Immunization, Vaccines and Biologicals

WHO recommends use of rotavirus vaccines in all national immunization programmes

Mother and child awaiting vaccination

In an updated position paper, published in the Weekly Epidemiological Record today, WHO recommends the use of rotavirus vaccines in all national immunization programmes, particularly in south and south-eastern Asia and sub-Saharan Africa.

The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal diseases with the scaling up of both prevention ― including promotion of early and exclusive breastfeeding, hand washing, improved water supply and sanitation ― and treatment packages.

WHO/UNICEF recommend that all children receive solutions made of low-osmolarity oral rehydration salts (ORS) to prevent and treat dehydration due to diarrhoea. Breast milk is also an excellent rehydration fluid and should be given to children still breastfeeding along with ORS. In addition to fluid replacement, children with diarrhoea should continue to be fed during the episode. Food intake supports fluid absorption from the gut into the bloodstream to prevent dehydration and helps maintain nutritional status and ability to fight infection. Children should also simultaneously receive zinc treatment which reduces the duration and severity of diarrhoea episodes, stool volume and the need for advanced medical care.

Plans for introduction of rotavirus vaccines should consider the epidemiology of the disease by age, the coverage and actual age at vaccination, and an evaluation of the estimated public health impact and potential risks (e.g. intussusception). In addition, cost-effectiveness assessment, issues of affordability of the vaccine, financial and operational impact on the immunization delivery system, and careful examination of current immunization practices should be taken into account.

Introduction of rotavirus vaccine should be accompanied by measures to ensure high vaccination coverage and timely administration of each dose.

Following a review of new evidence on age-specific burden of rotavirus disease and deaths, timeliness of vaccination, and the safety and effectiveness of different immunization schedules, WHO continues to recommend that the first dose of rotavirus vaccine be administered as soon as possible after 6 weeks of age, along with vaccination against diphtheria-tetanus-pertussis (DTP) vaccination, to ensure induction of protection prior to natural rotavirus infection.

However, the manufacturers conventional age restrictions on the first and last dose of rotavirus vaccines may have prevented vaccination of many vulnerable children in settings where the DTP doses are given late (i.e. after 15 weeks for DTP1 or after 32 weeks for DTP 2 or DTP3). By allowing infants to receive rotavirus vaccine together with DTP regardless of the time of vaccination, immunization programmes will be able to reach children who were previously excluded from the benefits of rotavirus vaccines.

Rotaviruses have infected nearly every child by the age of 3-5 years and are globally the leading cause of severe, dehydrating diarrhoea in children aged under 5 years of age. WHO estimates that in 2008, an estimated 453 000 rotavirus gastroenteritis-associated child deaths occurred worldwide .

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