Transcript Slides from JHU

Rotavirus: advocacy slides
These slides are intended to support your advocacy efforts.
Please incorporate those that may be useful to you in your
presentations.
For questions, please contact [email protected].
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 2013
Enteric Multicenter Study (GEMS), Kotloff, Lancet, May 2013
2Global
Diarrhea: a leading cause of child death
Neonatal diarrhea
Measles
1%
1%
AIDS Meningitis
2%
2%
Injury
5%
Malaria
7%
Neonatal
(excluding
diarrhea)
40%
Diarrhea
10%
Pneumonia
14%
Other
18%
Child Health Epidemiology Reference Group; Liu, Lancet, 2012
Diarrhea causes
10% of deaths in
children under 5
~800,000 child deaths
attributed to diarrhea
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-tosevere 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 the leading cause of hospitalizations for diarrhea in children
Rotavirus causes
~40%
of all diarrhea
hospitalizations in
children under 5
Parashar, Emerging Infections Diseases, 2006
Parashar, EID, 2003
Rotavirus
Other
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, 2013
Rev Infect Dis, 1991
2Ansari,
Rotavirus: treatment and prevention
Without access to treatment for the severe dehydration it can
cause, rotavirus can be a death sentence
• 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
Rotavirus: deadly
Rotavirus 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, 2008
Total deaths = 453,000
Rotavirus deaths: top 10 countries
India
98,621
Nigeria
41,057
Pakistan
39,144
DRC
32,653
Ethiopia
28,218
Afghanistan
Uganda
25,423
10,637
Indonesia
9,970
Bangladesh
9,857
Angola
8,788
WHO. Estimated rotavirus deaths for children under 5 years of age in 2008
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
14
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, 2006
Parashar, EID, 2003
Sample photo provided by Johns Hopkins University/IVAC, you can also include your own
References
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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):30613066.
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.
References
•
•
•
•
•
•
•
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, casecontrol 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
•
•
•
•
•
•
•
•
•
•
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: casecontrol 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 metaanalysis. 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.