Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Before initiation of the rotavirus vaccination program in the United States in 2006, approximately 80% of U.S. children had rotavirus gastroenteritis by age 5 years. Each year during the 1990s and early 2000s, rotavirus resulted in approximately 410,000 physician visits, 205,000272,000 emergency department visits, and 55,00070,000 hospitalizations among U.S. infants and children, with total annual direct and indirect costs of approximately $1 billion. In February 2006, a live, oral, human-bovine reassortant rotavirus vaccine (RotaTeq(R) [RV5]) was licensed as a 3-dose series for use among U.S. infants for the prevention of rotavirus gastroenteritis, and the Advisory Committee on Immunization Practices (ACIP) recommended routine use of RV5 among U.S. infants (CDC. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-12]). In April 2008, a live, oral, human attenuated rotavirus vaccine (Rotarix(R) [RV1]) was licensed as a 2-dose series for use among U.S. infants, and in June 2008, ACIP updated its rotavirus vaccine recommendations to include use of RV1. This report updates and replaces the 2006 ACIP statement for prevention of rotavirus gastroenteritis. ACIP recommends routine vaccination of U.S. infants with rotavirus vaccine. RV5 and RV1 differ in composition and schedule of administration. RV5 is to be administered orally in a 3-dose series, with doses administered at ages 2, 4, and 6 months. RV1 is to be administered orally in a 2-dose series, with doses administered at ages 2 and 4 months. ACIP does not express a preference for either RV5 or RV1. The recommendations in this report also address the maximum ages for doses, contraindications, precautions, and special situations for the administration of rotavirus vaccine.

Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC) : Prevention of rotavirus gastroenteritis among infants and children. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Strategies intended to address vaccine hesitancy: Review of published reviews.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673606688156.pdf

Rotavirus vaccines: current prospects and future challenges

Neonates have an immature immune system which cannot adequately protect against infectious diseases. Early in life, immune protection is accomplished by maternal antibodies transferred from mother to offspring. However, decaying maternal antibodies inhibit vaccination as is examplified by the inhibition of seroconversion after measles vaccination. This phenomenon has been described in both human and veterinary medicine and is independent of the type of vaccine being used. This review will discuss the use of animal models for vaccine research. I will review clinical solutions for inhibition of vaccination by maternal antibodies, and the testing and development of potentially effective vaccines. These are based on new mechanistic insight about the inhibitory mechanism of maternal antibodies. Maternal antibodies inhibit the generation of antibodies whereas the T cell response is usually unaffected. B cell inhibition is mediated through a cross-link between B-cell receptor (BCR) with the Fcg receptor IIB (FcgRIIB) by a vaccine-antibody complex. In animal experiments, this inhibition can be partially overcome by injection of a vaccine-specific monoclonal IgM antibody. IgM stimulates the B-cell directly through cross-linking the BCR via complement protein C3d and antigen to the complement receptor 2 (CR2) signaling complex. In addition, it was shown that interferon alpha binds to the CD21 chain of CR2 as well as the interferon receptor and that this dual receptor usage drives B cell responses in the presence of maternal antibodies. In lieu of immunizing the infant the concept of maternal immunization as a strategy to protect neonates has been proposed. This approach would still not solve the question of how to immunize in the presence of maternal antibodies but would defer the time of infection to an age where infection might not have such a detrimental outcome as in neonates. I will review successful examples and potential challenges of implementing this concept.

Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies.

Trial of an attenuated bovine rotavirus vaccine (rit 4237) in gambian infants

Trial of high-dose edmonston-zagreb measles vaccine in the gambia: antibody response and side-effects

Methodological issues concerning the collection and analysis of daily morbidity data in community studies in developing countries are discussed. The effects of recall period and inter-observer variation on symptom prevalence are considered in the context of a longitudinal study in The Gambia in which prevalence fell by about half over 1-weeks recall. In the same study many infant-days were recorded separately on two occasions allowing an assessment of reliability in this type of morbidity diary data. The implications of these findings both in terms of data quality and cost-effectiveness are discussed with the conclusion that weekly interviews examining the previous weeks morbidity on a day-by-day basis are operationally optimal. (authors)

Daily Morbidity Records: Recall and Reliability

Short, well demarcated epidemics of rotavirus diarrhoea were observed during two consecutive cool, dry seasons in The Gambia. This seasonal pattern has now been documented for 4 consecutive years. ...

Epidemiology of rotavirus in a periurban Gambian community.

SUMMARYTo investigate the hypothesis that rotavirus infection in young children can trigger chronic diarrhoeal disease, a group of cases from a documented epidemic of rotavirus and a group of matched controls were followed for a 1-year period after infection. No evidence of excess chronic diarrhoea or vomiting in the group known to have been infected with rotavirus was found.

Follow-up of Gambian children for a 1-year period after rotavirus infection.

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