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Rotavirus Vaccine on Diarrhea Mortality

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More Intervention Effect Estimate Summaries

Fischer Walker CL and Black RE. Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size. BMC Public Health.  2011, 11(Suppl 3)S16.


  • Diarrhea remains the second leading cause of death in children under years of age. (1)
  • Rotavirus is a leading cause of watery diarrhea in children, estimated to account for ~39% of diarrhea hospitalizations in young children. (2)
  • This group had recently published that a 74% (95% CI: 35-90%) reduction in very severe rotavirus infection was best approximated effectiveness against the fraction of diarrhea deaths attributable to rotavirus. (3)  
  • The current paper updates that analysis to include new available data from sub-Saharan Africa and Asia, and provides region-specific effect estimates of vaccine efficacy.

Intervention Effects

Rotavirus Vaccination (among fully vaccinated children) on Severe Rotavirus Episodes

  • 81% relative reduction (95% ci: 71.3-87.1%) in Latin America (1 study in 10 countries)
  • 49.7% relative reduction (95% ci: 22.8-67.1%) in Africa (2 studies in 5 countries)
  • 42.7% relative reduction (95% ci: 10.4-63.9%) in Asia (1 study in 1 high mortality Asian country)
  • 87.9% relative reduction (95% ci: 4.7-98.5%) in low mortality Asia and North America (2 studies in 4 countries)
  • 90.6% relative reduction (95% ci: 85.9-93.7%) in developed countries (2 studies in 7 countries)

Intervention Recommendation  

  • Strong evidence of serious morbidity reduction – highly plausible
  • Vaccine trials have not measured the effect of vaccine on diarrhea mortality. The overall quality of the evidence and consistency observed across studies suggests that estimating mortality based on a severe morbidity reduction is highly plausible.
  • Though the effect size appears greater among children living in developed as compared to low-income countries, the increased risk of diarrhea mortality is greater in developing countries further justifies the continued promotion of rotavirus vaccination.

References from Fischer Walker Paper Cited Here

  1. Black RE, Cousens S. Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P. Campbell H, Walker CF, Cibulskis R, et al. Global, regional and national causes of child mortality in 2008: a systematic analysis.  Lancet 2010, 375(9730): 1969-87.
  2. Parashar UD, Gibson CJ, Bresse JS, Glass RI.  Rotavirus and severe childhood diarrhea.  Emerg Infect Dis 2006; 12: 304-6.
  3. Munos MK, Walker CL, Black RE.  The effect of rotavirus vaccine on diarrhea mortality. Int J Epidemiol. 2010 Apr; 39 (Suppl 1): i56-62.

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