Clinical update: Rotavirus gastroenteritis and its prevention

The licensing of oral rotavirus vaccines in many countries has refocused attention on the epidemiology and disease burden of rotaviruses. Rotaviruses infect nearly all children by age 5 years, and are the most common cause of severe gastroenteritis during childhood. Every year, rotaviruses cause 114 million diarrhoea episodes, 2·4 million hospital admissions, and 600 000 deaths in children younger than 5 years worldwide. 98% of rotavirus-related deaths occur in developing countries, whereas in developed countries 220 000 children are admitted to hospital every year, and about one in 50 children are admitted to hospital by age 5 years. Rotavirus epidemics that arise every winter and spring coincide with peak activity of respiratory viruses and place extra demands on primary and hospital care. Rotavirus vaccines could reduce child mortality from all causes by 5% and admission to hospital for gastroenteritis by 40% or more worldwide. However, these reductions will take at least several years and will vary by setting. In the USA, where vaccine coverage is 90%, rotavirus vaccination should prevent about 80% of the 40 deaths and 60 000 rotavirus-associated hospital admissions annually. By contrast, modelling has found that 6000 deaths and 235 000 severe rotavirus episodes could be avoided annually in Nigeria. However, because of only 22% vaccine coverage in the Expanded Program on Immunisation (EPI), these figures are only 15% of the estimated disease burden. Therefore efforts to ensure that rotavirus vaccines are safe and efficacious must be matched by those making EPI vaccines available for all infants