05 August 2011


           On July 18th, just two weeks ago, the first doses of pentavalent rotavirus vaccine were given to thousands of young children in Northern Sudan.  Under the direction of GAVI, the Global Alliance for Vaccines and Immunization, plans are underway to introduce the vaccine in more than 40 countries by 2015, including the six Sub-Saharan countries with the highest mortality from rotoviral disease. 
Rotavirus infections are the most common cause of diarrhea in young children throughout the world, resulting in over 500,000 deaths each year, mostly in developing countries.  Rotavirus gastroenteritis causes more deaths in children each year than HIV, malaria and measles combined.  Transmission is by the fecal-oral route.  Treatment is supportive, and consists of re-hydration fluids and more recently by zinc supplementation.  Preventive measures include improved sanitation, provision of safe water, and better hand washing.  The most effective intervention, and the best hope for preventing the severe complications of rotavirus infection, however, is vaccination.  Rotavirus vaccine is currently part of routine immunization in infants throughout the USA and Europe.  Multiple trials that have taken place in Malawi, Mali and Kenya, and administration on a large scale in India and South Africa have shown a 50-70% reduction in severe cases of rotavirus diarrhea.  This experience has prompted the World Health Organization to recommend widespread administration in all developing countries. 
Although there were initially some concerns about the association in early vaccine trials with an increased incidence of intussusception, this problem has not recurred after subsequent modification of the vaccine. 
The widespread implementation of the GAVI Rotavirus Initiative has largely been enabled by an offer from Glaxo Pharmaceuticals to furnish 125 million doses of rotavirus vaccine at a 95% reduction in price. 
How exciting it is for us to consider that, at this very moment, low cost vaccines are being distributed throughout developing countries that are effective against rotavirus diarrhea and also against pneumococcal pneumonia, worldwide the two leading causes of death in young children.  

Submitted by Roger Boe MD

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