Rotavirus Vaccinations Can Cut Infant Diarrhea Deaths: Both Home and Abroad
Recently, WHO (World Health Organization) recommended the use of rotavirus vaccinations worldwide. The widespread use of these vaccines has the potential to prevent about two million deaths over the next decade. Even countries like Mexico are suggesting the use of rotavirus vaccine to have a substantial reduction of mortality of those affected.
This disease if not treated, can lead to malabsorption due to the destruction of absorptive cells in the intestines. The overall prevalence of rotavirus has been reduced from 33.2% to 26.4% in 2016 (Mchaile et al, 2017). In addition, because it is a virus it has the nature to mutate. There are now ten different rotaviruses that have been identified (A-J).
Demographics of rotavirus have changed since its introduction of the vaccination schedule. The virus is transmitted through the fecal-oral route. Gastroenteritis caused by bacterial pathogens result in bloody diarrhea. Diarrhea from rotavirus has rarely had that effect. This virus has been associated with delayed gastric emptying, however, the actual mechanism is not known.
The way rotavirus and other bowel viruses are often less severe. In addition, there is a seasonal aspect to rotavirus in many areas. It seems to be most active during the months of June to December. A big step toward slowing the spread of rotavirus is an increase in improvement of hygiene and sanitation. These factors alone, however, does not lower the incidence of the virus so vaccination is still the best course of action (Crawford et al, 2018).
In 2012, a study was done to see if there could be a difference in the death rates of children under the age of one year by making use of the vaccine. A randomized double-blind, placebo-controlled trial was conducted. This study showed that vaccination against the rotavirus should be included in childhood immunization programs as suggested by WHO World Health Organization. Initially, two vaccines were approved in 2006 for use in the US and Europe. Reduction of rotavirus was also reported after its introduction into the childhood vaccinations. But being a virus it has mutated so multiple vaccines have been manufactured (Cunliff et al, 2012).
Reduction of infant death by 34% in rural Malawi was found to be from the use of the rotavirus vaccine. This study led by students from the University of Liverpool, University College of London, and the John Hopkins Bloomberg School of Public Health. This was the first study of population level in low-income population country tested and showed the vaccine indeed saves lives (University of Liverpool,2018).
According to the Center of Disease Control (CDC), rotavirus is the most common causative of diarrhea in infants and young children. But older children and adults can also get sick from this virus. It has a two day incubation period. In children, they have severe watery stools, vomiting, fever, and/or abdominal pain. This can also lead to loss of appetite and dehydration that for an infant is especially dangerous.
Unfortunately, even children who have been vaccinated can sometimes still get sick from this but it is felt by the CDC that the vaccination lessens the effects of the virus. Rotavirus is shed in the feces. This means good hygiene and hand washing helps to decrease the chance of developing this disease. For older children and adults treatment is symptomatic as with them the biggest concern is dehydration so replacement of fluids is essential. Thankfully there are two vaccines available. One is given in three doses and the other in two doses: both vaccines are oral with drops put in the child’s mouth.
In addition, rotavirus vaccination is very safe and is effective at preventing rotavirus disease. Vaccines, like any medication, can have side effects. Most babies who receive the vaccine don’t have a problem with it. But for those few who do, the most common side effects are irritability and mild, temporary diarrhea or vomiting (CDC, 2018).
Each year rotavirus is responsible for about 37% of deaths from diarrhea among children below the age of five worldwide. The research reported in the New England Journal of Medicine, of the 3508 infants studied, only 31 cases were reported in the group given the vaccine. This was in opposition to the 87 cases of the virus in the placebo group. Sub-Saharan Africa, remains the highest death rate associated with rotavirus. Large-scale distribution of vaccine is difficult for a number of reasons. Some of them include cost with current prices of the two licensed vaccines. They are unsustainable without external subsidies. Global supplies are constrained and reliable transportation and storage make the delivery. In addition, there is a difficulty with having available refrigeration for storing and transporting the meds (Isanka et al, 2017).
Rotavirus is a major contributor to severe childhood diarrhea-causing nearly 200,000 deaths among children under five worldwide. The vast majority are from developing countries with several reporting rotavirus-specific deaths of 100 per 100,000 children.
In the US before the vaccine was introduced, an estimated 55,000 to 70,000 hospital admissions occurred each year. As of 2016, over 80 countries make use of the vaccines in their national immunization programs. Trials in South Africa and Malawi found the overall effectiveness of 62% against severe rotavirus in the first year of life. Much of this lessened response is felt to be related to the living conditions and nutritional condition of the infants prior to and after the vaccination has been administered. And while there have been examples of a positive impact of the vaccinations on morbidity and mortality from rotavirus, further use of the vaccine and further issues in the developing countries such as cost and transportation to the areas who really are of great need, more study is needed (Aliabadi et al, 2016).
Aliabadi, N., Tate,J.E., & Parashai,U.D. (2016). Potential Safety Issues and Other Factors That May Affect the Introduction and Uptake of Rotavirus Vaccines. Clinical Microbiology and Infection, 22(5). Elsevier. http://dx.doi.org/10.1016/j.cmi.2016.03.007
CDC (2018). Rotavirus. US Department of Health and Human Services. http://www.cdc.gov/rotavirus/about/symptoms.html
Crawford,S.E., Ramani, Tate,J.E. Parashar,U.D. Svensson,L., Hagbom,M. Franco,M.A…Estes,M.K. (2018). Rotavirus Infections. Nature Reviews Disease Primers,3(17083). Doi:10.1038/nrdp.2017.83
Cunliffe,N.A., Wille,D., Ngwira,B.M., Todd,S., Bostock,N.J., Turner,A.M., Chimperi,K.M., Neuzil,K.M. (2012). Efficacy of Human Rotavirus Vaccine Against Severe Gastroenteritis in Malawian Children in the First Two Years of Life: A Randomized, Double-Blind Placebo-Controlled Trial. Vaccine,30(1). Doi: 10.1016/j.vaccine.2011.09.120
Isanka,S., Guindo,O., Langendorf,C., Seck, A.M., Plikaytis, B.D., Makombe, N.S., McNeal,M.M…Grais,R.F. (2017). Efficacy of a Low-Cost, Heat Stable Oral Rotavirus Vaccine in Niger. New England Journal of Medicine, 326 (12). http://www.nejm.org
Mchaile,D.N., Phielmon,R.N., Kabika, S. Albogasi,E., Morijo,K.J., Kifaro,E. Mmbaga,B.T. (2017). BioMed Central Research Notes. Prevalence and Genotypes of Rotavirus A,ong Children Under Five Years Presenting With Diarrhea in Moshi Tanzania: A Hospital-Based Cross-Sectional Study.doi:10.1186/s13104-017-2883-3
The University of Liverpool. (2018). Rotavirus Vaccine Cuts Infant Diarrhea Deaths by a Third in Malawi. The University of Liverpool. https://news.liverpool.ac.uk/42018/08/13/Rotavirus-vaccine-cuts-infant-death-by-a-third