Rotavirus: advocacy slidesThese slides are intended to support your advocacy efforts. Please incorporate those that may be useful to you in your presentations.

For questions, please contact jen.farber@gmmb.com.

Special thanks to the ROTA Council’s Partners: Johns Hopkins University, PATH, US Centers for Disease Control and Prevention and Bill & Melinda Gates Foundation for their technical guidance and expertise in developing these slides.

Diarrhea

Diarrhea: global problem Diarrhea is a leading cause of death in children under age 5,

responsible for nearly 800,000 deaths1

It’s common. More than 1.7 billion cases occur annually in children under 51

It can cause severe dehydration and lead to hospitalization or death1

Diarrhea has lasting repercussions for children2

• Major contributing factor to malnutrition• Leads to growth delays• Children are 8.5 more times likely to die from any cause after an

episode

1WHO Diarrheal Disease Factsheet 20132Global Enteric Multicenter Study (GEMS), Kotloff, Lancet, May 2013

Diarrhea: a leading cause of child death

Child Health Epidemiology Reference Group; Liu, Lancet, 2012

Diarrhea causes10% of deaths in children

under 5

~800,000 child deaths attributed to diarrhea

Measles1%

Neonatal diarrhea1%

AIDS2%

Meningitis2%

Injury5%

Malaria7%

Diarrhea10%

Pneumonia14%

Other18%

Neonatal (excluding diarrhea)

39%

Diarrhea: devastating impact

Global Enteric Multicenter Study (GEMS), Kotloff, Lancet, May 2013

Diarrhea: causes are clear

Rotavirus is 1 of 4 pathogens causing the majority of moderate-to-severe diarrhea in children under age 5

Rotavirus is the #1 cause of diarrhea in infants (0-11 months)

GEMS, Kotloff, Lancet, May 2013

Diarrhea: hospitalizations in children

Rotavirus causes ~40%

of all diarrheahospitalizations in children under 5

Parashar, Emerging Infections Diseases, 2006Parashar, EID, 2003

Ro-tavirus

Other

Rotavirus the leading cause of hospitalizations for diarrhea in children

Rotavirus

Rotavirus: common and severe Most common cause of severe diarrhea among children1

Highly contagious and resilient2

Improvements in hygiene, sanitation and drinking water do not adequately prevent rotavirus1

Almost every child is infected by age 5, rich or poor, regardless of where they live1

Most infections occur in very young children1

1WHO Rotavirus Position Paper, 20132Ansari, Rev Infect Dis, 1991

Rotavirus: treatment and prevention

• Rotavirus cannot be treated with antibiotics or other drugs

• Prompt treatment with oral rehydration therapy (ORT) can be effective in treating mild infections

• Many of the world’s poorest children do not have access to ORT, despite the fact that it is effective and inexpensive

• Rotavirus prevention by vaccination is key to improving child survival

1 Santosham, Lancet, 2010

ORT coverage is only in ~30% of

places where the most diarrhea

deaths occur1

Without access to treatment for the severe dehydration it can cause, rotavirus can be a death sentence

Rotavirus: deadlyRotavirus is the leading cause of death due to diarrhea in young children

More than 1,200 children die each day from rotavirus

Responsible for 5% of all deaths in children under 5

95% of rotavirus deaths occur in low-income countries

eligible for GAVI support

Tate, Lancet, 2011

Estimated global rotavirus deaths, 2008Total deaths = 453,000

Angola

Bangladesh

Indonesia

Uganda

Afghanistan

Ethiopia

DRC

Pakistan

Nigeria

India

8,788

9,857

9,970

10,637

25,423

28,218

32,653

39,144

41,057

98,621

Rotavirus deaths: top 10 countries

Five countries (India, Nigeria, the Democratic Republic of the Congo, Ethiopia and Pakistan)

accounted for more than half of all rotavirus deaths in children under

age five in 2008

WHO. Estimated rotavirus deaths for children under 5 years of age in 2008

Rotavirus: devastating burden Responsible for millions

of hospitalizations and clinic visits annually

Accounts for approximately 40% of all diarrhea-related hospitalizations

Parashar, Emerging Infections Diseases, 2006Parashar, EID, 2003Sample photo provided by Johns Hopkins University/IVAC, you can also include your own

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References • Ansari SA, Springthorpe VS, Sattar SA. Survival and vehicular spread of human rotaviruses: possible relation to seasonality of

outbreaks. Reviews of infectious diseases. 1991; 13(3): 448-61.• Atherly D, Lewis K, Tate J et al. Projected health and economic impact of rotavirus vaccination in GAVI-eligible• countries: 2011–2030. Vaccine. 30S (2012) A7– A14.• Armah G, Sow S, Breiman R, et al. Efficacy of pentavalent human-bovine reassortant rotavirus vaccine against severe

rotavirus gastroenteritis in sub-Saharan Africa: a randomized, double-blind, placebo-controlled trial. The Lancet. 2010;376(9741):606-614.

• Buttery JP, Lambert SB, Grimwood K, et al. Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australia’s National Childhood vaccine schedule. Pediatric Infectious Disease Journal. 2011;30(suppl 1):S25–S29.

• Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, Elliott EJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine. 2011;29(16):3061-3066.

• CDC. Rotavirus vaccines and intussusception in the Vaccien Safety Datalink (VSD). http://www.cdc.gov/vaccines/acip/meetings/downloads/slides-jun-2013/02-Rotavirus-Weintraub.pdf. Published 2013. Accessed 29 July 2013.

• Cortese MM, Tate JE, Simonsen L, Edelman L, Parashar UD. Reduction in gastroenteritis in United States children and correlation with early rotavirus vaccine uptake from national medical claims databases. Pediatric Infectious Disease Journal. 2010;29:489–494.

• do Carmo GM, Yen C, Cortes J, Siqueira AA, de Oliveira WK, Cortez-Escalante JJ, et al. Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis. PLoS Medicine. 2011;8(4):e1001024.

• FDA. Risk of intussusception after rotavirus vaccination: results of a PRISM study. http://www.cdc.gov/vaccines/acip/meetings/downloads/slides-jun-2013/04-Rotavirus-Yih.pdf. Published 2013. Accessed 29 July 2013.

• Haber P, Patel M, Izurieta HS, Baggs J, Gargiullo P, Weintraub E, Cortese M, Braun MM, Belongia EA, Miller E, Ball R, Iskander J, Parashar UD. Postlicensure monitoring of intussusception after RotaTeq vaccination in the United States, February 1, 2006, to September 25, 2007. Pediatrics; 2008:121(6):1206-12.

• Kotloff KL, Nataro JP, Blackwelder WC, Nasrin D, Farag TH, Panchalingam S, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet. 2013.

• Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet. 2012; 379(9832): 2151-61.

• Madhi S, Cunliffe N, Steele D et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. The New England Journal of Medicine. 2010;362(4):289-298.

• Parashar U, Hummelman E, Bresee J, et al. Global illness and deaths caused by rotavirus disease in children. Emerging Infectious Diseases. 2003 May; 9(5):565–572.

References

References • Parashar UD, Gibson CJ, Bresse JS, et al. Rotavirus and severe childhood diarrhea. Emerging Infectious Diseases.

2006;12:304–306.• Patel MM, Glass R, Desai R, Tate J, Parashar UD. Fulfilling the promise of rotavirus vaccines: how far have we come since

licensure? Lancet Infect Dis 2012; 12; 561-70• Patel M, Richardson V, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. The New

England Journal of Medicine. 2011;364(24):2283- 2292.• Patel MM, Patzi M, Pastor D, Nina A, Roca Y, Alvarez L, et al. Effectiveness of monovalent rotavirus vaccine in Bolivia: case-

control study. BMJ. 2013;346:f3726• Patel MM, Santosham M, Tate, J. Preventing Rotavirus Disease in the Developing World: Issues, Opportunities, and

Challenges. Medscape, December 2012. http://www.medscape.org/viewarticle/776009 • Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, et al. Effect of rotavirus vaccination on death from childhood

diarrhea in Mexico. The New England Journal of Medicine. 2010;362(4):299–305.• Rheingans RD, Antil L, Dreibelbis R, et al. Economic costs of rotavirus gastroenteritis and cost-effectiveness of vaccination in

developing countries. JID 2009;200 (Supplement 1):S16–S27.• Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, Abate H, Breuer T, Clemens SC, et al. Safety and efficacy of an attenuated

vaccine against severe rotavirus gastroenteritis. N Engl J Med. 2006; 354(1): 11-22.• Santosham M, Chandran A, Fitzwater S, et al. Progress and barriers for the control of diarrhoeal disease. The Lancet. 2010;

376: 63–67.• Shui IM, Baggs J, Patel M, Parashar UD, Rett M, Belongia EA, Hambidge SJ, Glanz JM, Klein NP, Weintraub E. Risk of

intussusception following administration of a pentavalent rotavirus vaccine in US infants. JAMA; 2012: 307(6):598-604.

References • Soares-Weiser K, Maclehose H, Bergman H, Ben-Aharon I, Nagpal S, Goldberg E, Pitan F, Cunliffe N. Vaccines for preventing

rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev.; 2012:11:CD008521.• Steele AD, Neuzil KM, Cunliffe NA, Madhi SA, Bos P, Ngwira B, et al. Human rotavirus vaccine Rotarix provides protection

against diverse circulating rotavirus strains in African infants: a randomized controlled trial. BMC Infect Dis. 2012; 12: 213.• Tate JE, Burton AH, Boschi-Pinto C, Steele D, et al. 2008 estimate of worldwide rotavirus-associated mortality in children

younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. The Lancet. Published online October 25, 2011.

• Vesikari T, Matson DO, Dennehy P, Van Damme P, Santosham M, Rodriguez Z, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. N Engl J Med. 2006; 354(1): 23-33.

• WHO. Diarrhoeal disease. 2009 [cited 2011 September 28]; Available from: http://www.who.int/mediacentre/factsheets/fs330/en/index.html

• WHO. Meeting of the immunization Strategic Advisory Group of Experts, April 2009 – conclusions and recommendations. Weekly Epidemiological Record. 2009; 84(23):232-236.

• WHO. Rotavirus vaccines: WHO position paper – January 2013. Wkly Epidemiol Rec. 2009; 88(50): 49-64.• WHO: Rotavirus vaccine update 2012. Available from: http://www.sabin.org/sites/sabin.org/files/Fatima%20Serhan.pdf • WHO. Estimated rotavirus deaths for children under 5 years of age. Available from:

http://www.who.int/immunization_monitoring/burden/rotavirus_estimates/en/• Zaman K, Dang DA, Victor J, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants

in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. The Lancet. 2010;376(9741):615-623.