| Summary: | Rotavirus infection is a common cause of severe diarrheal disease and a major cause of deaths and
hospitalizations among young children. Incidence of rotavirus has declined globally with increasing
vaccine coverage. However, it remains a significant cause of morbidity and mortality in low-income
countries where vaccine access is limited and efficacy is lower. The oral human neonatal vaccine RV3-
BB can be safely administered earlier than other vaccines, and recent trials in Indonesia have demonstrated
high efficacy. In this study, we use a stochastic individual-based model of rotavirus transmission
and disease to estimate the anticipated population-level impact of RV3-BB following delivery according to
either an infant (2, 4, 6 months) and neonatal (0, 2, 4 months) schedule. Using our model, which
incorporated an age- and household-structured population and estimates of vaccine efficacy derived
from trial data, we found both delivery schedules to be effective at reducing infection and disease. We
estimated 95–96% reductions in infection and disease in children under 12 months of age when vaccine
coverage is 85%. We also estimate high levels of indirect protection from vaccination, including 78%
reductions in infection in adults over 17 years of age. Even for lower vaccine coverage of 55%, we estimate
reductions of 84% in infection and disease in children under 12 months of age. While open questions
remain about the drivers of observed lower efficacy in low-income settings, our model suggests RV3-BB
could be effective at reducing infection and preventing disease in young infants at the population level.
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