Expert opinion on rotavirus vaccination in infancy
ECDC has published an Expert Opinion on rotavirus vaccination in infancy. The paper provides EU/EEA Member States with relevant scientific information on burden of rotavirus disease, vaccine effectiveness and safety, and cost-effectiveness studies to support the decision-making process on the possible introduction of routine vaccination of children against rotavirus gastroenteritis. Authorised vaccines provide a high level of protection against severe disease in need of medical attention. Evidence suggests that rotavirus vaccination should be initiated before 12 weeks of age and can be administered together with other infant vaccines. The Expert Opinion provides options for monitoring and evaluating the impact of rotavirus vaccination.
Each year, around 75,000-150,000 children aged under five years of age are hospitalised in the EU/EEA due to rotavirus gastroenteritis. In addition, up to 4 times this number of children seek medical evaluation in emergency rooms or other out-patient facilities. Children seeking medical attention due to rotavirus disease have the potential to become sources of hospital-acquired infection, often affecting younger susceptible children hospitalised for other reasons.
Two rotavirus vaccines were authorised for prevention of rotavirus gastroenteritis in 2006. Vaccine effectiveness against hospitalisation ranges between 85 and 90%, and herd protection contributes to the overall impact of vaccination programmes.
As of May 2017, inclusion of rotavirus vaccines in the routine childhood immunisation programme has been initiated in 13 EU/EEA Member States, with one more EU/EEA Member State offering the vaccine in some regions. The remaining countries have not yet introduced the vaccine into their programmes for reasons related to cost effectiveness, insufficient expected epidemiological impact and competing health priorities. Other reasons identified included risk of emergence of serotypes not covered by the vaccine, improved clinical management preferred to vaccination, and concerns regarding safety, such as intussusception (a condition characterised by telescoping of the intestine onto itself).
Benefit-risk has been assessed by regulatory agencies worldwide and was found to be positive given the severity of disease and the availability of treatment of intussusception. In addition, a recent meta-analysis indicates that the risk of vaccine-related intussusception is reduced from approximately 1 in 20 000 to approximately 1 in 50 000 above the background incidence of 33 to 101 per 100,000 in unvaccinated, if the first dose is given before the age of 12 weeks.
Finally, the Expert Opinion suggests a series of monitoring activities to be considered in EU/EAA Member States and at EU level, including surveillance of severe rotavirus gastroenteritis leading to hospitalisation, rotavirus genotyping in a geographically representative sample and in breakthrough infections occurring in vaccinated infants, coverage and timing of vaccination and if needed follow up on routine adverse event reporting. Furthermore, to support cost effectiveness studies, the expert opinion encourages the sharing of health economic models among EU/EEA countries.
See all updates on rotavirus
Cost-effectiveness of universal rotavirus vaccination in reducing rotavirus gastroenteritis in Ireland
Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial
Herd immunity after two years of the universal mass vaccination program against rotavirus gastroenteritis in Austria
Related diseases and public health areas
Rotavirus infection is an acute infectious disease mainly affecting children. The main symptoms are fever, vomiting and diarrhoea and many affected children suffer from extensive fluid loss in need of medical attention. The incubation period is 1-2 days.Read more
Immunisation and vaccines
Vaccines represent one of the most effective and cost-saving public health intervention.Read more
ECDC Scientific advice provides a summary of primary evidence acknowledging uncertainties to support informed decisions and actions at the Union and country level in relation to public health measures to prevent and/or control communicable diseases.Read more
Burden of communicable diseases
The Burden of Communicable Diseases in Europe (BCoDE) is an ECDC project that aims to estimate the burden of communicable diseases applying composite health measures (DALYs: Disability Adjusted Life Years) to summarize the overall burden in one single metric and compare the relative burden of each communicable disease.Read more