Removing rotavirus vaccine age restrictions could save lives

By Helen Albert, Senior medwireNews Reporter

Removing or relaxing the current rotavirus vaccine age restrictions would help save children's lives, especially in low- and middle-income countries, say researchers.

The current restrictions only allow children to start the vaccine before the age of 15 weeks and complete all doses before 32 weeks of age, due to an assumed increased risk for intussusception in older children given the vaccine based on previous data.

However, Manish Patel (Centers for Disease Control and Prevention, Atlanta, Georgia, USA) and colleagues argue that the risks for intussusception are very small compared with the huge potential benefits of vaccinating children outside the current age ranges in low- and middle-income countries.

Patel and team carried out a modeling study, using data from the World Health Organization and various research papers and reviews, to estimate the pros and cons of a vaccination strategy in which the rotavirus vaccine is given with the diphtheria, tetanus, and polio vaccine up to the age of 3 years, compared with the current restricted vaccination strategy.

As reported in PLoS Medicine, they estimated that application of a restricted vaccination schedule in low- and middle-income countries would prevent 155,800 rotavirus deaths and potentially cause up to 253 intussusception deaths. The unrestricted strategy, however, would vaccinate 21-25% more children and prevent 203,000 rotavirus deaths while causing approximately 547 intussusception deaths.

This translates to a potential 154 deaths from rotavirus that could be averted for every intussusception death caused by the vaccine using the unrestricted schedule, say Patel and co-workers.

"Importantly, these estimates err on the side of safety in that they assume high vaccine-associated risk of intussusception and do not account for potential herd immunity or non-fatal outcomes," note the authors.

"Our analysis suggests that in low- and middle-income countries the additional lives saved by removing age restrictions for rotavirus vaccination would far outnumber the potential excess vaccine-associated intussusception deaths," they conclude.

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