Rotavirus gastroenteritis: why to back up the development of new vaccines?

Rotaviruses (RVs) are the main aetiologic agent of severe acute diarrhoea in children under the age of 5, worldwide. Given that the currently available preventive measures to fight against the transmission of RV disease are not sufficiently effective, vaccination likely represents the only efficacious adapted response to the massive impact of this infection. Although the two current RV vaccines have shown good tolerance and significant efficacy to protect infant against severe RV disease, their development have raised key questions that are still unanswered regarding their cost, efficacy and safety. These two vaccines have in common the disadvantages related to the use of oral attenuated live viruses which limit their implementation in both developed and developing countries. In order to overcome these hurdles, it is important to support the development of new, non-replicating vaccines which will not suffer the potential disadvantages of the present vaccines. New approaches and other routes of administration are being tested in animal models and soon will be evaluated in humans. Among those are viral-like particle-based vaccines which have provided the most promising results. Finally, the epidemiology of the disease which differs in developed and developing countries can affect decisions about vaccine composition and delivery. The answer brought by the development of new RV vaccines could reside in developing several types of RV vaccines specifically designed to be used in different settings.