News Release

There are still 453,000 deaths per year due to rotavirus-related diarrhea

Peer-Reviewed Publication

The Lancet_DELETED

New research published Online First in The Lancet Infectious Diseases shows there are still 453,000 deaths due to rotavirus-related diarrhoea, despite availability of a vaccine. To date, most countries that have implemented rotavirus vaccination are those with low diarrhoea-related and overall child mortality. Introduction of effective and available rotavirus vaccines in other countries, mostly middle-income or poorer, could substantially reduce worldwide deaths attributable to diarrhoea.

In this new study, Dr Jacqueline E Tate and Dr Umesh D Parashar, Centers for Disease Control and Prevention, Atlanta, GA, USA, and colleagues did a systematic review and meta-analysis of studies with at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. They also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network. Studies were classified into one of five groups on the basis of region and the level of child mortality in the country in which the study was done.

Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453 000 deaths in children younger than 5 years—37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan. India alone accounted for 22% of worldwide deaths attributable to rotavirus infection (98 621 deaths).

Some 420 000 (93%) of the total deaths were clustered in the poor countries of Asia and Africa, including those mentioned in India above. Less than 0.5% of the deaths (<1000) occurred in the world's high-income nations, many of which have adopted universal rotavirus vaccination (URVV) programmes, and already had low virus-related mortality.

The authors note their estimate of deaths due to rotavirus-related diarrhoea in 2008 is somewhat lower than the previous estimate of 527 000 deaths in 2004, saying the difference is largely because of an overall decrease in diarrhoea-related deaths in children younger than 5 years from 1•8 million in 2003 to 1•2 million in 2008. They add: "However, we do not know what proportion of this decrease is due to a true decline in diarrhoea-related mortality and what proportion is due to a change in the methods used to estimate the number of diarrhoea-related deaths."

The authors say that introduction of rotavirus vaccine in developing countries will probably have a substantial effect on worldwide rotavirus-related mortality because of the large number of diarrhoea-related deaths caused by rotavirus infection in developing countries. They conclude: "GAVI cofinancing of vaccine introduction will play a key part in the reduction of mortality due to diarrhoea associated with rotavirus infection, because 95% of rotavirus-related deaths are in countries that are eligible for GAVI support. As more countries introduce rotavirus vaccine into their national immunisation programmes, continued surveillance is crucial to update estimates of rotavirus-related mortality, including the age distribution of these deaths, and to measure the effect of vaccines and possible changes in the diversity of co-circulating rotaviruses."

In a linked Comment, Dr Ulrich Desselberger, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK, points out that the introduction of URVV programmes in various countries since 2006 (Australia, Belgium, Brazil, El Salvador, Finland, Mexico, Panama, USA, and others) has resulted in substantial reductions in admission to hospital for rotavirus-associated acute gastroenteritis and also to the flattening and delay of seasonal epidemiological curves. He also points out that the vaccine was less efficacious in Asian and African countries, but concludes: "It is probable that URVV programmes will result in a decrease in deaths associated with rotavirus disease, and the collated data are eagerly awaited."

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For Dr Jacqueline E Tate and Dr Umesh D Parashar Centers for Disease Control and Prevention, Atlanta, GA, USA, please contact CDC press office. T) +1 404 639-3286 E) media@cdc.gov

Dr Ulrich Desselberger, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK. T) +44 (0) 1223 763403 E) ud207@medschl.cam.ac.uk


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