Diarrhoea vaccine saves lives in developing countries

Vaccinating children in Africa and Mexico against one of the most common causes of diarrhoea – a germ called rotavirus – has been shown to cut cases of diarrhoea and reduce deaths from diarrhoea-related illness in children. Is it now time to add the vaccine to the UK childhood vaccine schedule?

What do we know already?

Even in developed countries like the UK, rotavirus is the most common cause of diarrhoea and sickness. About 18,000 children are admitted to hospital in England and Wales every year, suffering from severe diarrhoea and vomiting caused by rotavirus.

In the 1990s, children in the UK were routinely vaccinated against rotavirus. However, safety fears about the vaccine used at the time led to it being withdrawn from use. Although new vaccines have been developed since, they’ve not been added to the UK’s recommended childhood vaccine schedule. Children in many other developed countries, including the US and Australia, routinely receive the rotavirus vaccine.

However, it’s in less developed countries that rotavirus causes the worst problems. In parts of Africa, South America, and Asia, babies often die from diarrhoea and vomiting caused by rotavirus. The World Health Organization estimates that 230,000 children die of rotavirus infection in sub-Saharan Africa each year. But vaccination in developing countries can be difficult, because it’s hard to store vaccines in the refrigerated conditions they need. There have also been concerns about giving vaccines to babies in areas where many have a damaged immune system because of HIV.

Two new studies published this week look at the effects of the vaccine in two African countries (Malawi and South Africa), and in Mexico.

What does the new study say?

The vaccines worked well. The study in Africa divided almost 5,000 babies into three groups. Babies in one group got a dummy (placebo) vaccine, while the others had different doses of vaccine. The babies who were vaccinated (at either dose) were much less likely to have an attack of diarrhoea and vomiting during their first year of life.

Of the children who had the vaccine, 2 in every 100 had at least one severe episode of diarrhoea and vomiting caused by rotavirus during the year. But that happened to 5 in every 100 children who’d not had the vaccine. The researchers estimate that five episodes of diarrhoea and vomiting were prevented for every 100 children, over the course of a year.

In Mexico, the study compared death rates from diarrhoea and vomiting before the vaccine was introduced with the death rates in the year after the programme began. There were on average 675 fewer deaths in a year, from an average 1,793 in the years before the vaccine, down to 1,118 in the years after the vaccine.

How reliable are the findings?

The study in Africa was done as a randomised controlled trial, which is the best way to see whether or not a treatment works. The babies were checked once a week and their parents questioned about whether the baby had been ill. The results should be very reliable.

The Mexican study can give us only an estimate of the effect of vaccination, as there could be other things that influenced the death rates from diarrhoea, apart from the introduction of the vaccine. It’s very hard to exclude all the other things that could have made a difference.

But, put together, the two studies suggest rotavirus vaccines can make a real difference in less developed countries.

Where does the study come from?

The African study was a collaboration between researchers in South Africa, Malawi, and the University of Liverpool in the UK. The Mexican study included researchers from the National Center for Child and Adolescent Health in Mexico, and from the Centers for Disease Control and Prevention in the US. Both studies were published in the New England Journal of Medicine.

What does this mean for me?

Fortunately, it’s rare for rotavirus to cause death among babies and children in the UK. That’s because babies in the UK are likely to be well-nourished and healthy, and good treatment is quickly available when they get ill. But rotavirus can cause very unpleasant vomiting and diarrhoea.

Rotavirus vaccination isn’t usually available on the NHS. The UK Health Protection Agency says the best way to protect against rotavirus infection is good hygiene. Even so, it admits that most children will have been infected by rotavirus by the age of 5.

One of the researchers, Dr Nigel Cunliffe from the University of Liverpool, said he thought rotavirus vaccination would have “a very beneficial impact” on preventing illness caused by rotavirus in children in the UK. He urged the UK vaccines authority, the Joint Committee on Vaccination and Immunisation, to look again at the case for introducing routine rotavirus vaccination for UK children.

What should I do now?

Good hygiene means washing hands regularly, especially before eating or preparing food, and after using the toilet.

If your child gets diarrhoea or vomiting, the most important thing is to ensure they don’t lose too much water. They should drink sips of water often, or you could use oral rehydration salts, made up into a drink, to help protect against dehydration. These are available from a pharmacist. If you are worried that your baby or child is getting dehydrated, get help urgently from your GP.

From:

Madhi SA, Cunliffe NA, Steele D, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. New England Journal of Medicine. 2010; 362: 289-298.

Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, et al. Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico. New England Journal of Medicine. 2010; 362: 299-305.

To find out more, see our information on diarrhoea in children.

© BMJ Publishing Group Limited (”BMJ Group”) 2010

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