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[KISUMU, KENYA] Rotavirus vaccination can reduce the risk of infants dying from diarrhoea by almost a third, according to a large trial in Malawi.

The findings add to evidence that child mortality can be cut if more African countries roll out the vaccine.

Globally, diarrhoea causes 1 per cent of deaths in children over four weeks of age, according to the team of researchers from Malawi, the United Kingdom and the United States.

“Countries that haven’t introduced this vaccine should introduce it and countries that have introduced it should redouble their efforts,”

Naor Bar-Zeev

Rotavirus infections are a major cause of death from diarrhoea among infants and young children, especially in low-income areas Africa and Asia — but large studies were needed to estimate the protective effect of vaccination in low-income areas.

Malawi introduced the monovalent rotavirus vaccine in October 2012, reducing deaths from infant diarrhoea by 31 per cent in Mchinji, a rural part of the country known for high levels of child deaths, according to the study published in the September edition of Lancet Global Health.

“Countries that haven’t introduced this vaccine should introduce it and countries that have introduced it should redouble their efforts to make sure the vaccine reaches children in all provinces, especially in hard to reach places,” says Naor Bar-Zeev, study co-author and associate professor in the international health department of thet US-based Johns Hopkins Bloomberg School of Public Health.

“If a country has a vaccine coverage rate of 65 per cent it is still worth their effort to make that coverage 85 or 90 per cent,” Bar-Zeev tells SciDev.Net.

The researchers followed all 48,682 infants born between January 2012 and June 2015 in Mchinji, in central Malawi. They then analysed data on the children who survived to age ten weeks.

They determined vaccination status for each child through records that were either held by caregivers or reported through home visits between four months and a year after birth. Through home visits, they also confirmed survival or cause of death.

According to Bar-Zeev, rotravirus typically infects children in the first or second year of life, often leading to vomiting and diarrhoea that could cause profound dehydration that can lead to death.
Map illustrating countries that have introduced rotavirus vaccine and those that have not yet introduced itMap of map illustrating countries that have introduced rotavirus vaccine and those that that have not yet introduced it
“This large population-based birth cohort study is the first to report rotavirus vaccine-associated infant mortality reductions from a low-income country using the WHO recommended Expanded Programme on Immunisation schedule of six and ten weeks,” the authors write.

According to Bar-Zeev, significant gains in child survival in Africa can be made once Nigeria and other African countries such as Algeria, Chad, Egypt, Somalia, Tunisia and South Sudan introduce the vaccine. He adds that other countries should also prioritise rotavirus vaccination because of their high infant mortality or large populations — these are Cambodia, China, North Korea, Papua New Guinea and Syria.

Lucinda Manda-Taylor, a senior lecturer at the University of Malawi’s College of Medicine, says: “This trial and earlier trials in Malawi and South Africa have demonstrated that the vaccine is effective. The implementation and use of [the] rotavirus vaccine in childhood immunisation programmes will help save lives.”

Introducing the vaccine will help countries looking to address the Sustainable Development Goal of ensuring healthy lives and wellbeing at all ages, adds Manda-Taylor, who is also the editor-in-chief of the Malawi Medical Journal. It is the moral and ethical duty of policymakers to make sure that children get the rotavirus vaccine, she tells SciDev.Net.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Naor Bar-Zeev and others   Impact of monovalent rotavirus vaccine on diarrhoea-associated post-neonatal infant mortality in rural communities in Malawi: a population-based birth cohort study (Lancet Global Health, September, 2018