Skip to main content

Understanding Reduced Rotavirus Vaccine Efficacy in Low Socio-Economic Settings

Author(s): Lopman, Benjamin A.; Pitzer, Virginia E.; Sarkar, Rajiv; Gladstone, Beryl; Patel, Manish; et al

To refer to this page use:
Abstract: Introduction: Rotavirus vaccine efficacy ranges from .90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. Methods: We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. Results: Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. Discussion: The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements.
Publication Date: 6-Aug-2012
Electronic Publication Date: 6-Aug-2012
Citation: Lopman, Benjamin A., Pitzer, Virginia E., Sarkar, Rajiv, Gladstone, Beryl, Patel, Manish, Glasser, John, Gambhir, Manoj, Atchison, Christina, Grenfell, Bryan T., Edmunds, W. John, Kang, Gagandeep, Parashar, Umesh D. (2012). Understanding Reduced Rotavirus Vaccine Efficacy in Low Socio-Economic Settings. PLoS ONE, 7 (8), e41720 - e41720. doi:10.1371/journal.pone.0041720
DOI: doi:10.1371/journal.pone.0041720
EISSN: 1932-6203
Pages: e41720 - e41720
Type of Material: Journal Article
Journal/Proceeding Title: PLoS ONE
Version: Final published version. This is an open access article.

Items in OAR@Princeton are protected by copyright, with all rights reserved, unless otherwise indicated.