Rotavirus vaccination in developing countries

Although two oral rotavirus vaccines are licensed in many countries, multiple factors may affect decision-making regarding introduction into national immunization programs in developing countries. Financial and logistic challenges to introduction of rotavirus vaccines in countries with limited infrastructure and resources are accompanied by a perceived lack of need and evidence from recent vaccine trials, which demonstrated significantly lower efficacy in high burden countries. Nonetheless, even at a low efficacy, the use of existing vaccines in developing countries is predicted to alleviate considerable rotavirus disease burden and mortality. Potential alternate strategies for improving response to existing vaccines or the development of improved vaccines need to be considered to ensure that the remaining burden of mortality and morbidity can be addressed in the future.

► Developing countries have very high rotavirus disease burden. ► Oral rotavirus vaccine trials from Africa and South Asia show low efficacy. ► Decrease in total number of rotavirus episodes after vaccination is greater in poor countries because of higher initial burden of disease. ► Many biological, logistic and financial challenges exist against wider vaccine introduction. ► Strategies for existing vaccine use and new vaccine development need consideration.