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BMC Public Health. 2011 Apr 13;11 Suppl 3:S16. doi: 10.1186/1471-2458-11-S3-S16.

Rotavirus vaccine and diarrhea mortality: quantifying regional variation in effect size.

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  • 1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cfischer@jhsph.edu

Abstract

BACKGROUND:

Diarrhea mortality remains a leading cause of child death and rotavirus vaccine an effective tool for preventing severe rotavirus diarrhea. New data suggest vaccine efficacy may vary by region.

METHODS:

We reviewed published vaccine efficacy trials to estimate a regional-specific effect of vaccine efficacy on severe rotavirus diarrhea and hospitalizations. We assessed the quality of evidence using a standard protocol and conducted meta-analyses where more than 1 data point was available.

RESULTS:

Rotavirus vaccine prevented severe rotavirus episodes in all regions; 81% of episodes in Latin America, 42.7% of episodes in high-mortality Asia, 50% of episodes in sub-Saharan Africa, 88% of episodes low-mortality Asia and North Africa, and 91% of episodes in developed countries. The effect sizes observed for preventing severe rotavirus diarrhea will be used in LiST as the effect size for rotavirus vaccine on rotavirus-specific diarrhea mortality.

CONCLUSIONS:

Vaccine trials have not measured the effect of vaccine on diarrhea mortality. The overall quality of the evidence and consistency observed across studies suggests that estimating mortality based on a severe morbidity reduction is highly plausible.

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