. How have rotavirus vaccines worked in developing countries in Latin America? Brendan Flannery, Pan American Health Organization, Brazil and Lúcia De Oliveira, Immunization Unit/FCH, Washington, DC 9th International Rotavirus Symposium, Johannesburg, South Africa, August 2-3, 2010
How have rotavirus vaccines worked in developing countries in the Americas Political support Rotavirus surveillance network Disease burden and cost effectiveness Vaccine introduction Impact of vaccination Special studies Lessons learned
Political support
Pan American Health Organization s (PAHO) Regional Immunization Program Reduce inequities in health between resourcewealth and resource poor countries Political commitment, technical, operational and financial support Providing new and underutilized vaccines to the children and families who need them
Resolution by Ministers of Health, PAHO Directing Council meeting in 2006 Support WHO s Global Immunization Vision and Strategy and the Millennium Development Goals Resolve to mobilize additional funding to sustainably introduce new vaccines against rotavirus, pneumococcal and human papillomavirus Of 20 countries with highest under 5 mortality, 13 have introduced rotavirus vaccines Latin American countries on track to meet MDG4
Financing immunization programs National support for EPI: 93% is financed by governments Vaccine price, PAHO s Revolving Fund, 2009: Rotarix: US$ 7.50 /dose, $15 /child RotaTeq: US$ 5.50 /dose, $16.5 /child Rotavirus vaccine represents 97.3% of the cost of the basic immunization schedule of countries (OPV, DPT, Hib, HepB, MMR) GAVI countries: Bolivia and Honduras approved by GAVI, Guyana financed on its own
Rotavirus surveillance network
PAHO Guidelines Field guide Epidemiologic surveillance of Diarrheal diseases due to rotavirus Field guide on Introduction of New Vaccines based on WHO Guidelines
Countries participating in rotavirus surveillance network
Percent rotavirus-positive samples from children <5 hospitalized for diarrhea in participating countries, 2006-2007 De Oliveira, Rotavirus Surveillance in Latin American and Caribbean, JID 2009
Seasonality of hospitalizations for rotavirus in participating countries, 2006 2007 Northern hemisphere Southern hemisphere De Oliveira, Rotavirus Surveillance in Latin American and Caribbean, JID 2009
Disease burden and cost effectiveness
Causes of death among children <5 years in the Americas, 2008 Black et al., Lancet, 12 May 2010
Estimates of rotavirus disease burden in the Region of the Americas 15,000 deaths 75,000 hospitalizations 2 million clinic visits 10 million cases of rotavirus diarrhea Source: De Oliveira, Expert Rev. Vaccines, 2008
Cost-effectiveness Introduction of new vaccines needs to be grounded in evidence that they are cost effective: PRO-VAC: 5 years strategic plan to strengthen national capacity to make evidence-based decisions for new vaccines http://new.paho.org/provac/
Vaccine introduction
Rotavirus vaccine introduction Latin American countries : first countries to introduce rotavirus vaccine in public health sector: March 2006 in Panama As of May 2010, 14 countries and one territory had introduced rotavirus vaccine: 13 - Rotarix (GSK) 2 - RotaTeq (Merck)
Introduction of rotavirus vaccines in Latin America, 2006-2010 Countries and total population <1 year 16 10000 Number of coun ntries 14 12 10 8 6 4 2 9000 8000 7000 6000 5000 4000 3000 2000 1000 Children <1 year (th housands) 0 2006 2007 2008 2009 2010 0
Latin America and Caribbean countries with rotavirus vaccines into their routine schedules
Age in weeks at vaccination, Nicaragua and Brazil RotaTeq, Nicaragua Dose 1 Dose 2 Dose 3 Rotarix, Brazil
Comparison of first dose coverage for RotaTeq vs. DPT-HepB-Hib, Nicaragua, 2007 (RotaTeq introduced October 2006) Orozco et al., Uptake of rotavirus vaccine, Nicaragua, JID 2009
Rotavirus and DPT coverage for 8 Latin American countries, 2009 % co overage 100 90 80 70 60 50 40 30 20 10 0 RV2/3 DTP3 Source: Country reports
Impact of vaccination
Diarrhea and rotavirus related admissions among children <5 years at seven hospitals, El Salvador, January to June,* 2006-2009
ERROR: stackunderflow OFFENDING COMMAND: ~ STACK: