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. How have rotavirus vaccines worked in developing countries in Latin America? Brendan Flannery, Pan American Health Organization, Brazil and Lúcia De Oliveira, Immunization Unit/FCH, Washington, DC 9th International Rotavirus Symposium, Johannesburg, South Africa, August 2-3, 2010 How have rotavirus vaccines worked in developing countries in the Americas Political support Rotavirus surveillance network Disease burden and cost effectiveness Vaccine introduction Impact of vaccination Special studies Lessons learned Political support Pan American Health Organization’s (PAHO) Regional Immunization Program Reduce inequities in health between resourcewealth and resource poor countries Political commitment, technical, operational and financial support Providing new and underutilized vaccines to the children and families who need them Resolution by Ministers of Health, PAHO Directing Council meeting in 2006 Support WHO’s Global Immunization Vision and Strategy and the Millennium Development Goals Resolve to mobilize additional funding to sustainably introduce new vaccines against rotavirus, pneumococcal and human papillomavirus Of 20 countries with highest under 5 mortality, 13 have introduced rotavirus vaccines Latin American countries on track to meet MDG4 Financing immunization programs National support for EPI: 93% is financed by governments Vaccine price, PAHO’s Revolving Fund, 2009: Rotarix: US$ 7.50 /dose, $15 /child RotaTeq: US$ 5.50 /dose, $16.5 /child Rotavirus vaccine represents 97.3% of the cost of the basic immunization schedule of countries (OPV, DPT, Hib, HepB, MMR) GAVI countries: Bolivia and Honduras approved by GAVI, Guyana financed on its own Rotavirus surveillance network PAHO Guidelines • Field guide “Epidemiologic surveillance of Diarrheal diseases due to rotavirus” • Field guide on “Introduction of New Vaccines” based on WHO Guidelines Countries participating in rotavirus surveillance network Percent rotavirus-positive samples from children <5 hospitalized for diarrhea in participating countries, 2006-2007 De Oliveira, Rotavirus Surveillance in Latin American and Caribbean, JID 2009 Seasonality of hospitalizations for rotavirus in participating countries, 2006–2007 Northern hemisphere Southern hemisphere De Oliveira, Rotavirus Surveillance in Latin American and Caribbean, JID 2009 Disease burden and cost effectiveness Causes of death among children <5 years in the Americas, 2008 Black et al., Lancet, 12 May 2010 Estimates of rotavirus disease burden in the Region of the Americas 15,000 deaths 75,000 hospitalizations 2 million clinic visits 10 million cases of rotavirus diarrhea Source: De Oliveira, Expert Rev. Vaccines, 2008 Cost-effectiveness Introduction of new vaccines needs to be grounded in evidence that they are cost effective: PRO-VAC: 5 years strategic plan to strengthen national capacity to make evidence-based decisions for new vaccines http://new.paho.org/provac/ Vaccine introduction Rotavirus vaccine introduction Latin American countries : first countries to introduce rotavirus vaccine in public health sector: March 2006 in Panama As of May 2010, 14 countries and one territory had introduced rotavirus vaccine: 13 - Rotarix (GSK) 2 - RotaTeq (Merck) 16 10000 14 9000 8000 12 7000 10 6000 8 5000 6 4000 3000 4 2000 2 1000 0 0 2006 2007 2008 2009 2010 Children <1 year (thousands) Number of countries Introduction of rotavirus vaccines in Latin America, 2006-2010 Countries and total population <1 year Latin America and Caribbean countries with rotavirus vaccines into their routine schedules Age in weeks at vaccination, Nicaragua and Brazil RotaTeq, Nicaragua Dose 1 Rotarix, Brazil Dose 2 Dose 3 Comparison of first dose coverage for RotaTeq vs. DPTDPT-HepBHepB-Hib Hib,, Nicaragua, 2007 (RotaTeq introduced October 2006) Orozco et al., Uptake of rotavirus vaccine, Nicaragua, JID 2009 Rotavirus and DPT coverage for 8 Latin American countries, 2009 100 90 % coverage 80 70 60 50 40 30 20 10 0 Source: Country reports RV2/3 DTP3 Impact of vaccination Diarrhea and rotavirus related admissions among children <5 years at seven hospitals, El Salvador, January to June,* 2006-2009 ERROR: stackunderflow OFFENDING COMMAND: ~ STACK:
