HEALTH: Rotavirus Vaccine Making Headway in Africa
Marguerite A. Suozzi
NEW YORK, Jan 27 2010 (IPS) – New vaccination programmes against rotavirus are starting to have a positive impact, and could eventually prevent hundreds of thousands of child deaths a year, according to a new report.
It is not widely known that pneumonia and diarrhoea are the two biggest child-killers globally, or that we now have new vaccines against the leading causes of both these disease, said Dr. Mickey Chopra, chief of health and associate director of programmes at the U.N. children s agency (UNICEF).
On Wednesday, the New England Journal of Medicine published a report on the positive effects of rotavirus vaccinations in Africa and Mexico.
Rotavirus is the most important cause of severe gastroenteritis among children worldwide, according to the report, and is largely a result of the unavailability of clean drinking water and adequate sanitation systems.
While prevention remains the best protection from infant mortality due to rotavirus infection, the report found that, Human rotavirus vaccine significantly reduced the incidence of severe rotavirus gastroenteritis among African infants during the first year of life, in Malawi and South Africa.
The report noted that African nations are disproportionately affected by rotavirus infection. According to World Health Organisation (WHO) estimates, 527,000 children die annually from rotavirus infection and 230,000 of these deaths occur in sub-Saharan Africa.
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The report also found that of the seven countries with the highest infant mortality rate due to rotavirus diarrhea, six are in Africa.
In the case of Mexico, researchers concluded that, After the introduction of a rotavirus vaccine, a significant decline in diarrhea-related deaths among Mexican children was observed, suggesting a potential benefit from rotavirus vaccination. Dr. Mathuram Santosham, a professor of International Health and Pediatrics at Johns Hopkins University in Baltimore, is optimistic about the additional benefits of vaccination.
Although not evaluated in the studies in this issue of the Journal, herd immunity has been shown to be induced by rotavirus vaccines (as an indirect effect) by reducing the exposure of unvaccinated persons to the organism, said Santoshum, in an editorial published in conjunction with the reports.
Thus, introduction of the vaccine into countries is likely to have a greater effect than that predicted on the basis of the efficacy trials, he said.
But while public health officials praise the rotavirus vaccination s potential to combat child mortality and improve children s health in Africa and Mexico, leading the World Health Organisation (WHO) to advocate for the inclusion of rotavirus vaccinations in every nation s immunisation programme, the successful implementation of this recommendation presents a real and serious challenge in poor and middle-income countries.
The storage and shipment requirements to avert cold-chain breaks of rotavirus vaccines are far greater than those of typical childhood vaccines, which will make the logistics of vaccination programmes in developing countries more difficult, said Santosham.
Another challenge, according to Santosham, is the short window recommended for administering the vaccination.
This recommendation is a serious impediment to the widespread use of rotavirus vaccines, especially in countries with the highest child mortality, which tend to have the lowest vaccine coverage and the lowest rate of on-time immunisation, he said.
Finally, the cost of immunisation is considerable for those living in poor and middle-income countries. The GAVI Alliance, created 10 years ago with the help of the Bill and Melinda Gates Foundation, is working to lessen the financial burden of immunisation by providing grants to poor countries that need vaccine coverage.
Vaccines are a miracle because with three doses, mostly given in the first two years of life, you can prevent deadly diseases for an entire lifetime, said Bill Gates in his second annual letter on behalf of the Gates Foundation.
Because the impact is so incredible, vaccines are the foundation s biggest area of investment more than 800 million dollars every year and the return is substantial, Gates said, focusing on the importance of innovative thinking in combating the world s most pressing problems, and improving the human condition.
Gates also cited the urgency of finding affordable and effective vaccinations to prevent disease, particularly in poor countries, and asserted the foundation s commitment to creating and distributing these vaccines in high-need areas.
Rotavirus vaccine could save 225,000 to 325,000 lives per year, and pneumococcal vaccine could save 265,000 to 400,000 lives per year, he said, adding that in the next five years, the Gates Foundation hopes to provide the rotavirus vaccine to over half the children who need it.