability sample of 800 girls aged 11–15 years was selected from 12 schools in Mysore to take home questionnaires to be completed by their parents. The questionnaire elicited information on socio-demographic characteristics, attitudes and practices relevant to vaccination. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with completion of routine vaccination. Results Of the 797 (99.6%) parents who completed questionnaires, 29.9% reported completing all routine vaccinations for their children. Parents who had obtained optional vaccinations for their children (adjusted odds ratio [AOR]: 4.56; 95% confidence interval [CI]: 3.09–6.74), who believed in vaccines’ effectiveness (2.50; 1.19–5.28) and who asked doctors or nurses about vaccination (2.07; 1.10–3.90) were significantly more likely to report complete vaccination, after controlling for all other factors. Belief that the disease was more protective than vaccination was independently associated with lower likelihood of vaccination series completion (0.71; 0.52–0.96). No other attitudinal or socio-demographic factors were associated with vaccine completion. Conclusion Interest and belief in vaccine effectiveness are important facilitators motivating parents to obtain full vaccination for their children in India.Journal of Infection and Public Health 07/2014; 8(1). DOI:10.1016/j.jiph.2014.05.003