This document summarizes information about rotavirus, which is a leading cause of severe diarrhea in young children worldwide. It discusses the disease burden of rotavirus, describing it as responsible for over 600,000 childhood deaths annually, especially in low-income countries like India. The document also reviews rotavirus virology, epidemiology, clinical manifestations, preventive measures, challenges, and two available oral vaccines - Rotarix and RotaTeq. It emphasizes that while improvements in hygiene and sanitation can help reduce transmission, vaccination is needed to significantly reduce the mortality and morbidity caused by rotavirus diarrhea.

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

6. 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

7. 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)

8. 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

9. MODE OF TRANSMISSION
 Faeco-oral route
 Direct contact
 Fomites
 Respiratory droplets
 Incubation period - 24 to 48 hrs

10. CLINICAL MANIFESTATIONS
 Vomiting
 Mild watery diarrhea of short duration
 Severe gastroenteritis
 Life-threatening dehydration secondary to
gastrointestinal fluid loss

11.  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.

12. PREVENTIVE MEASURES
 Breast-feeding
 Hand washing
 Improve water quality and sanitation
 Oral rehydration therapy- to prevent
dehydration

13. 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

14. 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.

15. Resistance to
disinfectants
Ineffectiveness
to ORS
Need for
effective
vaccine

16. VACCINES
 RotaShield
 Rotarix
 RotaTeq
 Rotavac

17.  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

18. 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%

19. 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

20. 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

22. 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,

24. 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

25. 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

26. 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

27. 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

28. 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.

29. 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

30. 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)

31. 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.

32. 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.

33. THANK YOU