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Review
. 2018 Feb;17(2):145-161.
doi: 10.1080/14760584.2018.1418665. Epub 2017 Dec 29.

Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors

Daniel E Velasquez  1 , Umesh Parashar  1 , Baoming Jiang  1
Affiliations
Review

Decreased performance of live attenuated, oral rotavirus vaccines in low-income settings: causes and contributing factors

Daniel E Velasquez et al. Expert Rev Vaccines. 2018 Feb.

Abstract

Introduction: Numerous studies have shown that the oral rotavirus vaccines are less effective in infants born in low income countries compared to those born in developed countries. Identifying the specific factors in developing countries that decrease and/or compromise the protection that rotavirus vaccines offer, could lead to a path for designing new strategies for the vaccines' improvement.

Areas covered: We accessed PubMed to identify rotavirus vaccine performance studies (i.e., efficacy, effectiveness and immunogenicity) and correlated performance with several risk factors. Here, we review the factors that might contribute to the low vaccine efficacy, including passive transfer of maternal rotavirus antibodies, rotavirus seasonality, oral polio vaccine (OPV) administered concurrently, microbiome composition and concomitant enteric pathogens, malnutrition, environmental enteropathy, HIV, and histo blood group antigens.

Expert commentary: We highlight two major factors that compromise rotavirus vaccines' efficacy: the passive transfer of rotavirus IgG antibodies to infants and the co-administration of rotavirus vaccines with OPV. We also identify other potential risk factors that require further research because the data about their interference with the efficacy of rotavirus vaccines are inconclusive and at times conflicting.

Keywords: Rotavirus; efficacy; immunogenicity; review; vaccines.

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Conflict of interest statement

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Figures

Figure 1.
Figure 1.. Rotavirus vaccines IgA seroconversion by season of their first dose (a) and rotavirus vaccine effectiveness in the first year of life by season of birth (b).
Abbreviations: SC: seroconversion, RV1: Rotarix, RV5: Rotateq * statistically significant at p < 0.1; 1[56,57,74]; 2[75-78]; 3against RVGE; € World Bank list of economies (December 2016) low-income (L); lower middle-income (LM); upper middle-income (UM); high-income (H).
Figure 2.
Figure 2.. Rotateq efficacy by age at first dose.
Abbreviations: SC: seroconversion, RV5: Rotateq; †Statistically significant (p < 0.05); *Statistically significant at p < 0.1; 1against RVGE; 2[49].
Figure 3.
Figure 3.. Rotarix IgA seroconversion by number of doses and schedules1.
Abbreviations: SC: seroconversion, RV1: Rotarix; †Statistically significant (p < 0.05); 1[31,32,90-93]; € World Bank list of economies (December 2016) low-income (L); lower middle-income (LM); upper middle-income (UM); high-income (H).
Figure 4.
Figure 4.. Rotavirus vaccine IgA seroconversion with and without OPV concurrently.
Abbreviations: SC: seroconversion, RV1: Rotarix, RV5: Rotateq † Statistically significant (p < 0.05); 1[75,106-113]; 22 doses at 6 and 10 weeks of age; 32 doses at 10 and 14 weeks of age; € World Bank list of economies (December 2016) low-income (L); lower middle-income (LM); upper middle-income (UM); high-income (H).
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