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Rota Vaccines in review
(Developments last 6 Months)
Dr.Sanjay Srirampur
[email protected]
5/24/2017
IAPCOI - DEC 2011
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Rota Vaccines in review
(Developments last 6 Months)
Agenda
1. Real World Impact of Vaccine
2. Efficacy of Vaccine
3. Indirect Effects
4. Intussusception Increased incidence?
5. Strain Replacement
6. Epidemiology Update 2011
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Real World Impact of Vaccine
Effectiveness
Impact Studies
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Efficacy Studies
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Indirect Effect
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Safety of Rota Vaccines
Intussusception
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Post Marketing surveillance
•Increased incidence of intussusception
•After the first dose and within one week
•Risk substantially less than RRV
•Mexico
•Brazil
•Australia
•U.S.A
•Benefit outweighs the risk
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Summary Recommendations
•Evidence that small increase in rate of intussusception
•Risk substantially less than that of RRV
•In Africa and Asia studies regarding safety are wanting
•In Africa and Asia data on Intussusception is wanting
•Safety studies should run parallel to the introduction of vaccine
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Contraindications
1. Severe allergic reaction to a previous dose
2. Infants diagnosed with SCID
3. Infants with a H/O Intussusception
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Strain Replacement
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The Pediatric Infectious Disease Journal •
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Volume 30, Number 1, January 2011
IAPCOI - DEC 2011
Conclusions:
Our data demonstrate the reemergence of RV-A genotype
G2P4 in Brazil from 2005 to 2008, and that the rate of G2P4 detection
decreased in 2009, probably reflecting natural oscillations of RV-A genotypes
The Pediatric Infectious Disease Journal •
Volume 30, Number 1, January 2011
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Epidemiology Update - 2011
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2008 estimate of worldwide rotavirus-associated mortality
in children younger than 5 years before the introduction of
universal rotavirus vaccination programmes: a systematic
review and meta-analysis
Jacqueline E Tate, Anthony H Burton, Cynthia Boschi-Pinto, A Duncan Steele, Jazmin
Duque, Umesh D Parashar, and the WHO-coordinated Global
Rotavirus Surveillance Network*
Findings Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453 000
deaths (95% CI 420 000–494 000) in children younger than 5 years—37% of deaths attributable
to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted
for more than half of all deaths attributable to rotavirus
infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone
accounted for 22% of deaths (98 621 deaths).
wwwlancet online: Published
Oct 25, 2011
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Indian Rotavirus Surveillance Network
(IRSN)
• 10 representative
hospitals in 7 cities.
• 4 testing laboratories.
• Technical co-ordination
by Indian Council for Medical
Research (ICMR) & US
Centers for Disease Control
and Prevention (US CDC).
• Surveillance results available
from Dec 2005-Nov 2007 for
children aged <5 years who
presented with acute
gastroenteritis and required
hospitalization with
rehydration for at least 6 hr.
IAPCOI
- DEC 2011
Adapted 5/24/2017
from: Gagandeep Kang et al, Multicenter, Hospital-Based Surveillance
of Rotavirus
Disease and Strains among Indian Children Aged <5
Years, JID 2009; 200:S147–53.
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Projected impact and cost-effectiveness of a
rotavirus vaccination program in India, 2008.
Eposito et al
RESULTS:
With use of a vaccine that has an estimated effectiveness of 50%, a rotavirus vaccination
program in India would prevent ~44,000 deaths, ~293,000 hospitalizations, and ~328,000
outpatient visits annually, which would avert $20.6 million in medical treatment costs.
Vaccination would be cost-saving at the GAVI Alliance price of $0.15 per dose. At $1.00 per
dose, a vaccination program would cost $49.8 million, which would result in an expenditure
of $21.41 per DALY averted or $662.94 per life saved. Even at $7.00 per dose, vaccination
would be highly cost-effective. In sensitivity analyses, varying efficacy against severe
rotavirus disease and vaccine price had the greatest impact on cost-effectiveness.
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Clin Inf Dis: 2011 Jan 15;52(2):171-7.
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Rota Vaccines in review
(Developments last 6 Months)
Agenda
1. Real World Impact of Vaccine
2. Efficacy of Vaccine
3. Indirect Effects
4. Intussusception Increased incidence?
5. Strain Replacement
6. Epidemiology Update 2011
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Thank You
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