Department of Community Medicine, Maulana Azad Medical College, New Delhi, India.
Indian J Public Health. 2012 Jan-Mar;56(1):17-21. doi: 10.4103/0019-557X.96951.
Rotavirus is currently by far the most common cause of severe diarrhea in infants and young children worldwide and of diarrheal deaths in developing countries. Worldwide Rotavirus is responsible for 611,000 childhood deaths out of which more than 80% occur in low-income countries. The resistance of rotavirus to commonly used disinfectants and ineffectiveness of oral rehydration therapy due to severe vomiting indicates that if an effective vaccine is the preferred option. WHO has recommended inclusion of rotavirus vaccine in the National Schedules where under 5 mortality due to diarrheal diseases is ≥ 10%. Currently two vaccines are available against rotavirus. Rotarix (GlaxoSmithKline) is a monovalent vaccine recommended to be orally administered in two doses at 6-12 weeks. Rota Teq (Merck) is a pentavalent vaccine recommended to be orally administered in three doses starting at 6-12 weeks of age. Serodiversity of rotavirus in India and its regional variation favor either a monovalent vaccine that can induce heterotypic immunity or a polyvalent vaccine incorporating majority of serotypes prevalent in the country. However, the efficacy of available rotavirus vaccines is less in low-income countries. Both the candidate vaccines when coadministered with OPV, immune response to first dose of these vaccines is reduced. However, immune responses to subsequent rotavirus vaccine doses are not affected. In view of this, WHO recommends three doses of either vaccine to be given to children in developing countries to produce the optimum response. Indigenous vaccine, 116E (Bharat Biotech) based on human rotavirus of serotype G9P [11] is still under Phase 2 trials. Another multivalent vaccine is being developed by Shantha Biotechnics in India. The cost effectiveness of the three dose schedule of the available and the rsults of the field trials of the indigenous vaccines should be assessed before inclusion of rotavirus vaccine in the National Immunization Schedule.
轮状病毒是目前为止全世界导致婴幼儿严重腹泻和发展中国家腹泻死亡的最主要原因。全世界范围内，轮状病毒导致 61.1 万名儿童死亡，其中超过 80%的死亡发生在低收入国家。轮状病毒对常用消毒剂有抵抗力，并且由于严重呕吐，口服补液疗法效果不佳，这表明如果有有效的疫苗，这将是首选方案。世界卫生组织建议在 5 岁以下儿童因腹泻病导致的死亡率≥10%的国家免疫规划中纳入轮状病毒疫苗。目前有两种针对轮状病毒的疫苗。Rotarix（葛兰素史克）是一种单价疫苗，建议在 6-12 周龄时口服两剂。Rota Teq（默克）是一种五价疫苗，建议在 6-12 周龄时口服三剂。印度轮状病毒血清型的血清多样性及其区域变异有利于单价疫苗，该疫苗可以诱导异源免疫，或者是一种包含该国大多数流行血清型的多价疫苗。然而，在低收入国家，现有的轮状病毒疫苗的有效性较低。当这两种候选疫苗与 OPV 联合使用时，这些疫苗的第一剂免疫反应会降低。然而，随后的轮状病毒疫苗剂量的免疫反应不受影响。鉴于此，世界卫生组织建议在发展中国家的儿童中接种三剂疫苗，以产生最佳的免疫反应。基于血清型 G9P [11]的人轮状病毒 116E（Bharat Biotech）的本土疫苗仍处于第二阶段试验中。印度 Shantha Biotechnics 正在开发另一种多价疫苗。在将轮状病毒疫苗纳入国家免疫规划之前，应该评估三剂方案的成本效益以及本土疫苗的现场试验结果。
