Editorial

Rotavirus vaccination in Central American children Expert Rev. Vaccines 13(6), 687–690 (2014)

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Rolando Ulloa-Gutierrez Author for correspondence: Servicio de Infectologı´a Pedia´trica, Hospital Nacional de Nin˜os “Dr. Carlos Sa´enz Herrera,” Centro de Ciencias Me´dicas, PO Box 1654-1000, Avenida Paseo Colo´n, San Jose´, Costa Rica Tel.: +506 2258 2173 Fax: +506 2258 2173 [email protected]

Marı´a L Avila-Aguero Servicio de Infectologı´a Pedia´trica, Hospital Nacional de Nin˜os “Dr. Carlos Sa´enz Herrera,” Centro de Ciencias Me´dicas, PO Box 1654-1000, Avenida Paseo Colo´n, San Jose´, Costa Rica

Rotavirus is the leading cause of acute diarrhea in children younger than five years of age around the world. Severe dehydration and mortality rates are higher in developing countries, especially those from Latin America, Africa, and Asia. The vaccine has been introduced in the national immunization programs of more than half of Latin American countries, and impact data from some of these nations has been already published. The two rotavirus vaccines, the 2-dose monovalent (RV-1) and the 3-dose pentavalent (RV-5) vaccine, have been available in the market to all Central American countries. Rotavirus vaccine has been universally introduced in the expanded immunization national programs of Guatemala, Honduras, El Salvador, Nicaragua and Panama, but not in Belize and Costa Rica. This review summarizes what has been published about the epidemiology and impact of universal rotavirus vaccination in Central America.

Rotavirus is the leading cause of acute vaccine-preventable diarrhea in children around the world who are younger than 5 years of age. Severe dehydration and mortality rates are higher in developing countries, especially in Latin America, Africa and Asia. In Latin America and the Caribbean, rotavirus is responsible for around 15,000 deaths, 75,000 hospital admissions and 2,000,000 outpatient visits every year. Therefore, vaccination is a key point among the global efforts to achieve Millennium Development Goal 4 and reduce childhood mortality by two-third by 2015. To date, the rotavirus vaccine has been introduced in the national immunization programs of more than half of the Latin American countries, and impact data from some of these nations have been already published or reported. Among the most populated countries in Latin America, Brazil and Mexico have seen the most dramatic beneficial impact of universal rotavirus vaccination in terms of decreasing hospital admission rates, outpatient visits, severely dehydrated cases, and in particular, deaths [1]. Rotavirus surveillance networks in Central American and other Latin American

countries were crucial for determining the disease burden. Cost-effectiveness studies in these nations and the involvement of Latin American countries in clinical trials evaluating the safety, efficacy and immunogenicity of the currently available rotavirus vaccines were key factors in Latin America to introduce the vaccine at a faster rate compared with other pediatric vaccines [1–7]. Historically, at least one to two decades or even more has been the gap delay between developed and developing countries in introducing universal vaccines in the extended immunization programs. However, the story of rotavirus seemed different for Latin America. The two rotavirus vaccines, the twodose monovalent vaccine (RV1, Rotarix, GSK) and the three-dose pentavalent vaccine (RV5, RotaTeq, Merck), are available in the private market of all Central American countries. The vaccine has been universally introduced in the expanded immunization national programs of Guatemala, Honduras, El Salvador, Nicaragua and Panama, but not in Belize and Costa Rica. The first countries to introduce universal rotavirus vaccination were El Salvador (RV1), Nicaragua (RV5) and Panama (RV1) in

KEYWORDS: Central America • children • developing countries • Latin America • rotavirus • vaccination • vaccine introduction • vaccine preventable diseases

informahealthcare.com

10.1586/14760584.2014.905747

 2014 Informa UK Ltd

ISSN 1476-0584

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Expert Review of Vaccines Downloaded from informahealthcare.com by Clemson University on 06/03/14 For personal use only.

Editorial

Ulloa-Gutierrez & Avila-Aguero

2006, followed by Honduras (RV1) in 2009 and Guatemala (RV1) in 2010. The Ministry of Health of each country, the national immunization or advisory committees, the PanAmerican Health Organization Revolving Fund and the collaboration of public–private partnerships such as Global Alliance for Vaccines and Immunization rotavirus funding occurred in Nicaragua and Honduras [8], all have contributed to rotavirus vaccine introduction. In this editorial, we focus only on what has been published regarding the epidemiology and impact of universal rotavirus vaccination in Central America in those countries where it has been introduced. In El Salvador, rotavirus was associated with a large outbreak of diarrhea throughout the country in December 2000 and continued until late February 2001 [9]. The outbreak was associated with an increase in the number of hospitalizations and deaths due to acute gastroenteritis, particularly among children younger than 5 years of age. Estimates of disease burden revealed that rotavirus was responsible for 23,080 consultations in El Salvador in 2001 and that 1 in 7 children would require a consultation by the age of 5. It was estimated that 295 children in the country died due to rotavirus infection by the age of 5. This risk of death from rotavirus for a child 1 year (odds ratio: 0.70; 95% CI: 0.47–1.05). Effectiveness of the vaccine was twofold greater among the 6–11 months group compared with the >12 months group. Thus, the investigators demonstrated a good vaccine efficacy against rotavirus hospitalizations (»64%) and severe rotavirus disease (»70%) among infants younger than 12 months of age, and a nationwide decrease in hospital admissions due to diarrhea during the rotavirus seasons of 2007 through 2010. In Guatemala, diarrhea has been historically one of the most common causes of morbidity and death in children younger than 5 years of age. Therefore, the rotavirus vaccine was a priority for this country and RV1 was introduced in 2010 in a two-dose regimen. Prior to its introduction, in a study in which children

Rotavirus vaccination in Central American children.

Rotavirus is the leading cause of acute diarrhea in children younger than five years of age around the world. Severe dehydration and mortality rates a...
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