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HEALTH: WHO Urges Universal Rotavirus Vaccine

Marina Litvinsky

WASHINGTON, Jun 5 2009 (IPS) - The World Health Organisation (WHO) urged Friday that rotavirus vaccines be included in routine immunisation schedules of countries around the world in order to provide global protection against the most common and lethal form of diarrheal disease.

The rotavirus is responsible for more than 500,000 diarrheal deaths and two million hospitalisations annually among children. More than 85 percent of these deaths occur in developing countries in Africa and Asia.

This new policy will help ensure access to rotavirus vaccines in the world’s poorest countries.

“This is a tremendous milestone in ensuring that vaccines against the most common cause of lethal diarrhea reach the children who need them most,” noted Dr. Thomas Cherian, coordinator of the Expanded Programme on Immunisation at the WHO Department of Immunisation, Vaccines, and Biologicals.

The new recommendation by the WHO’s Strategic Advisory Group of Experts (SAGE) extends a 2005 approval of two rotavirus vaccines in the Americas and Europe, where clinical trials had demonstrated safety and efficacy in low and intermediate mortality populations.

As oral vaccines can have variable efficacy in different populations, new clinical trials were conducted in Africa and Asia, where more than 85 percent of rotavirus deaths occur, in order to test the efficacy of the vaccine in countries with high child mortality. The data from these trials led to the recommendation for global use of the vaccine.

Because there are many causes of diarrheal disease, SAGE emphasized the importance of providing rotavirus vaccination in the context of a comprehensive diarrheal disease control strategy, including improvement of water quality, hygiene, and sanitation; provision of oral rehydration solution and zinc supplements; and overall improved case management.

“The new evidence and the WHO recommendation are major breakthroughs for the health of our children,” said Dr. Oyewale Tomori, vice chancellor of Redeemer’s University, Nigeria, who has served as regional laboratory coordinator for the World Health Organisation (Africa Region).

“Too many of our children are dying from rotavirus and other causes of diarrhea. We urgently need these lifesaving vaccines against rotavirus,” he said.

Incidence rates of rotavirus are nearly the same worldwide, regardless of water quality, hygiene or socioeconomic conditions. It is transmitted through the fecal-oral route and often occurs through contact with contaminated water, food, or objects such as a child’s toy or bottle.

Rotavirus is highly contagious. Symptoms include severe diarrhea, vomiting, and fever, lasting from three to eight days. Rotavirus infection can often lead to dehydration due to loss of fluids and electrolytes. Untreated, the severe dehydration can lead to shock, cardiac arrhythmia, and death.

Children under the age of two are most at risk of severe rotavirus infection. Each year, rotavirus is responsible for more than 500,000 deaths and two million hospitalisations among children. While around 70 deaths each year are attributed to rotavirus in industrialised nations, nearly 1,400 children die from rotavirus each day in the developing world.

“I have done extensive research focusing on maternal and child health policy for many years. Even with the advances we have made in recent decades, children around the world are still dying each day from preventable and treatable illnesses like pneumonia and diarrheal diseases such as rotavirus infections,” said Zulfiqar Bhutta, professor and head of the division of maternal and child health at the Aga Khan University and SAGE member.

“Vaccines are a critical component in our work to protect children from this deadly diarrheal disease. We need to ensure rotavirus vaccines are available to children everywhere. The need is especially great in developing nations in Africa and Asia where the vast majority of rotavirus associated deaths occur,” Bhutta said.

The WHO, PATH, a nonprofit organisation, and the U.S. Centres for Disease Control and Prevention joined to establish the Rotavirus Vaccine Programme in 2003, with support from the GAVI Alliance.

The partnership set out to accelerate the availability of rotavirus vaccines in the developing world by conducting clinical trials, gathering disease burden data through routine surveillance, forecasting demand, conducting advocacy, and disseminating a solid evidence base to inform policymakers considering rotavirus vaccine introduction.

Vaccination provides the best means of protection from rotavirus. In 2006, the GAVI Alliance added rotavirus vaccines to its portfolio of vaccines for which it provides financial support to developing countries, underscoring GAVI’s commitment to reduce the traditional 15- to 20-year lag between the introduction of new vaccines in wealthy countries and their availability in the developing world.

“The GAVI Alliance welcomes this exciting recommendation,” said GAVI CEO Dr. Julian Lob-Levyt. “It represents another important step in our ability to achieve significant impact on under-five deaths in the world’s poorest communities and make progress towards the Millennium Development Goals.”

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