Elmira Flem

Effect of withholding breastfeeding on the immune response to a live oral rotavirus vaccine in North Indian infants

Interference from transplacental and breast milk antibodies may impede the performance of oral live vaccines. The effect of breastfeeding on the immunogenicity of Rotarix, a two-dose oral monovalent rotavirus vaccine, was examined in a community-based trial in New Delhi, India. Four hundred mother-infant pairs were randomized into two equal groups. Infants were aged 6-7 weeks at enrollment. Mothers were encouraged to either breastfeed or to withhold breastfeeding during the 30 min prior to and after each vaccine dose was administered. We collected blood specimens from infants at enrollment and 4 weeks after the second vaccine dose. Blood and breast milk specimens were obtained from mothers at baseline and breast milk specimens were collected at the time of the second vaccine dose. Seroconversion was defined as infant serum anti-VP6 IgA antibody level of ≥20 IU/mL 4 weeks after the second vaccine dose and a ≥4-fold rise from baseline. There was no difference in the proportion who seroconverted between the two groups (26% vs 27%; p=0.92). The levels of infant serum IgA, maternal serum and breast milk IgA and IgG anti-rotavirus antibodies predicted the anti-rotavirus IgA level in infants at end-study and explained approximately 10% of the variability of the immune response (r(2)=0.10, p<0.001). In this population, the immune response to Rotarix was not enhanced by withholding breastfeeding around the time of vaccination. Maternal anti-rotavirus antibodies explained little of the variability in the immune response to the vaccine. Factors other than maternal anti-rotavirus antibodies probably explain why infants in low-and middle-income settings respond poorly to live oral rotavirus vaccines.

Costs of Diarrheal Disease and the Cost-Effectiveness of a Rotavirus Vaccination Program in Kyrgyzstan

INTRODUCTION We examined the cost-effectiveness of a rotavirus immunization program in Kyrgyzstan, a country eligible for vaccine funding from the GAVI Alliance. METHODS We estimated the burden of rotavirus disease and its economic consequences by using national and international data. A cost-effectiveness analysis was conducted from government and societal perspectives, along with a range of 1-way sensitivity analyses. RESULTS Rotavirus-related hospitalizations and outpatient visits cost US

Dynamic model of rotavirus transmission and the impact of rotavirus vaccination in Kyrgyzstan.

580,864 annually, of which

Childhood intussusception in Uzbekistan: Analysis of retrospective surveillance data

421,658 (73%) is direct medical costs and

Rotavirus infection in hospitalized children and estimates of disease burden in Kyrgyzstan, 2005-2007.

159,206 (27%) is nonmedical and indirect costs. With 95% coverage, vaccination could prevent 75% of rotavirus-related hospitalizations and deaths and 56% of outpatient visits and could avert

Rotavirus gastroenteritis in Norway: Analysis of prospective surveillance and hospital registry data

386,193 (66%) in total costs annually. The medical break-even price at which averted direct medical costs equal vaccination costs is

Detection and characterization of group A rotaviruses in children hospitalized with acute gastroenteritis in Norway, 2006-2008.

0.65/dose; the societal break-even price is

Burden of Rotavirus Disease in Norway: Using National Registries for Public Health Research.

1.14/dose for a 2-dose regimen. At the current GAVI Alliance-subsidized vaccine price of

Rotavirus Gastroenteritis in Uzbekistan: Implications for Vaccine Policy in Central Asia

0.60/course, rotavirus vaccination is cost-saving for the government. Vaccination is cost-effective at a vaccine price

Dynamic modeling of cost-effectiveness of rotavirus vaccination Kazakhstan.

9.41/dose, according to the cost-effectiveness standard set by the 2002 World Health Report. CONCLUSIONS Addition of rotavirus vaccines to childhood immunization in Kyrgyzstan could substantially reduce disease burden and associated costs. Vaccination would be cost-effective from the national perspective at a vaccine price