Rotavirus is a leading cause of acute gastroenteritis in children worldwide. This highly contagious virus can cause severe diarrhea, fever and vomiting, with more severe diarrheal disease occurring in infants and young children. Infected individuals may become severely dehydrated and require hospitalization. Rotavirus has a 2.5 percent fatality rate among infected children in low-income countries. This rate is higher in areas without reliable access to health care.
There are four rotavirus vaccines currently available for global use, and more than 120 countries have introduced rotavirus vaccines into their national immunization programs. However, an estimated 58 million children still do not have access to vaccines due to high vaccine costs and a lack of access to health care. The COVID-19 pandemic caused further disruptions to vaccine access and distribution, and data suggest a 6-7 percent decrease in global immunization rates since the onset of the pandemic.
In the United States, western Europe and South America, rotavirus vaccines are 90-100 percent effective in preventing severe infection. However, these vaccines are only moderately effective in low- and middle-income countries in Africa and Asia. This disparity may be related to a variety of factors, such as malnutrition or differences in exposure to other pathogens, and researchers are still evaluating causes for these differences.
In response to the ongoing disparity in vaccine coverage and to monitor vaccine effectiveness and safety so that children are protected from this deadly virus, the CDC Foundation works with 11 priority countries, including Indonesia, Pakistan, Nigeria and Burkina Faso, alongside the World Health Organization (WHO); Gavi, the Vaccine Alliance; the Centers for Disease Control and Prevention (CDC) and the Bill & Melinda Gates Foundation. These programs are helping the public health community determine the effectiveness and safety of newer rotavirus vaccines, including two more cost-effective Indian-manufactured vaccines.
Jacqueline Tate, PhD, CDC
Jacqueline Tate, PhD, is the viral gastroenteritis epidemiology team lead in the Division of Viral Diseases at CDC. As she explained, the goal of these surveillance efforts is to study and examine the impact, safety and effectiveness of the vaccines—providing information for each country and its neighbors. Cost is a major barrier to adding a rotavirus vaccine to a national immunization campaign. “Vaccines are huge investments,” explained Dr. Tate. “Country-level data can be a form of advocacy for the region. Other countries look to the effectiveness of the vaccines as evidence for why they should also introduce the vaccine as well.”
In addition to these ongoing surveillance projects, the CDC Foundation has partnered with Universitas Gadjah Mada (UGM) in Indonesia to conduct the first post-licensure evaluation of a new live, oral rotavirus vaccine that can be used on a neonatal schedule. Unlike the currently available rotavirus vaccines, this new vaccine is porcine (swine)-free. For countries like Indonesia, where 87 percent of people identify as Muslim and observe Halal, this helps remove a major barrier to the uptake of the vaccine. Shown to be safe and effective in clinical trials involving thousands of infants in Indonesia as participants, this vaccine has the potential for much wider acceptance among Muslim populations and is an incredible example of the ways public health adapts to and is informed by the needs of different populations.