Supplementary Online Content

Supplementary Online Content Troeger C, Khalil IA, Rao PC, et al. Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatr. Published online August 3, 8. doi:./jamapediatrics.8.96 Supplement. etable. Covariates used in GBD 6 diarrhea modeling etable. The association between rotavirus detection and diarrhea case status etable 3. Data points used for rotavirus proportion modeling by country and source population etable 4. Deaths, mortality rate per,, incidence per, and number of cases due to rotavirus in 6 among children under 5 etable 5. Deaths averted due to the rotavirus vaccine and remaining avertable deaths if vaccine coverage were % in 6 by GBD region and country efigure. Data coverage maps efigure. Diagnostic ability to discriminate cases and controls of qpcr efigure 3. Modeled rotavirus vaccine coverage among children under 5 in 6 efigure 4. Modeled number of under 5 deaths averted due to rotavirus vaccine in 6 efigure 5. A comparison of the number of deaths and PAFs due to rotaviral diarrhea in GBD 5 and GBD 6 in all ages and children under-5 efigure 6. Visualizing uncertainty around PAF estimates This supplementary material has been provided by the authors to give readers additional information about their work. etable. Covariates used in GBD 6 diarrhea modeling. Level is ranked from (causally related) to 3 (distally related). Direction is the required negative or positive association with diarrhea mortality. Covariate Level Direction Diarrhea Summary Exposure Variable (SEV) + Height for age < SD + Sanitation SEV +

Water SEV + Weight for age < SD + Weight for height < SD + Handwashing - Rotavirus vaccine - Safe sanitation - Safe water - Breastfeeding SEV + Vitamin A deficiency + Zinc deficiency + Healthcare access and quality index - LDI per Capita 3 - Maternal education per capita 3 - Socio-demographic index 3 - Population <5/km 3 Population >/km 3

etable. The association between rotavirus detection and diarrhea case status. The odds ratios of diarrhea given the presence of rotavirus in a stool sample, based on a molecular diagnostic case definition, is shown for the two age groups used in this study. Age Odds ratio (95% CI) Under 5.4 (9.9-3.) Over 4. (7.4-5.7)

etable 3. Data points used for rotavirus proportion modeling by country and source population. Location iso3 Code Data points Inpatient population Rotavirus exclusive testing New for GBD 6 Angola AGO Albania ALB 6 5 6 Argentina ARG 9 Australia AUS 4 9 Austria AUT Belgium BEL 4 4 7 Burkina Faso BFA 7 8 5 5 Bangladesh BGD 98 48 4 Bulgaria BGR 8 8 Bosnia and Herzegovina BIH 5 5 Bolivia BOL 3 3 Brazil BRA 4 93 87 6 Botswana BWA 7 Central African Republic CAF 7 8 3 Switzerland CHE Chile CHL 9 China CHN 94 4 9 Cote d'ivoire CIV 4 4 4 Cameroon CMR 9 7 5 Democratic Republic of the Congo COD 6 Congo COG 7 7 Colombia COL 8 4 Cuba CUB 4 4 4 Germany DEU 6 4 Denmark DNK 3 3 Ecuador ECU Egypt EGY England ENG 3 Spain ESP 85 74 47 Estonia EST 3 3 Ethiopia ETH 9 8 8 Finland FIN 7 3 Fiji FJI 9 9 France FRA 6 4 7 Gabon GAB Ghana GHA 4 7 The Gambia GMB 9 6

Location iso3 Code Data points Inpatient population Rotavirus exclusive testing New for GBD 6 Guinea-Bissau GNB 5 5 5 Greece GRC 8 5 Guatemala GTM 5 8 3 Guyana GUY Honduras HND Haiti HTI Hungary HUN 3 3 3 Indonesia IDN 3 9 8 7 India IND 9 87 46 48 Ireland IRL Iran IRN 7 6 Iceland ISL 7 Israel ISR 3 Italy ITA 3 3 7 3 Jordan JOR Japan JPN 5 6 7 Kazakhstan KAZ 3 3 3 Kenya KEN 88 8 58 Kyrgyzstan KGZ 5 Cambodia KHM 9 8 7 South Korea KOR 54 48 45 Laos LAO 8 5 Libya LBY 5 4 Sri Lanka LKA Morocco MAR 9 9 5 Madagascar MDG 8 8 Mali MLI 7 9 Mongolia MNG Mozambique MOZ 8 9 3 Mauritius MUS 7 7 Malawi MWI 4 3 Malaysia MYS Namibia NAM Niger NER Nigeria NGA 43 3 3 Nicaragua NIC 3 Netherlands NLD 5 5 Nepal NPL 65 8 3 Oman OMN

Location iso3 Code Data points Inpatient population Rotavirus exclusive testing New for GBD 6 Pakistan PAK 33 4 5 Peru PER 7 3 3 Philippines PHL 9 9 8 Papua New Guinea PNG 6 6 Poland POL 6 Portugal PRT Paraguay PRY 9 9 8 Western Europe R 3 3 Southern Sub-Saharan Africa R Romania ROU 4 3 Russia RUS 7 7 Rwanda RWA Saudi Arabia SAU 8 3 4 Sudan SDN 4 Senegal SEN 4 Singapore SGP 9 El Salvador SLV 3 3 Suriname SUR Sweden SWE 8 8 7 Togo TGO Thailand THA 39 8 Tunisia TUN 6 5 3 Turkey TUR 3 6 4 Taiwan TWN Tanzania TZA 7 Uganda UGA 5 4 6 6 North East England UKC 6 6 North West England UKD 5 4 8 Yorkshire and the Humber UKE 8 8 East Midlands UKF West Midlands UKG 8 7 East of England UKH 6 6 Greater London UKI 8 8 South East England UKJ South West England UKK 4 4 United States USA 6 9 8 Uzbekistan UZB 8 8 5 Saint Vincent and the Grenadines VCT Venezuela VEN 5 4 7

Location iso3 Code Data points Inpatient population Rotavirus exclusive testing New for GBD 6 Vietnam VNM 7 7 South Africa ZAF 9 5 6 Zambia ZMB 9 9 9 Zimbabwe ZWE 3

etable 4. Deaths, mortality rate per,, incidence per, and number of cases due to rotavirus in 6 among children under 5. Location Global Southeast Asia, East Asia, and Oceania East Asia China North Korea Taiwan Southeast Asia Cambodia Indonesia Laos Malaysia Maldives Mauritius Myanmar Philippines Sri Lanka Deaths 8,53 (4,496-55,648) 4,499 (3,498-5,63) 649 (478-88) 474 (363-6) 73 (8-3) (-3) 3,765 (,895-4,789) 96 (55-58),994 (,498-,6) 39 (39-6) 7 (5-) (-) (-) 34 (48-69) 887 (558-,38) 3 (-6) Mortality rate per,.3 (6.5-4.6) 3.7 (.8-4.6). (.7-.4).8 (.6-.) 5.8 (.8-.5). (.-.3) 6.6 (5.-8.4) 5. (.9-8.4) 8.8 (6.6-.5) 9. (.3-55.).3 (.-.5).4 (.3-.7).7 (.-.5) 7. (3.-3.) 7.7 (4.8-.9). (.-.4) Incidence per, 4.3 (3.3-59.5) 35.5 (7.3-45.5) 5.3 (85.4-83.7). (76.7-6.) 37. (35.-546.) 94.3 (6.3-34.4) 57.9 (36.5-76.) 667.9 (453.8-9.4) 538.7 (369.3-776.) 833. (569.3-,58.).5 (6.-357.7) 58. (64.9-396.8) 374.8 (4.-574.) 334.7 (4.7-499.9) 57.3 (39.-67.) 34.7 (47.8-358.6) Cases 58,73,78 (93,95,64-34,67,879) 38,563,33 (7,4,7-53,73,367) 8,8,369 (5,643,598-,34,956) 6,86,66 (4,736,-9,95,575),4,987 (77,8-,79,896),885 (,49-37,854) 9,845,38 (,86,78-4,494,63),3,98 (83,6-,688,584),948,7 (8,878,37-8,654,5) 899,94 (64,47-,49,885) 579,57 (38,9-93,53) 9,5 (6,76-4,6) 4,854 (5,93-38,74),93,74 (,343,46-3,7,99) 5,868,48 (4,54,6-7,763,54) 36,99 (5,95-499,533)

Location Seychelles Thailand Timor-Leste Vietnam Oceania American Samoa Federated States of Micronesia Fiji Guam Kiribati Marshall Islands Northern Mariana Islands Papua New Guinea Samoa Solomon Islands Tonga Vanuatu Central Europe, Eastern Europe, and Central Asia Deaths (-) 5 (5-39) 54 (7-98) 44 (5-73) 85 (44-53) (-) (-) 4 (-7) (-) (-3) (-) (-) 7 (34-36) (-) 5 (-9) (-) (-4) 37 (-456) Mortality rate per,.4 (.-.6).8 (.5-.3) 3.5 (6.-59.).6 (.3-.) 6. (3.-.8).5 (.3-.9).8 (.3-.5) 7. (3.3-3.6). (.-.4). (4.9-.8). (.4-.3). (.-.) 6.7 (3.-.7).4 (.-.8) 6. (3.-.7). (.4-.) 5. (.3-9.9). (.8-.6) Incidence per, 35.8 (4.7-545.7) 487.9 (366.5-664.4) 734.8 (48.6-,8.8) 63.3 (4.7-99.) 34.9 (8.3-487.) 76.8 (78.5-47.4).5 (4.9-33.) 3. (.7-469.3) 83.8 (8.6-433.6) 343. (7.-58.) 6.8 (67.8-39.7) 39.8 (44.9-69.4) 334.9 (3.8-55.) 3.7 (93.9-458.9) 387.3 (54.-575.) 83.5 (87.-49.6) 44.9 (66.9-596.) 43. (96.-65.9) Cases,955 (,84-4,584),,3 (96,6-,66,77),87 (79,346-8,3) 4,5,34 (3,4,76-6,55,488) 448,63 (87,666-67,555),69 (,334-3,),89 (,393-3,83) 6,95 (,987-5,56) 4,96 (3,73-7,578) 4,665 (,953-7,78),58 (,649-3,848) 6,7 (3,794-9,598) 348,845 (,664-56,94) 8,333 (5,355-,674) 3,748 (,87-47,44) 3,88 (,56-5,744) 6,35 (,778-4,7) 3,7,87 (9,5,945-8,44,868)

Location Central Asia Armenia Azerbaijan Georgia Kazakhstan Kyrgyzstan Mongolia Tajikistan Turkmenistan Uzbekistan Central Europe Albania Bosnia and Herzegovina Bulgaria Croatia Czech Republic Hungary Macedonia Deaths 37 (45-366) (-) 7 (3-5) (-3) 9 (5-5) 3 (5-34) (-) 43 (7-63) 7 (9-3) 5 (7-8) 4 (9-3) (-) (-) (-3) (-) (-) (-) (-) Mortality rate per,.5 (.5-3.8).5 (.3-.9).8 (.3-5.).4 (.-.8).5 (.3-.8) 3. (.-4.5). (.-.).6 (6.3-3.) 3. (.6-5.3).4 (.-.8).4 (.3-.6). (.-.3).4 (.-.6).5 (.3-.9). (.-.). (.-.). (.-.).6 (.3-.) Incidence per, 7.5 (7.9-6.5) 33.5 (43.5-358.7) 33.6 (9.-47.7) 37.9 (44.-368.) 8.9 (.3-76.) 4.6 (89.-.8) 354. (3.4-58.) 34.4 (93.4-47.) 353.6 (.-547.5) 78.7 (45.8-5.4) 7.6 (5.7-,7.8) 337. (5.-57.7) 399.4 (53.4-593.6) 58.9 (3.-78.3) 68.4 (44.-,46.) 586.9 (356.8-95.) 75.5 (67.4-435.) 434. (63.5-67.6) Cases,899,833 (,87,968-,89,6) 5,55 (3,7-8,674) 8, (77,56-437,855) 66,44 (4,34-,773) 353,358 (9,333-539,9) 4,8 (7,375-7,63) 3,766 (85,733-96,5) 334,7 (,34-56,35) 89,5 (7,974-93,444) 378,433 (,7-63,96) 4,5,58 (,864,684-5,868,45) 58,485 (35,574-9,594) 68,983 (43,757-,5) 7,97 (8,794-65,566) 35,746 (8,44-8,86) 33,9 (,976-57,954) 4, (85,87-,43) 49,436 (3,4-76,38)

Location Montenegro Poland Romania Serbia Slovakia Slovenia Eastern Europe Belarus Estonia Latvia Lithuania Moldova Russia Ukraine High-income High-income Asia Pacific Brunei Japan Deaths (-) (-4) 5 (-) (-) (-) (-) 55 (36-78) (-) (-) (-) (-) (-) 48 (3-7) 5 (-) 34 (9-64) (8-3) (-) 8 (6-) Mortality rate per,. (.-.3). (.-.).7 (.-.5).3 (.-.5).3 (.-.5). (.-.).4 (.3-.6). (.-.). (.-.). (.-.). (.-.).5 (.3-.8).5 (.3-.8). (.-.4). (.-.3). (.-.).3 (.-.4). (.-.) Incidence per, 97.3 (78.6-466.9) 86.8 (585.8-,68.7),86.8 (85.6-,66.8) 54.5 (343.6-784.4) 66.6 (384.-,53.4) 74.6 (48.7-,.3) 5.4 (36.5-73.4) 4.4 (55.-67.) 499.5 (34.4-687.6) 58.7 (368.8-856.4) 748.5 (479.-,96.7) 35.4 (.5-48.7) 53.6 (374.7-749.4) 497.5 (38.4-73.) 8.8 (8.-7.7) 33. (.7-49.9) 35.8 (.3-54.) 36. (.-54.5) Cases,995 (6,64-7,67),7,463 (,64,-,5,93) 945,983 (678,79-,35,46),879 (4,-3,989) 96,77 (4,399-33,656) 74,9 (43,458-6,99) 7,,8 (4,96,838-,,54) 39,56 (5,359-36,384) 38,355 (4,98-5,796) 75,3 (47,675-,75) 3,83 (84,59-93,677) 7,54 (46,96-7,6) 5,6,797 (3,73,9-7,45,344),94,68 (88,64-,899,3) 6,93,77 (4,77,88-9,978,464) 5,4 (57,464-379,899),5 (78-,89) 87,85 (5,95-83,8)

Location South Korea Singapore Australasia Australia New Zealand Western Europe Andorra Austria Belgium Cyprus Denmark England Finland France Germany Greece Iceland Ireland Deaths (-3) (-) 3 (-4) (-3) (-) 5 (38-64) (-) (-) (-) (-) (-) 5 (4-6) (-) 8 (-6) 6 (4-8) (-) (-) (-) Mortality rate per,. (.-.). (.-.). (.-.). (.-.). (.-.3). (.-.3). (.-.4). (.-.).3 (.-.4).6 (.3-.).5 (.4-.7). (.-.). (.-.).5 (.3-.7). (.-.). (.-.). (.-.). (.-.) Incidence per, 4. (4.7-37.9) 53.6 (34.-83.8) 34.3 (.7-5.3) 8.8 (8.-44.) 6.9 (4.-98.3) 9. (43.9-37.8) 3.9 (6.3-44.5) 7.5 (68.-4.5) 49.5 (5.-386.4) 89.7 (58.6-55.6) 453.3 (87.4-69.8) 44.9 (9.9-.3) 736. (47.-,88.9) 6.9 (66.5-49.) 55. (57.9-39.) 4.6 (6.5-69.3) 94.6 (8.5-36.5).7 (6.7-9.3) Cases 53,5 (3,5-83,835) 9,53 (6,4-4,844) 6,334 (39,4-94,978) 43,9 (7,465-67,36) 8,4 (,73-8,755) 4,866,57 (3,96,6-7,79,975) 696 (378-,9) 6,79 (66,83-6,78) 54,96 (94,43-39,9) 4,977 (8,-6,4) 9,55 (8,33-97,739) 46,37 (9,777-76,6) 4,67 (37,76-37,54),,477 (649,967-,597,) 886,893 (548,85-,36,736) 49,74 (9,54-8,57) 4,6 (,535-6,554) 4,774 (3,74-7,545)

Location Israel Italy Luxembourg Malta Netherlands Northern Ireland Norway Portugal Scotland Spain Sweden Switzerland Wales Southern Latin America Argentina Chile Uruguay High-income North America Deaths 3 (-4) 5 (3-7) (-) (-) (-3) (-) (-) (-) (-) (-) (-) (-) (-) 33 (5-43) 8 (-38) (-4) (-3) 39 (9-5) Mortality rate per,.4 (.3-.5). (.-.3).3 (.-.5). (.-.). (.-.3).4 (.-.8). (.-.).3 (.-.5).3 (.-.5). (.-.). (.-.).3 (.-.4).5 (.3-.8).7 (.5-.8).8 (.6-.). (.-.3).8 (.4-.3). (.-.) Incidence per, 66.6 (7.3-46.5).7 (5.6-86.7) 4. (3.-47.) 95.4 (5.-7.) 48.5 (68.3-666.) 98.6 (7.5-356.).9 (5.3-4.7) 63.9 (98.8-53.6) 93.5 (4.6-355.4) 78. (5.8-5.5). (37.7-339.9) 73. (7.4-47.) 3.8 (7.-56.4) 4. (66.3-3.5) 36.7 (78.9-33.).3 (36.5-37.).7 (6.-6.3) 3.4 (9.-45.) Cases 4,4 (98,65-7,8) 57,733 (48,64-77,83) 6,99 (3,84-,48),8 (,-3,63) 37,773 (33,44-579,48) 3,55 (,748-4,4) 6,85 (3,634-3,756) 75,773 (45,686-7,6) 5,75 (8,49-96,776) 85,335 (5,338-74,38) 4,968 (78,54-93,95) 3,67 (7,437-7,737) 5,3 (7,373-9,4),,37 (83,556-,59,433) 839,95 (634,9-,,8) 57,959 (66,675-387,43) 4,36 (4,838-38,53) 65,8 (4,958-97,57)

Location Canada Greenland United States Latin America and Caribbean Caribbean Antigua and Barbuda The Bahamas Barbados Belize Bermuda Cuba Dominica Dominican Republic Grenada Guyana Haiti Jamaica Puerto Rico Deaths (-) (-) 37 (8-48),59 (976-,595) 98 (6-38) (-) (-) (-) (-) (-) 3 (-4) (-) 34 (7-6) (-) 5 (3-9) 46 (79-6) 4 (-8) (-) Mortality rate per,. (.-.).3 (.-.5). (.-.).5 (.-3.) 5. (.9-8.).9 (.4-.7).7 (.-.6).6 (.-.3).6 (.6-3.6). (.-.).4 (.3-.6). (.6-.3) 3.6 (.9-6.5).7 (.3-.5) 8.4 (4.8-3.7) 9.6 (5.-7.).4 (.6-.8).3 (.-.6) Incidence per, 3. (7.9-48.5) 4.9 (4.-66.) 3.4 (9.-44.8) 447. (37.3-64.) 86.6 (.4-99.3) 33. (7.-585.) 73. (4.4-5.) 6.9 (35.9-483.) 9. (59.-53.) 8.7 (4.9-59.7) 6.4 (44.-96.7) 64. (38.8-485.6) 85. (46.4-535.8) 55.5 (9.8-473.9) 35. (6.7-54.5) 9.7 (67.-88.) 75. (93.6-34.) 85.7 (93.5-358.) Cases 58,977 (34,983-94,549) 4 (84-9) 593,7 (375,338-875,9),38,6 (4,53,864-9,44,68) 77,44 (459,648-,34,977),494 (79-,75) 8,7 (4,57-5,97) 4,93 (,3-7,576),6 (6,567-,63),5 (68-,345) 7,33 (88,84-83,),49 (75-,65) 9,7 (48,973-545,9) 3,48 (,549-5,654) 5,35 (6,85-37,439) 8,8 (,47-84,58) 46,86 (5,4-84,58) 44,635 (,467-86,)

Location Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Virgin Islands, U.S. Andean Latin America Bolivia Ecuador Peru Central Latin America Colombia Costa Rica El Salvador Guatemala Honduras Mexico Nicaragua Panama Deaths (-) (-) (-4) (-) (-) 8 (54-3) 44 (5-73) 9 (-3) 6 (9-5) 74 (538-93) 85 (55-5) 3 (-5) 6 (8-8) 39 (94-95) 5 (9-8) 8 (-364) 5 (3-9) 6 (9-9) Mortality rate per,.9 (.3-.).7 (.9-3.) 4.9 (.4-8.9).9 (.3-.3). (.-.4). (.8-.7) 3. (.8-5.3). (.6-.7).5 (.3-.7) 3. (.4-4.).4 (.5-3.5).8 (.4-.6).9 (.5-5.) 7. (4.8-9.9) 5.3 (3.-8.5).4 (.8-3.).9 (.5-.4) 4.7 (.5-8.3) Incidence per, 38.4 (3.5-688.8) 3.7 (48.8-344.6) 87.9 (7.-93.7) 46. (77.-69.4) 7.8 (39.3-59.7) 56. (7.3-353.4) 437.6 (94.3-64.) 3.7 (95.-48.5) 54.8 (98.8-.6) 367.3 (4.6-533.6) 656. (44.6-966.3) 44.4 (3.-85.7) 55. (343.4-839.7) 39.5 (56.-539.9) 46.6 (75.-63.) 3.9 (9.6-34.) 66.3 (3.-5.3) 473.3 (47.8-858.) Cases 3,88 (,37-6,894),98 (,47-3,83) 9,94 (6,8-5,497),978 (6,84-3,9),484 (76-,784),679,785 (,3,593-,38,98) 584,9 (39,939-854,57) 545,584 (39,857-85,74) 547,3 (349,35-783,48) 8,9,7 (5,4,57-,95,43),3,63 (,374,-3,7,39) 43,84 (75,6-64,579) 57,963 (6,3-393,69) 747,833 (49,368-,33,93) 399,764 (57,735-565,6),378,537 (,5,635-3,66,993) 4,4 (8,937-7,3) 7,45 (9,8-3,3)

Location Venezuela Tropical Latin America Brazil Paraguay North Africa and Middle East Afghanistan Algeria Bahrain Egypt Iran Iraq Jordan Kuwait Lebanon Libya Morocco Palestine Oman Deaths 9 (78-75) 67 (5-345) 59 (98-335) 9 (5-4) 4,93 (,74-6,4) 84 (4-,5) 43 (-83) (-) 94 (463-,558) 56 (55-363) 3 (8-68) 7 (4-) (-) (-4) (-4) 35 (34-39) 7 (3-) (-3) Mortality rate per, 4. (.7-6.).7 (.3-.).7 (.3-.).4 (.8-.3) 6.6 (4.3-.) 6.9 (8.3-3.7).9 (.4-.8). (.-.3) 8.3 (4.-4.3).9 (.7-4.5) 4. (.7-7.9).7 (.4-.).3 (.-.5).6 (.3-.3).5 (.-.9).3 (5.8-7.).6 (.3-.).3 (.-.6) Incidence per, 694. (44.-,9.8) 74. (5.3-993.) 734.9 (59.3-985.) 976.9 (64.-,39.) 45.8 (67.4-68.8) 6.6 (33.9-,7.3) 5.3 (4.-4.8) 5.8 (9.7-443.3) 99.9 (3.9-97.) 96.4 (63.8-,43.3) 375.9 (99.-64.) 39.4 (5.3-57.9) 3.5 (69.-6.4) 386.6 (4.3-637.3) 87.6 (6.8-96.9) 475.9 (37.9-79.) 356.6 (9.9-595.7) 64.5 (46.6-956.8) Cases,965,4 (,48,478-,886,493),553,5 (7,446,877-4,59,79),48,349 (7,4,676-3,737,5) 35,549 (88,969-435,57) 6,48, (6,98,98-38,665,9),85,954 (,578,83-4,84,54),84,98 (7,453-,39,554) 4,8 (,53-4,747),39,35 (,48,493-3,55,97) 6,8,659 (4,44,3-,94,55),783,55 (,474,37-4,546,39) 374,7 (4,3-548,98) 88,54 (46,7-5,76) 6,53 (64,594-9,) 9,88 (5,59-46,79),68,5 (69,948-,59,394) 38,437 (4,99-637,) 76,4 (75,9-4,88)

Location Qatar Saudi Arabia Sudan Syria Tunisia Turkey United Arab Emirates Yemen South Asia Bangladesh Bhutan India Nepal Pakistan Sub-Saharan Africa Central Sub-Saharan Africa Angola Deaths (-) 7 (4-) 53 (7-,73) 5 (-) 4 (-7) 39 (-65) (-),93 (385-,3) 3,396 (,6-7,453) 78 (477-,6) 3 (-5),8 (7,44-3,73) 6 (84-84),69 (,4-3,3) 4,733 (83,46-8,84) 5,67 (9,98-3,94),4 (,4-3,8) Mortality rate per,. (.-.4).3 (.-.4).7 (4.9-8.).3 (.-.6).5 (.3-.9).6 (.3-.). (.-.3) 3.6 (8.3-48.) 8.7 (6.6-.4) 5.5 (3.3-8.) 3.6 (.6-6.4) 9. (6.6-.) 4. (.-7.) 9.4 (6.-3.5) 66.9 (53.3-8.3) 75. (48.-5.) 4.8 (.7-66.9) Incidence per, 55.6 (83.-8.9) 4.4 (47.8-33.5) 494.9 (344.7-693.7) 4.6 (7.-44.8) 37.7 (35.3-46.8) 57. (9.-34.9) 5.4 (3.8-434.7) 659.3 (359.9-,8.7). (56.7-3.9) 44.4 (333.3-5.) 898.7 (69.-,33.) 94.7 (7.-85.3) 458.3 (377.-554.5) 73. (7.3-4.5) 74.6 (589.-934.),353.4 (,65.-,683.) 66.5 (476.-949.4) Cases 9,7 (,53-35,585) 57,8 (376,953-84,879),87,5 (,7,5-,56,4) 469,7 (46,94-85,83) 85,5 (8,38-377,533),6,39 (,97,98-,37,44) 34,6 (,86-44,747),978,63 (,65,935-5,333,69) 35,69,5 (5,43,3-48,4,337) 6,8,744 (4,97,575-7,77,46) 67,965 (46,8-93,64),6,577 (4,756,86-33,4,659),99,59 (,587,98-,333,9) 4,8,67 (,865,976-5,9,83) 7,33,76 (93,39,38-47,54,73) 8,733,79 (,6,65-35,735,936) 3,34,69 (,38,788-4,749,9) Central African Republic,3 66.,63. 999,3

Location Congo Democratic Republic of the Congo Equatorial Guinea Gabon Eastern Sub-Saharan Africa Burundi Comoros Djibouti Eritrea Ethiopia Kenya Madagascar Malawi Mozambique Rwanda Somalia South Sudan Deaths Mortality rate per, Incidence per, Cases (759-,95) (.-59.4) (96.3-,63.8) (73,76-,9,6) 73 (5-46),58 (6,6-9,978) 5 (-) 44 (4-74) 6,3 (3,4-9,85),84 (,84-,97) 8 (9-34) 9 (9-36) 89 (58-468),649 (,76-3,738),44 (,8-,99),78 (96-,74), (599-,54),6 (74-,84) 65 (4-985) 58 (58-93) 93 (443-,76) 36.6 (.-6.8) 85.8 (47.-4.) 5.5 (.5-.6) 8. (9.8-3.) 6. (.8-3.7) 84.7 (5.6-36.6) 9.6 (.-36.4). (5.-.) 36.3 (9.9-58.8) 7.3 (.-4.5).4 (5.3-9.4) 44. (4.7-7.5) 3. (8.7-48.) 4.5 (4.9-37.) 34.7 (.9-5.6) 39. (9.6-7.5) 3.9 (5.5-6.) 944.9 (79.7-,.),63.5 (,9.7-,.3),6. (645.-,59.) 789.7 (578.9-,33.5) 43. (33.6-56.5) 6. (39.9-94.5) 534.7 (33.4-8.) 473. (84.6-759.4) 53. (33.9-847.9) 99. (33.9-37.) 343. (8.5-5.3) 358.5 (.-554.3) 58. (375.7-857.7) 366.8 (8.-48.4) 7. (57.8-93.5) 636. (4.-99.8) 79.9 (435.3-,3.) 74,8 (536,55-99,997) 3,49,73 (8,55,88-8,867,977) 4,6 (63,3-56,) 96,75 (43,749-56,65) 6,95,99 (,63,853-34,965,79),36,33 (83,6-,955,556) 5,97 (3,-78,737) 59,94 (35,67-95,89) 39,488 (35,534-636,56) 4,49,58 (3,455,96-5,496,36),6,59 (,55,5-3,38,79),384,649 (85,38-,4,),88,469 (,3,479-,77,4),84,77 (,46,3-,47,55),336, (,6,959-,694,96) 75,3 (499,-,75,89),46,88 (,97,64-3,374,5) Tanzania,4 3.6 77.,6,35

Location Uganda Zambia Southern Sub-Saharan Africa Botswana Lesotho Namibia South Africa Swaziland Zimbabwe Western Sub-Saharan Africa Benin Burkina Faso Cameroon Cape Verde Chad Cote d'ivoire The Gambia Deaths Mortality rate per, Incidence per, Cases (775-,834) (8.6-.4) (96.-389.4) (,84,554-3,657,7),46 (,44-3,7) 7 (466-,86),54 (,7-,7) (5-) 4 (89-8) (53-63) 39 (5-489) 75 (43-9) 866 (553-,66) 7,33 (53,5-9,87),86 (,94-,78),699 (,584-4,48),96 (,77-3,59) 3 (-5) 4,9 (,693-6,486),596 (,57-3,947) 37 (3-54) 8.6 (9.-4.8) 5.4 (6.4-38.) 7.6 (.4-4.) 4.3 (.-8.) 54.7 (34.4-84.6) 3.3 (6.-48.9) 6.4 (4.-9.8) 36. (.8-56.9) 34. (.8-5.).3 (8.-4.) 94.5 (57.3-4.7) 84.5 (49.6-33.) 5.6 (3.3-78.9) 3.9 (.3-6.) 6. (.9-45.6) 7.9 (44.-.9). (6.4-4.7) 694. (536.4-883.6) 454.8 (347.8-57.) 37.3 (57.5-34.) 77.6 (4.6-8.) 99. (93.5-443.8) 39. (96.7-477.).5 (45.7-38.) 44.6 (5.5-375.) 7. (75.6-396.7) 95. (73.-,5.4) 57.8 (36.-86.6),8. (96.5-,549.) 94.3 (695.7-,68.9) 4.5 (5.3-639.9),4.8 (695.8-,6.) 636.3 (47.5-99.9) 76.8 (7.4-58.) 5,38,86 (4,48,9-6,669,4),83,67 (98,67-,6,55),5,738 (,47,96-3,,783), (,34-34,889) 75,5 (48,855-,5) 8,7 (67,-6,469),9,643 (787,473-,78,763) 5,8 (3,768-76,668) 7,65 (454,567-,6,9) 59,763,343 (47,747,55-75,87,78),8,98 (77,444-,683,) 3,888,875 (3,98,9-4,986,47) 3,556,39 (,735,863-4,596,857) 3,59 (8,683-47,569),874,43 (,793,88-4,5,43),4,796 (,459,666-3,5,367) 64,94 (43,3-94,8) Ghana 664 5.3 7.6 3,89,343

Location Guinea Guinea-Bissau Liberia Mali Mauritania Niger Nigeria Sao Tome and Principe Senegal Sierra Leone Togo Deaths Mortality rate per, Incidence per, Cases (4-,5) (9.4-3.6) (575.-877.9) (,654,688-4,5,3) 85 (476-,435) 95 (7-93) 665 (4-,4),9 (694-,668) 77 (-7) 4,6 (,654-6,) 47,683 (3,76-66,7) 5 (3-) 93 (575-,37), (676-,78) 439 (57-694) 4.8 (3.4-7.5) 63. (37.6-94.7) 93. (56.3-43.6) 35. (.-53.) 34.4 (.3-5.6).9 (7.-6.9) 6.5 (7.4-4.4) 6. (7.6-8.6) 35.5 (.6-5.8) 7.9 (65.-7.4) 4. (3.5-63.4) 76.8 (477.-,3.) 799.7 (59.4-,93.4) 88.9 (55.-,34.8) 87. (3.4-68.4) 679. (438.-995.6) 76.3 (573.-98.9),6. (93.6-,386.3) 6.8 (375.-98.) 63. (4.6-85.) 63. (396.8-983.) 885.9 (697.8-,8.),56,68 (954,754-,47,538) 44,354 (6,753-364,69) 65,35 (39,99-95,88) 576,676 (4,78-86,975) 339, (8,583-496,95),656,64 (,5,3-3,37,36) 33,5,45 (7,43,439-4,68,63),796 (,96-3,7),57,4 (,8,596-,8,663) 648,546 (4,969-,3,3) 967,975 (76,38-,,8)

etable 5. Deaths averted due to the rotavirus vaccine and remaining avertable deaths if vaccine coverage were % in 6 by GBD region and country. Location Deaths averted Avertable deaths Global 8844 (46-4675) High-income 67 (44-94) High-income North America 3 (-4) Canada (-) Greenland (-) United States 3 (-4) Australasia 4 (-6) Australia 3 (-6) New Zealand (-) High-income Asia Pacific (-) Brunei (-) Japan (-) Singapore (-) South Korea (-) Western Europe (-34) Andorra (-) Austria (-) Belgium 3 (-5) Cyprus (-) Denmark (-) Finland (-) France (-) Germany (-3) Greece (-) 8358 (36954-6837) 69 (3-35) 3 (6-3) (-) (-) (6-) (-) (-) (-) 8 (4-4) (-) 6 (3-) (-) (-3) 3 (4-64) (-) (-) (-) (-) (-) (-) 4 (6-7) 3 (-7) (-)

Location Deaths averted Avertable deaths Iceland (-) (-) Ireland (-) (-) Israel 4 (-6) (-) Italy (-) 3 (-7) Luxembourg (-) (-) Malta (-) (-) Netherlands (-) (-3) Norway (-) (-) Portugal (-) (-) Spain (-) (-) Sweden (-) (-) Switzerland (-) (-) England 4 (3-5) (-) Northern Ireland (-) (-) Scotland (-3) (-) Wales (-) (-) Southern Latin America (-) 6 (7-33) Argentina (-) 3 (6-6) Chile (-) (-4) Uruguay (-) (-3) Central Europe, Eastern Europe, and Central Asia 75 (6-384) 6 (6-45) Eastern Europe (-) 4 (-84) Belarus (-) (-) Estonia (-) (-) Latvia (-) (-) Lithuania (-) (-) Moldova

Location Deaths averted Avertable deaths Ukraine (-) Central Europe (-) Albania (-) Bosnia and Herzegovina (-) Bulgaria (-) Croatia (-) Czech Republic (-) Hungary (-) Macedonia (-) Montenegro (-) Poland (-) Romania (-) Russian (-) Serbia (-) Slovakia (-) Slovenia (-) Central Asia 74 (6-383) Armenia (-4) Azerbaijan (-) Georgia (-) Kazakhstan (-) Kyrgyzstan (-) Mongolia (-) Tajikistan 3 (48-6) Turkmenistan (-) Uzbekistan 4 (-5) (-) (-) 4 (-) 9 (9-37) (-) (-) (-3) (-) (-) (-) (-) (-) (-4) (6-) 37 (8-7) (-) (-) (-) (3-84) (-) (6-55) (-) 7 (3-6) 8 (8-36) (-) 4 (-4) 3 (5-3) (-)

Location Deaths averted Avertable deaths Latin America and Caribbean 68 (875-597) 38 (3-78) Central Latin America 867 (459-38) 76 (73-45) Colombia 7 (79-86) 8 (-7) Costa Rica (-) (-6) El Salvador 9 (8-34) 3 (-) Guatemala 6 (9-4) 6 (5-45) Honduras 83 (34-48) 7 (-4) Mexico 44 (59-347) 84 (4-58) Nicaragua 5 (4-37) (-) Panama (5-) 6 (-9) Venezuela 63 (4-87) 49 (9-5) Andean Latin America (45-77) 6 (4-53) Bolivia 5 (-9) (-3) Ecuador 33 (5-58) (-9) Peru 7 (8-9) 4 (-) Caribbean 95 (43-69) 9 (5-69) Antigua and Barbuda (-) (-) The Bahamas (-) (-) Barbados (-) (-) Belize (-) (-) Bermuda (-) (-) Cuba (-) (-4) Dominica (-) (-) Dominican Republic 5 (6-9) 6 (4-5) Grenada (-) (-) Guyana (4-9) (-) Haiti 69 65

Location Deaths averted Avertable deaths Jamaica (-) Puerto Rico (-) Saint Lucia (-) Saint Vincent and the Grenadines (-) Suriname (-) Trinidad and Tobago (-) Virgin Islands, U.S. (-) Tropical Latin America 554 (37-869) Brazil 549 (35-86) Paraguay 5 (3-8) Southeast Asia, East Asia, and Oceania 4 (855-6) East Asia 864 (5-379) China 864 (5-379) North Korea (-) Taiwan (-) Southeast Asia 54 (34-775) Cambodia (-) Indonesia (-) Laos (-) Malaysia (-) Maldives (-) Mauritius (-) Myanmar (-) Philippines 54 (34-774) Sri Lanka (-) Seychelles (-) (3-8) (8-9) 3 (-) (-) (-) (-) (-4) (-) (-) 5 (-55) (-45) 3 (-) 79 (37-5776) 9 (7-46) 56 (8-) 3 (43-348) (-3) 539 (7-539) 73 (7-79) 53 (883-53) 5 (7-696) 6 (-3) (-) (-) 47 (75-67) 34 (-85) (-6) (-)

Location Deaths averted Avertable deaths Thailand (-) 9 (8-39) Timor-Leste (-) 4 (4-5) Vietnam (-) 34 (3-79) Oceania 5 (-8) 63 (8-75) American Samoa (-) (-) Federated States of Micronesia (-) (-) Fiji 4 (-7) (-3) Guam (-) (-) Kiribati (-) (-) Marshall Islands (-) (-) Northern Mariana Islands (-) (-) Papua New Guinea (-) 55 (6-54) Samoa (-) (-) Solomon Islands (-) 4 (-) Tonga (-) (-) Vanuatu (-) (-4) North Africa and Middle East (43-638) 5 (655-748) Afghanistan (-) 64 (8-79) Algeria (-) 33 (9-) Bahrain (-) (-) Egypt (-) 69 (38-677) Iran (-) 9 (3-375) Iraq 93 (7-99) 67 (3-554) Jordan 8 (4-) (-5) Kuwait (-) (-) Lebanon (-) (-5) Libya 5

Location Deaths averted Avertable deaths Morocco 46 (67-863) Palestine (-) Oman (-) Qatar (-) Saudi Arabia (5-4) Sudan 99 (9-68) Syria (-) Tunisia (-) Turkey (-) United Arab Emirates (-5) Yemen 373 (6-839) South Asia 47 (94-8) Bangladesh (-) Bhutan (-) India 47 (94-8) Nepal (-) Pakistan (-) Sub-Saharan Africa 46 (68-38666) Southern Sub-Saharan Africa 686 (833-589) Botswana 3 (7-46) Lesotho (-) Namibia 69 (34-6) South Africa 36 (64-5) Swaziland 68 (44-6) Zimbabwe (584-864) Western Sub-Saharan Africa 987 (585-4768) (-3) (-) 8 (7-94) 5 (-5) (-3) (-) (-) 7 (43-764) 4 (-) 3 (-7) 3 (-66) (-) 558 (99-4) 93 (57-8) 598 (68-77) (-6) 77 (469-334) (4-9) 659 (69-334) 6734 (964-35336) 49 (8-3) (-6) 8 (46-4) 36 (9-) 85 (8-) (4-76) 57 (4-485) 4866 (8-94596)

Location Deaths averted Avertable deaths Benin (-) 38 (544-98) Burkina Faso 797 (49-47) 689 (6-973) Cameroon (646-8) 753 (65-837) Cape Verde (-) (-5) Chad (-) 335 (39-694) Cote d'ivoire 9 (486-463) 3 (49-38) The Gambia 33 (7-5) (3-9) Ghana 877 (454-335) 3 (39-366) Guinea (-) 649 (8-64) Guinea-Bissau 8 (6-88) 76 (4-94) Liberia 7 (64-83) 48 (49-95) Mali 8 (-3) 67 (5-54) Mauritania 35 (9-58) 6 (39-5) Niger 74 (44-36) 955 (75-4356) Nigeria (-) 3648 (787-663) Sao Tome and Principe 3 (-5) (-7) Senegal 85 (46-44) 5 (8-655) Sierra Leone 667 (3-9) 439 (34-97) Togo 56 (36-4) 74 (57-43) Eastern Sub-Saharan Africa 58 (5538-9647) 6976 (673-68) Burundi 544 (97-4348) 37 (76-4) Comoros (-) 4 (4-38) Djibouti 8 (3-6) 9 (-9) Eritrea 673 (-56) 9 (3-77) Ethiopia 584 (44-7) 545 (66-998) Kenya 3 (654-68) 455 (8-96) Madagascar 9 636

Location Deaths averted Avertable deaths Malawi 394 (65-554) Mozambique 545 (35-787) Rwanda 358 (566-68) Somalia (-) South Sudan (-) Tanzania 534 (76-465) Uganda (-) Zambia 79 (388-6) Central Sub-Saharan Africa 3 (63-663) Angola 976 (536-466) Central African Republic (-) Congo 37 (77-97) Democratic Republic of the Congo (-) Equatorial Guinea (-) Gabon (-) (5-885) (77-797) 8 (5-53) 553 (98-77) 57 (4-78) 396 (5-76) 7 (5-9) 55 (68-755) 639 (87-937) 9 (63-483) 88 (4533-3499) 874 (56-35) 94 (44-889) 7 (38-9) 97 (38-895) 4 (-) 34 (-77)

efigure. Data coverage maps. A) Shows the number of unique sources providing data in the rotavirus model and B) shows the number of diarrhea samples from the data sources (i.e. the population sample size of the data). The data shown detail the proportion of diarrhea episodes where rotavirus is present. B)

efigure. Diagnostic ability to discriminate cases and controls of qpcr. The modeling strategy requires that the continuous qpcr test results are dichotomized into positive and negative results so that the odds represent the strength of association between rotavirus and diarrhea. The ability to discriminate a stool sample as either a case or control, termed the diagnostic accuracy, of the quantitative PCR (qpcr) array for rotavirus is shown where the relative quantity of rotavirus in a stool sample decreases from left to right. The accuracy is the proportion of stool samples that are correctly classified as case or control. We defined a cutoff point for the presence of rotavirus as the point where the diagnostic accuracy is maximized (blue line).

efigure 3. Modeled rotavirus vaccine coverage among children under 5 in 6. efigure 4. Modeled number of under 5 deaths averted due to rotavirus vaccine in 6.

efigure 5. A comparison of the number of deaths and PAFs due to rotaviral diarrhea in GBD 5 and GBD 6 in all ages and children under-5. The axes are on a log scale and locations are labeled with the iso3 code (see Supplementary Table ) and colored to represent GBD regions.

efigure 6. Visualizing uncertainty around PAF estimates. These plots show the standard error of the distribution of PAF draws by region and rotavirus burden.