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Routine rotavirus vaccination would 'eliminate' infections in two years

A rotavirus immunisation programme could eradicate severe cases in young children within two years in England and Wales, a new modelling study predicts.

It is the first study to incorporate trial evidence that the pentavalent vaccine confers immunity for up to three years rather than the one year seen with natural immunity.

Researchers from Yale University in the US applied European data on rotavirus efficacy and safety to a model including demographic information and expected uptake rates from England and Wales.

They found in a vaccine programme where it was assumed immunity only lasted a year, immunisation reduced incidence of severe disease by over 70% and delayed the seasonal epidemic by two and a half months.

That would be close to what has been shown by other analyses, which have formed the basis of policy in the UK, where Government advisers have so far been unconvinced a vaccine programme would be cost-effective.

But when the analysis assumed immunity from rotavirus vaccination would last three years, as more recent study findings suggest, researchers found its introduction could eradicate the disease altogether. In the US there has been a substantial drop in incidence despite vaccine coverage only reaching 75% in 2009, they said.

Study leader Dr Katherine Atkins, an epidemiologist at the Yale School of Public Health, said: ‘If protection does not wane over three years, severe rotavirus infection in children under five years could be eliminated within two years.'

UK vaccination advisers have so far ruled out introducing rotavirus vaccination into the infant schedule. Members of the Joint Committee on Vaccination and Immunisation said although a programme would reduce incidence of gastroenteritis, vaccine prices did not meet ‘current economic criteria' for the NHS.

The pentavalent vaccine looked at in the study (Rotateq) is £25 per dose. Another licensed vaccine Rotarix comes in at £35 per dose.

Dr George Kassianos, RCGP immunisation lead and a GP in Bracknell, Berkshire, said the Department of Health needed to push prices down.

‘The tariff is not the price the DH would end up paying. It needs to put it out to tender to get a better deal. We have got two very effective vaccines, and both would be easy to incorporate into the existing schedule at two, three and four months. We need to do this as soon as possible because there are huge benefits to babies and fewer hospital stays.'

Vaccine 2011 online 28 November

 

Rotavirus-induced gastroenteritis

  • In England and Wales there are an estimated 130,000 episodes of rotavirus-induced gastroenteritis annually in the under fives.
  • Around 12,700 of these children are hospitalised.
  • It is thought there are around three to four deaths a year.
  • Even with the most pessimistic predictions, vaccination could cut peak epidemics of severe disease from 16,500 to 3,000 cases a week.
  • And any rotavirus infection would drop from69,000 cases to 14,000 a week.
  • But new modelling shows that routine immunisation could totally eliminate the disease in infants.

[Points 1-3 taken from JCVI report, and 4-6 from Vaccine paper]

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