Rotavirus vaccination: A concise review

ArticleinClinical Microbiology and Infection 18 Suppl 5(s5):57-63 · July 2012with20 Reads
DOI: 10.1111/j.1469-0691.2012.03981.x · Source: PubMed
Abstract
Clin Microbiol Infect 2012; 18 (Suppl. 5): 57–63 Live attenuated oral rotavirus vaccines were tested for proof-of-concept in the early 1980s, the first vaccine (RotaShield®, Wyeth) was introduced in 1998 but was subsequently withdrawn because of association with intussusception, and the two currently licensed vaccine (Rotarix®, GlaxoSmithKline, and RotaTeq®, Merck) were introduced in 2006. Before licensure both vaccines were extensively tested for safety (for intussusception) and efficacy in trials comprising in over 60 000 infants each. Rotarix is a single-strain human rotavirus vaccine (RV1) and RotaTeq is a combination of five bovine–human reassortant rotaviruses (RV5). Although the composition of the two vaccines is different, their field effectiveness and, largely, mechanism of action are similar. Both prevent effectively severe rotavirus gastroenteritis (RVGE) but are less efficacious against mild RVGE or rotavirus infection. Field effectiveness of these vaccines in Europe and the USA against severe RVGE has been above 90% and in Latin America around 80%. Trials in Africa have yielded efficacy rates between 50 and 80%. Rotavirus vaccination has been introduced into the national immunization programmes of about 20 countries in Latin America, with Brazil and Mexico as leading countries, as well as in the USA, Australia and South Africa. Introduction into other African countries will start in 2012. In Europe, Belgium, Luxembourg, Austria and Finland and five federal states of Germany have introduced universal rotavirus vaccination. The reasons for the slow progress in Europe include low mortality from RVGE, unfavourable cost–benefit calculations in some countries, and concerns that still exist over intussusception.
    • "The first preventive human vaccine for rotavirus infections was RotaShield Ò , which was licensed in 1998. Unfortunately, it was discovered that the vaccine may have contributed to an increased risk for intussusceptions and was subsequently withdrawn from the market in 1999 [12]. Currently, two rotavirus vaccines are distributed at a global level, namely RotaRix Ò (RV1) and RotaTeq Ò (RV5) [13], while at least two local brands produce the vaccine, Lanzhou Lamb Ò and RotaVac Ò , which are used in China and India respectively [14]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: For more than three decades, the number and influence of economic evaluations of healthcare interventions have been increasing and gaining attention from a policy level. However, concerns about the credibility of these studies exist, particularly in studies from low- and middle- income countries (LMICs). This analysis was performed to explore economic evaluations conducted in LMICs in terms of methodological variations, quality of reporting and evidence used for the analyses. These results were compared with those studies conducted in high-income countries (HICs). Methods: Rotavirus vaccine was selected as a case study, as it is one of the interventions that many studies in both settings have explored. The search to identify individual studies on rotavirus vaccines was performed in March 2014 using MEDLINE and the National Health Service Economic Evaluation Database. Only full economic evaluations, comparing cost and outcomes of at least two alternatives, were included for review. Selected criteria were applied to assess methodological variation, quality of reporting and quality of evidence used. Results: Eighty-five studies were included, consisting of 45 studies in HICs and 40 studies in LMICs. Seventy-five percent of the studies in LMICs were published by researchers from HICs. Compared with studies in HICs, the LMIC studies showed less methodological variety. In terms of the quality of reporting, LMICs had a high adherence to technical criteria, but HICs ultimately proved to be better. The same trend applied for the quality of evidence used. Conclusion: Although the quality of economic evaluations in LMICs was not as high as those from HICs, it is of an acceptable level given several limitations that exist in these settings. However, the results of this study may not reflect the fact that LMICs have developed a better research capacity in the domain of health economics, given that most of the studies were in theory led by researchers from HICs. Putting more effort into fostering the development of both research infrastructure and capacity building as well as encouraging local engagement in LMICs is thus necessary.
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    • "Несколько меньшую эффективность имеют РВ-вакцины в развивающихся странах, вероятно, из-за интерференции в кишечнике с широко распространенными энтеровирусами. Так, в отношении тяжелого РВГЭ эффективность РотаТека составила 43% в Бангладеш, 65% – в Гане, 73% – во Вьетнаме и 83% – в Кении [22] . В Ботсване за два года массовой вакцинации госпитализация детей 0–5 лет по поводу гастроэнтерита любой этиологии снизилась на 23%, а смертность детей 0–2 лет – на 22% [26] Безопасность вакцины РотаТек, как и вакцины Ротарикс, тщательно изучалась в предрегистрационных испытаниях: не было выявлено существенной разницы в неблагоприятных событиях в основной группе и группе ЗДОРОВЫЙ РЕБЕНОК плацебо, а риск развития кишечной инвагинации у вакцинированных был на 20% ниже [17] . "
    Article · Jan 2016
    • "Noroviruses (NoVs) and rotaviruses (RVs) are the major causative agents of pediatric acute gastroenteritis (AGE) in children worldwide. There is no licensed vaccine for NoV available, and despite efficacious live RV vaccines currently in use [1], there is a need [2] for nonlive RV vaccines that could be safer [3], more affordable, and more efficacious in developing countries [4][5][6]. Our group has developed a subunit combination vaccine candidate against NoV and RV gastroenteritis, consisting of NoV virus-like particles (VLPs) and RV VP6, aiming to confer protection from both leading etiological agents of severe AGE [7][8][9]. "
    [Show abstract] [Hide abstract] ABSTRACT: We have recently shown that tubular form of rotavirus (RV) recombinant VP6 protein has an in vivo adjuvant effect on the immunogenicity of norovirus (NoV) virus-like particle (VLP) vaccine candidate. In here, we investigated in vitro effect of VP6 on antigen presenting cell (APC) activation and maturation and whether VP6 facilitates NoV VLP uptake by these APCs. Mouse macrophage cell line RAW 264.7 and dendritic cell line JAWSII were used as model APCs. Internalization of VP6, cell surface expression of CD40, CD80, CD86, and major histocompatibility class II molecules, and cytokine and chemokine production were analyzed. VP6 nanotubes were efficiently internalized by APCs. VP6 upregulated the expression of cell surface activation and maturation molecules and induced secretion of several proinflammatory cytokines and chemokines. The mechanism of VP6 action was shown to be partially dependent on lipid raft-mediated endocytic pathway as shown by methyl- β -cyclodextrin inhibition on tumor necrosis factor α secretion. These findings add to the understanding of mechanism by which VP6 exerts its immunostimulatory and immunomodulatory actions and further support its use as a part of nonlive RV-NoV combination vaccine.
    Full-text · Article · Jan 2016
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