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Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
Rotavirus  challenges ahead
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Rotavirus challenges ahead

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  • 1. ROTAVIRUS- CHALLENGES AHEAD - Dr. Gulrukh Hashmi
  • 2. OVERVIEW  Introduction  Disease burden  Virus description  Epidemiology  Vaccine  Challenges  Conclusion
  • 3. INTRODUCTION  Diarrhea remains one of the commonest illnesses of childhood.  In developing countries it is 3rd most common cause of deaths  20 different pathogens cause diarrhea.  Rotavirus causes 25-55% hospital admissions for diarrhea
  • 4. DISEASE BURDEN  Rotavirus is the most common cause of severe diarrhea in infants and young children worldwide.  Globally it is responsible for 611,000 childhood deaths  More than 80% deaths occur in low-income countries and India records the highest mortality
  • 5. ROTAVIRUS DISEASE BURDEN IN INDIA 122,000-153,000 457,000-884,000 2 million Estimated annual number and risk of death, hospitalization, and outpatient visits due to rotavirus diarrhea in children <5 years of age in India. Adapted from: J. E. Tate et al. Disease and economic burden of rotavirus diarrhea in India/Vaccine 27 S (2009) F18–F24 EVENTSRISK 1 in every 177-196 children 1 in every 31-59 children 1 in every 13 children Deaths Hospitalizations Outpatient Visits
  • 6. FINANCIAL BURDEN  It is estimated that India spends approximately Rs 1.8–3.2 billion (US$ 37.4 to 66.8 million) in direct medical costs annually  Rs 107–176 million (US$ 2.2–3.7 million) in non-medical costs for the treatment of rotavirus diarrhea in children <5 years of age  With a total burden of Rs 2.0–3.4 billion (US$ 41–72 million)
  • 7. VIROLOGY  Rotaviruses are double stranded RNA viruses  Belongs to the family Reoviridae  Scientists have described 7 groups(A-G)  Only A,B,C infect humans of which A is commonest.  A is further divided in G and P serotypes
  • 8. MODE OF TRANSMISSION  Faeco-oral route  Direct contact  Fomites  Respiratory droplets  Incubation period - 24 to 48 hrs
  • 9. CLINICAL MANIFESTATIONS  Vomiting  Mild watery diarrhea of short duration  Severe gastroenteritis  Life-threatening dehydration secondary to gastrointestinal fluid loss
  • 10.  Majority of children become infected with rotavirus within the first three years of life  With a peak incidence of rotavirus diarrhea between six to 24 months of age  Initial infection after 3months of age is most likely to cause severe diarrhea and dehydration.
  • 11. PREVENTIVE MEASURES  Breast-feeding  Hand washing  Improve water quality and sanitation  Oral rehydration therapy- to prevent dehydration
  • 12. IMPROVEMENT IN HYGIENE AND SANITATION DOES NOT SIGNIFICANTLY REDUCE ROTAVIRUS INFECTION  Almost every child infected by 2 year irrespective of socio economic class  Rotavirus is highly contagious  Resistant to inactivation  Highly Stable
  • 13. ROTAVIRUS DIARRHEA AND ORT  Oral rehydration therapy reduces mortality but does not decrease the episode duration or their consequences such as malnutrition.  Adherence to ORT is poor.  Leads to use of antibiotics or other treatment of no proven value.
  • 14. Resistance to disinfectants Ineffectiveness to ORS Need for effective vaccine
  • 15. VACCINES  RotaShield  Rotarix  RotaTeq  Rotavac
  • 16.  Two oral, live, attenuated rotavirus vaccines  Rotarix (GlaxoSmithKline Biologicals,Rixensart, Belgium)  RotaTeq (Merck & Co. Inc., West Point, PA, USA)  Available internationally  Both vaccines are considered safe and effective  WHO now recommends that infants worldwide be vaccinated against Rotavirus
  • 17. Rotavirus Vaccines RotaTeq Rotarix Manufacturer Merk & Co. GSK Genetic framework Bovine Rotavirus – WC3 Human Rotavirus-89- 12 Composition 5 Human, Bovine reassortant Single Human rotavirus Genotypes G1, 2, 3, 4 and [P8] G1 [P8] Dosage Schedule 3 doses at 2, 4 and 6 months 2 doses at 2 and 4 months Route oral oral Presentation liquid Lysophilized- reconstituted Efficacy against severe disease 85% 95% Virus shedding Up to 13 % 17 % - 27%
  • 18. ROTARIX™ VACCINE  Administered orally  A two-dose schedule  Infants approximately 2 and 4 months of age  The first dose can be administered at the age of 6 weeks and must be given no later than the age of 12 weeks.  The interval between the two doses should be at least 4 weeks.  The two-dose schedule should be completed by age 16 weeks and not later than 24 weeks of age
  • 19. ROTATEQ™ VACCINE  Three oral doses at ages 2, 4, and 6months.  The first dose should be administered between ages 6 – 12 weeks and subsequent doses at intervals of 4 – 10 weeks.  Vaccination should not be initiated for infants aged > 12 weeks.  All three doses should be administered before the age of 32 weeks
  • 20. BENEFITS OF VACCINATION A universal rotavirus immunization program in Asia has the potential to avert  109,000 deaths  1.4 million hospitalizations  7.7 million outpatient visits, and US $ 139 million in healthcare costs each year, for children < 5 years of age,
  • 21. ROTAVAC  Developed by Govt of India and Bharat biotech  Oral vaccine to be given in 3 doses at 6,10 and 14 weeks.  More affordable than the other two vaccines  Needs to be licensed and sanctioned by WHO before it can be sold in India and distributed globally
  • 22. ROTAVAC  The efficacy of vaccine in study was 50 to 58% while that of Rotarix vaccine in West is 90%.  The trials for vaccine enrolled only 6,779 infants.  Impossible to compare the side effects of this vaccine with the previously available ones
  • 23. CHALLENGES FOR IMPLEMENTATION  Monitoring impact of rotavirus vaccines on diarrheal disease burden in resource-limited settings  Improving rotavirus vaccine performance in developing countries.  Monitoring the safety of rotavirus vaccines & further understanding the relationship between rotavirus vaccines and intussusceptions
  • 24. CHALLENGES  Monitoring rotavirus vaccine impact on circulating rotavirus strains  Overcoming programmatic challenges  Accurate information on vaccine risk and benefits to maintain public trust in rotavirus immunization  Ensuring adequate vaccine supply and competition
  • 25. CONCLUSION  Rotavirus diarrhea is a significant public health problem in India  Rotavirus accounts for more severe dehydrating diarrhea in children.  In view of continuing high morbidity and mortality from rotavirus diarrhea and enormous economic consequences thereof, there is a strong case for immunization against rotavirus infection in India.
  • 26. CONCLUSION  Availability of current rotavirus vaccines and continued development of new rotavirus vaccines  Introduction of the vaccine in routine immunisation schedule  Progress needed in different areas.  Decline in morbidity and mortality
  • 27. REFERENCES  WHO AFMC’s Textbook of Public health and community medicine  Shaun K Morris, Shally Awasthi,Ajay Khera,Diego G Basani. Rotavirus mortality in India: estimates based on a nationally representative survey of diarrheal deaths ; Bull Word Health Organisation 2012,90:720-727.  Penelope H Dennehy. Rotavirus Vaccine : an overview Clinical Microbiology Reviews,Jan 2008,198-208 Vol 21,No.1  J.E.Tate,Manish m Patel, Global impact of rotavirus vaccines expert review Vaccines 9 (4), 395-40407(2010)
  • 28. REFERENCES  Dheeraj shah, panna choudhary, piyush Gupta Promoting appropriate management of diarrhea: a systematic review of literature for advocacy and action: Unicef-PhFI series on newborn and child health,India Indian Pediatrics Journal Vol 49-August 16,2012627-650.  Rakesh Lodha and Dheeraj Shah. Prevention of Rotavirus Diarrhea in India: Is Vaccination the Only Strategy?. Indian Pediatr 2012;49: 441-443  Paramita Sengupta. Rotavirus: The Challenges Ahead  . Glass RI, Parashar VD, Bresee JS, Turcios R, Fischer TK, Widowson MA, et al. Rotavirus vaccines: current prospects and future challenges. Lancet.2006;368:323–32.
  • 29. REFERENCES  Naik TN. Commentary. Rapid diagnosis of rotavirus infection: prevent unnecessary use of antibiotics for treatment of children Diarrhea. Indian J Med Res.2004;119:5–7  WHO. World Health Org Report of the meeting on future directions for rotavirus vaccine research in developing countries. Geneva: 2000. Feb, Report no. WHO/VandB/00.23.  Pratibha Masand. Propaganda by consumer goods companies to curb rotavirus infection.  Consensus recommendation on immunization and IAP Immunization time table 2012. Indian academy of Paediatrics Committee on Immunization. Indian paediatrics, July 2012;vol. 49.pp 549-564.
  • 30. THANK YOU

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