Rotavirus challenges ahead


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Rotavirus challenges ahead

  1. 1. ROTAVIRUS- CHALLENGES AHEAD - Dr. Gulrukh Hashmi
  2. 2. OVERVIEW  Introduction  Disease burden  Virus description  Epidemiology  Vaccine  Challenges  Conclusion
  3. 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. 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. 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. 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. 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. 8. MODE OF TRANSMISSION  Faeco-oral route  Direct contact  Fomites  Respiratory droplets  Incubation period - 24 to 48 hrs
  9. 9. CLINICAL MANIFESTATIONS  Vomiting  Mild watery diarrhea of short duration  Severe gastroenteritis  Life-threatening dehydration secondary to gastrointestinal fluid loss
  10. 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. 11. PREVENTIVE MEASURES  Breast-feeding  Hand washing  Improve water quality and sanitation  Oral rehydration therapy- to prevent dehydration
  12. 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. 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. 14. Resistance to disinfectants Ineffectiveness to ORS Need for effective vaccine
  15. 15. VACCINES  RotaShield  Rotarix  RotaTeq  Rotavac
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 30. THANK YOU