Rotavirus Vaccines : Anti-rotavirus antibodies,WHO Stands,IAPCOI Recommendations

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Immunization and Vaccination

Rota virus vaccine

Immunization and Vaccination

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Results

ROTA VIRUS VACCINE

Javed Ahmed
Pediatric Intensivist, Nanavati Hospital, Mumbai

Q. Is there any Indian data on efficacy of rotavirus vaccine?
A. A placebo controlled monovalent rotavirus efficacy study done in India and serum anti-rotavirus IgA antibody were estimated Seroconversion rates were 58.3% (95% CI 48.7-67.4) in vaccinees and 6.3% (95% CI 2.5-12.5) in placebo. Seroconversion rates in the vaccinees were similar to that seen in Latin America study vaccinees which had shown 86% efficacy of the vaccine. (5)

Q. Are anti-rotavirus antibodies suggestive of protection?
A. Immunity against rotavirus is complex and involve both B cell (antibody mediated major) and T cell mediated (minor). It has been shown that serum anti IgA correlate maximum with protection but in absence of IgA, serum IgG is also protective. (13,14). Immunity is mucosal (local) as well as systemic. CD4+ T cell are also help in clearing the virus infections by helping proper induction of B cell response.

Q. Do the current rotavirus vaccines protect against rotaviral diarrhea in India? Are the strains protective against Indian strains?
A. Yes rotavirus strain are same in India as abroad and vaccine is also protective against rotavirus diarrhea in India (5), though protection is a bit lower than western world due to high diarrheal burden in India

Q. What is World Health Organization (WHO) stands on rotavirus vaccination?
A. Because of rotavirus vaccine efficacy and safety WHO has recommended rotavirus vaccine to be included in national immunization programme. Strategic Advisory Group of Experts (SAGE) also recommends that in countries where diarrheal death accounts for > 10% of mortality among children aged < 5 year, rotavirus vaccine should be introduced.

Q. What is Indian Academy of Pediatrics Committee on Immunization (IAPCOI) recommendation on rotavirus vaccination?
A. IAP has acknowledged the effectiveness of the vaccine and included it in routine immunization, and suggested that it should be included in national immunization programme.

Q. Which are newer rotavirus vaccines under development?
A. There are two vaccines: neonatal rotavirus strains i.e. 116E: G9P8(11) human-bovine serotype from Delhi which is commonly found in neonatal nurseries in India and I321: G10P8(11) bovine-human type from Bangalore. It need further efficacy trial before general recommendation.

References:

Parashar UD, Hummelman EG, Bresse JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Em Infect Dis, 2003; 9:565-571.
UNICEF. 2008 State of the World's Children Report. http:// www. unicef. Org/ sowc08/ full report /full_report.php. Accessed on 25th December 2009.
Burden of diarrhea in india estimation of burden of diarrheal disease in india. National Institute of cholera and enteric diseases Kolkata. http://www.whoindia.org/LinkFiles/Commision_on_Macroeconomic_and_
Health_Bg_P2_Estimation_of_the_burden_of_diarrhoeal_diseases_in_India.
pdf
Yewale V, Choudhury P, Thacker N. IAP guidebook on immunization year 2009-2011. Indian Academy of Pediatrics. Mumbai. 2011
Shah NK. Rotavirus vaccine - What are the concerns of the developing countries? Journal of Pediatric Sciences. 2010; 5: e50.
Yachha SK, Singh. V, Kanwar S ,Mehta S. Epidemiology , subgroups and serotypes of Rotavirus diarrhea in north Indian communities. Indian pediatric 1994; 31:27-33.
Zaman K, Sack DA, Yunus M, et al. Immunogenicity of an oral polio vaccine is unaffected when co-administered with a human rotavirus vaccine in Bangladeshi children. Proc 5th World Congr Pediatr Infect Dis (WSPID) 2007.
Schuster V, Vesikari T, Karvonen A et al. Breastfeeding does not influence the efficacy of Rotarix^TM. Paper presented at 25th International Congress of Pediatrics (ICP) 2007, Athens, Greece PP0990
Peres-Sachel I, Salinas B, Tomat M, et al. Efficacy of Human Rotavirus Vaccine RIX4414 in malnourished children. J Infect Dis 2007;196:537-40.
Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, Abate H, Breuer T, Clemens SC et al. Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis. N Engl J Med 2006; 354:11-22.
Linhares AC, Velazquez FR, Pérez-Schael I, Llorens XS, Abate H, Espinoza S et al. Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomized, double blind, placebo controlled phase III study. Lancet, 2008; 371:1181-1189.
Vesikari T, Matson D, Dennehy P, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med 2006; 354: 23-33
Velazquez, F.R., et al., Serum antibody as a marker of protection against natural rotavirus infection and disease. J Infect Dis, 2000. 182(6): 1602-1609
O'Neal, C.M., G.R. Harriman, and M.E. Conner, Protection of the villus epithelial cells of the small intestine from rotavirus infection does not require immunoglobulin A. J Virol, 2000. 74(9): 4102-4109