Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
BMC Public Health. 2011 Apr 13;11 Suppl 3(Suppl 3):S16. doi: 10.1186/1471-2458-11-S3-S16.
Diarrhea mortality remains a leading cause of child death and rotavirus vaccine an effective tool for preventing severe rotavirus diarrhea. New data suggest vaccine efficacy may vary by region.
We reviewed published vaccine efficacy trials to estimate a regional-specific effect of vaccine efficacy on severe rotavirus diarrhea and hospitalizations. We assessed the quality of evidence using a standard protocol and conducted meta-analyses where more than 1 data point was available.
Rotavirus vaccine prevented severe rotavirus episodes in all regions; 81% of episodes in Latin America, 42.7% of episodes in high-mortality Asia, 50% of episodes in sub-Saharan Africa, 88% of episodes low-mortality Asia and North Africa, and 91% of episodes in developed countries. The effect sizes observed for preventing severe rotavirus diarrhea will be used in LiST as the effect size for rotavirus vaccine on rotavirus-specific diarrhea mortality.
Vaccine trials have not measured the effect of vaccine on diarrhea mortality. The overall quality of the evidence and consistency observed across studies suggests that estimating mortality based on a severe morbidity reduction is highly plausible.
腹泻仍是导致儿童死亡的主要原因，轮状病毒疫苗是预防严重轮状病毒腹泻的有效工具。新数据表明，疫苗的效果可能因地区而异。
我们回顾了已发表的疫苗效力试验，以评估疫苗对严重轮状病毒腹泻和住院的区域性效力。我们使用标准方案评估证据质量，并在有超过 1 个数据点的情况下进行荟萃分析。
轮状病毒疫苗可预防所有地区的严重轮状病毒发作；拉丁美洲 81%的病例、高死亡率亚洲地区 42.7%的病例、撒哈拉以南非洲地区 50%的病例、低死亡率亚洲和北非地区 88%的病例、发达国家 91%的病例。将在 LiST 中使用观察到的预防严重轮状病毒腹泻的效果大小作为轮状病毒疫苗对轮状病毒特异性腹泻死亡率的效果大小。
疫苗试验并未测量疫苗对腹泻死亡率的影响。观察到的证据总体质量和研究间的一致性表明，基于严重发病率降低来估计死亡率是非常合理的。
