Widespread experience with rotavirus vaccines under conditions of routine use in many countries worldwide coupled Z-VAD-FMK manufacturer with clinical trial data provide much insight into the performance, impact, safety, and cost-effectiveness of rotavirus vaccines. The objective of this paper is to review data from international settings to help address key questions regarding anticipated rotavirus vaccine

performance and impact in India. Both internationally licensed rotavirus vaccines, RV1 and RV5, were found to be highly efficacious in clinical trials conducted in the USA, Latin America, Europe, and high income Asian countries (Table 2). RV1 was 85% (95% CI: 71–83%) efficacious in preventing severe rotavirus gastroenteritis (Vesikari score ≥11) among Latin American infants [1]. In subsequent trials examining efficacy during the first

click here two years of life, RV1 was 81% (95% CI: 71–87%) efficacious against severe rotavirus gastroenteritis in Latin American children, 90% (95% CI: 85–94%) efficacious in European children, and 96% (95% CI: 85–100%) efficacious in children in high income Asian countries [7], [8] and [9]. Similarly, in clinical trials conducted mainly in the USA and Finland, RV5 was 96% (95% CI: 91–98%) efficacious against hospitalizations due to rotavirus gastroenteritis caused by G1–G4 strains, 94% (95% CI: 89–97%) against emergency department visits, and 86% (95% CI: 74–93%) against office visits [2]. Because live oral vaccines, including earlier candidate rotavirus vaccines, have a history of performing less well in developing countries [10], [11], [12], [13], [14], [15], [16] and [17], WHO specifically recommended that efficacy trials of both RV1 and RV5 be conducted in low income countries of Africa and Asia before issuing a global recommendation for rotavirus vaccine use. Vaccine efficacy was modest in these trials. In Africa (South Africa and Malawi), two doses of RV1 administered at 10 and 14 weeks

of age had 59% (95% CI: 36–74%) efficacy against severe rotavirus diarrhea during the first year of life and three doses at Idoxuridine 6, 10, and 14 weeks of age had 64% (95% CI: 42–78%) efficacy [18]. Efficacy appeared to decline during the second year of life, particularly among 2 dose recipients. In Malawi, efficacy was similar for two and three dose recipients during the first year of life (49% (95% CI: 11–72%) and 50% (95% CI: 11–72%), respectively) [18] and [19]. However, in the second year of life, efficacy disappeared in two dose recipients (3% (95% CI: −101 to 53%)) while declining to 33% (95% CI: −49 to 71%) among three dose recipients [18] and [19]. In South Africa, efficacy was similar in the three dose recipients during the first year of life (82% (95% CI: 55–94%)) and overall during the first two years of life (85% (95% CI: 35–98%)) [18] and [20].