Rotavirus vaccine introduction in the Americas: Progress and lessons learned

Immunization Unit, Family and Community Health, Pan American Health Organization, 525 23rd Street, NW, Washington, DC 20037, USA.
Expert Review of Vaccines (Impact Factor: 4.21). 05/2008; 7(3):345-53. DOI: 10.1586/14760584.7.3.345
Source: PubMed


In Latin America and the Caribbean, rotavirus causes approximately 15,000 deaths, 75,000 hospitalizations, 2 million clinic visits and 10 million cases of rotavirus diarrhea annually. Two safe vaccines are available that are effective in preventing severe illness. To date, seven countries in Latin America (Brazil, Ecuador, El Salvador, Panama, Mexico, Nicaragua and Venezuela) have introduced the vaccine. For successful rotavirus vaccine introduction, the lessons learned re-emphasize the critical need for countries to have precise plans that will ensure technical, programmatic and financial sustainability of vaccine introduction. Of these lessons learned, programmatic feasibility and financial sustainability were particularly challenging for countries that were the first to introduce a rotavirus vaccine.

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Available from: Jon Kim Andrus, Oct 13, 2015
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    • "Preparation for A[H1N1]pdm ESAVI surveillance in LAC Since 2002, countries in LAC have had at their disposal guidelines for ESAVI response [10]; to support country efforts to carry out ESAVI surveillance as part of A[H1N1]pdm vaccination campaigns, efforts were made to enhance this routine surveillance across LAC. Planning for A[H1N1]pdm vaccine safety monitoring also incorporated lessons learned from the Safety of New Vaccines (SANEVA) network, developed in 2006 to monitor adverse events related to new vaccines [11]. The Pan American Health Organization, WHO's Regional Office for the Americas (PAHO/WHO) elaborated and distributed a field guide specific to A[H1N1]pdm ESAVI surveillance, crisis prevention and management [12]. "
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    ABSTRACT: As part of the vaccination activities against influenza A[H1N1]pdm vaccine in 2009-2010, countries in Latin American and the Caribbean (LAC) implemented surveillance of events supposedly attributable to vaccines and immunization (ESAVI). We describe the serious ESAVI reported in LAC in order to further document the safety profile of this vaccine and highlight lessons learned. We reviewed data from serious H1N1 ESAVI cases from LAC countries reported to the Pan American Health Organization/World Health Organization. We estimated serious ESAVI rates by age and target group, as well as by clinical diagnosis, and completed descriptive analyses of final outcomes and classifications given in country. A total of 1000 serious ESAVI were reported by 18 of the 29 LAC countries that vaccinated against A[H1N1]pdm. The overall reporting rate in LAC was 6.91 serious ESAVI per million doses, with country reporting rates ranging from 0.77 to 64.68 per million doses. Rates were higher among pregnant women (16.25 per million doses) when compared to health care workers (13.54 per million doses) and individuals with chronic disease (4.03 per million doses). The top three most frequent diagnoses were febrile seizures (12.0%), Guillain-Barré Syndrome (10.5%) and acute pneumonia (8.0%). Almost half (49.1%) of the serious ESAVI were reported among children aged <18 years of age; within this group, the highest proportion of cases was reported among those aged <2 years (53.1%). Of all serious ESAVI reported, 37.8% were classified as coincidental, 35.3% as related to vaccine components, 26.4% as non-conclusive and 0.5% as a programmatic error. This regional overview of A[H1N1]pdm vaccine safety data in LAC estimated the rate of serious ESAVI at lower levels than other studies. However, the ESAVI diagnosis distribution is comparable to the published literature. Lessons learned can be applied in the response to future pandemics. Copyright © 2014. Published by Elsevier Ltd.
    Vaccine 11/2014; 33(1). DOI:10.1016/j.vaccine.2014.10.070 · 3.62 Impact Factor
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    • "However, transport is a major component of vaccine supply chains and can be a source of bottlenecks. Rotavirus vaccine introduction overwhelmed both storage and transport capacities of vaccine supply chains in several Latin American countries in 2006 and 2007 [8]. Many low- and middle-income countries face difficulties in maintaining efficient vaccine supply chains with the current routine immunization regimen, let alone with any of the 12 new, bulkier vaccines that are proposed for introduction by 2019 and are expected to create bottlenecks in both storage and transport aspects of vaccine supply chains [1]. "
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    ABSTRACT: When addressing the urgent task of improving vaccine supply chains, especially to accommodate the introduction of new vaccines, there is often a heavy emphasis on stationary storage. Currently, donations to vaccine supply chains occur largely in the form of storage equipment. This study utilized a HERMES-generated detailed, dynamic, discrete event simulation model of the Niger vaccine supply chain to compare the impacts on vaccine availability of adding stationary cold storage versus transport capacity at different levels and to determine whether adding stationary storage capacity alone would be enough to relieve potential bottlenecks when pneumococcal and rotavirus vaccines are introduced by 2015. Relieving regional level storage bottlenecks increased vaccine availability (by 4%) more than relieving storage bottlenecks at the district (1% increase), central (no change), and clinic (no change) levels alone. Increasing transport frequency (or capacity) yielded far greater gains (e.g., 15% increase in vaccine availability when doubling transport frequency to the district level and 18% when tripling). In fact, relieving all stationary storage constraints could only increase vaccine availability by 11%, whereas doubling the transport frequency throughout the system led to a 26% increase and tripling the frequency led to a 30% increase. Increasing transport frequency also reduced the amount of stationary storage space needed in the supply chain. The supply chain required an additional 61,269L of storage to relieve constraints with the current transport frequency, 55,255L with transport frequency doubled, and 51,791L with transport frequency tripled. When evaluating vaccine supply chains, it is important to understand the interplay between stationary storage and transport. The HERMES-generated dynamic simulation model showed how augmenting transport can result in greater gains than only augmenting stationary storage and can reduce stationary storage needs.
    PLoS ONE 12/2013; 8(5):e64303. DOI:10.1371/journal.pone.0064303 · 3.23 Impact Factor
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    • "The proportion of diarrhoeal hospitalizations attributable to rotavirus is also consistent with other studies completed in the Americas and with estimates for other low-middleincome countries (Kane et al. 2004; Parashar et al. 2006). Of note, Guatemala-specific data from the Rotavirus Surveillance Network in the Americas found 52% of specimens to test positive for rotavirus in 2006 (de Oliveira et al. 2008). This figure is higher than our estimate of 31% and may be a reflection of year-to-year variations commonly observed with rotavirus disease, regional differences in the burden of rotavirus disease within Guatemala, or differences in the severity of patients enrolled in the two surveillance systems, as the detection rate of rotavirus is known to increase with increasing severity of illness. "
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    ABSTRACT: To assess the burden of rotavirus disease in Guatemala, in view of the recent introduction of a national rotavirus vaccination programme. We examined data from an active, facility-based surveillance system in Santa Rosa, Guatemala, from October 2007 through September 2009 among children <5years of age presenting to the hospital or ambulatory clinics with diarrhoea (≥3 loose stools in 24 h during the last 7 days). Demographic and epidemiological data were collected, and specimens were tested for rotavirus via enzyme immunoassay. Genotyping was performed via reverse transcriptase polymerase chain reaction. We enrolled 347 hospitalized patients <5 years of age with diarrhoea and 1215 from ambulatory clinics. Specimens from 275 (79%) hospitalized children and 662 (54%) from ambulatory visits were tested for rotavirus. Rotavirus accounted for 32% of hospitalizations and 9% of ambulatory visits for diarrhoea, resulting in adjusted annual rates of 36 hospitalizations and 372 ambulatory visits per 10 000 children. Ninety-one per cent of hospitalizations and 81% of ambulatory visits for rotavirus diarrhoea occurred in children <2 years. G1P8 represented 71% and 95% of rotavirus genotypes for 2007-2008 and 2008-2009 rotavirus seasons, respectively. Rotavirus is a major cause of diarrhoea in children <5 years of age in Santa Rosa, Guatemala, highlighting the potential health benefits of vaccination and the need for continued surveillance to assess impact and effectiveness of the rotavirus vaccination programme in Guatemala.
    Tropical Medicine & International Health 12/2011; 17(2):254-9. DOI:10.1111/j.1365-3156.2011.02911.x · 2.33 Impact Factor
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