Diarrhea remains one of the commonest illnesses of
In developing countries it is 3rd most common cause of
20 different pathogens cause diarrhea.
Rotavirus causes 25-55% hospital admissions for
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
ROTAVIRUS DISEASE BURDEN IN INDIA
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
1 in every 177-196 children
1 in every 31-59 children
1 in every 13 children
It is estimated that India spends approximately Rs 1.8–3.2
billion (US$ 37.4 to 66.8 million) in direct medical costs
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
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
MODE OF TRANSMISSION
Incubation period - 24 to 48 hrs
Mild watery diarrhea of short duration
Life-threatening dehydration secondary to
gastrointestinal fluid loss
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.
Improve water quality and sanitation
Oral rehydration therapy- to prevent
IMPROVEMENT IN HYGIENE AND SANITATION
DOES NOT SIGNIFICANTLY REDUCE ROTAVIRUS
Almost every child infected by 2 year irrespective of
socio economic class
Rotavirus is highly contagious
Resistant to inactivation
ROTAVIRUS DIARRHEA AND ORT
Oral rehydration therapy reduces mortality but does not
decrease the episode duration or their consequences such
Adherence to ORT is poor.
Leads to use of antibiotics or other treatment of no
Two oral, live, attenuated rotavirus vaccines
Rotarix (GlaxoSmithKline Biologicals,Rixensart,
RotaTeq (Merck & Co. Inc., West Point, PA, USA)
Both vaccines are considered safe and effective
WHO now recommends that infants worldwide be
vaccinated against Rotavirus
Manufacturer Merk & Co. GSK
Genetic framework Bovine Rotavirus – WC3 Human Rotavirus-89-
Composition 5 Human, Bovine
Genotypes G1, 2, 3, 4 and [P8] G1 [P8]
Dosage Schedule 3 doses at 2, 4 and 6
2 doses at 2 and 4
Route oral oral
Presentation liquid Lysophilized-
Virus shedding Up to 13 % 17 % - 27%
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
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
All three doses should be administered before the age of 32
BENEFITS OF VACCINATION
A universal rotavirus immunization program in Asia has
the potential to avert
1.4 million hospitalizations
7.7 million outpatient visits, and US $ 139 million in
healthcare costs each year, for children < 5 years of
Developed by Govt of India
and Bharat biotech
Oral vaccine to be given in 3 doses at 6,10 and 14
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
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
CHALLENGES FOR IMPLEMENTATION
Monitoring impact of rotavirus vaccines on diarrheal
disease burden in resource-limited settings
Improving rotavirus vaccine performance in developing
Monitoring the safety of rotavirus vaccines & further
understanding the relationship between rotavirus
vaccines and intussusceptions
Monitoring rotavirus vaccine impact on circulating
Overcoming programmatic challenges
Accurate information on vaccine risk and benefits to
maintain public trust in rotavirus immunization
Ensuring adequate vaccine supply and competition
Rotavirus diarrhea is a significant public health problem
Rotavirus accounts for more severe dehydrating diarrhea
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.
Availability of current rotavirus vaccines and continued
development of new rotavirus vaccines
Introduction of the vaccine in routine immunisation
Progress needed in different areas.
Decline in morbidity and mortality
WHO AFMC’s Textbook of Public health and community
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
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)
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
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.
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.