Understanding reduced rotavirus vaccine efficacy in low socio-economic settings

Benjamin A. Lopman, Virginia E. Pitzer, Rajiv Sarkar, Beryl Gladstone, Manish Patel, John Glasser, Manoj Gambhir, Christina Atchison, Bryan T. Grenfell, W. John Edmunds, Gagandeep Kang, Umesh D. Parashar

Research output: Contribution to journalArticlepeer-review

109 Scopus citations


Introduction: Rotavirus vaccine efficacy ranges from &90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance. Methods: We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy. Results: Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES. Discussion: The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements.

Original languageEnglish (US)
Article numbere41720
JournalPloS one
Issue number8
StatePublished - Aug 6 2012

All Science Journal Classification (ASJC) codes

  • General
  • General Biochemistry, Genetics and Molecular Biology
  • General Agricultural and Biological Sciences


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