The authors

of the Latin American study noted that in Bra

The authors

of the Latin American study noted that in Brazil, unlike in Mexico, rotavirus vaccine was co-administered with oral polio vaccine (OPV) and since co-administration SB203580 research buy of the first dose of rotavirus vaccine with OPV has been shown to reduce the immunogenicity of the former, speculated whether this might be a possible explanation of the observed difference in intussusception risk in the two countries. This raises the possibility that in developing countries where the vaccine will generally be co-administered with OPV and where the immunogenicity of the vaccine is lower, the risk of intussusception would be even lower than that observed in Latin America. If this is confirmed through careful post-marketing surveillance in select early introducer countries, global advisory committees might be more Ku-0059436 mw inclined to relax the age restrictions for vaccine use, thus making it easier to deliver vaccine and achieve high coverage in developing countries in Africa and Asia. Data from developing countries in Asia and Africa show greater strain diversity than has been described in industrialized countries [20]. A review paper in this supplement (Miles et al.) describes the strain diversity of rotavirus in Bangladesh, India and Pakistan and also refers to the reports of the emergence of reassortant zoonotic strains in the region. The implications of strain diversity

on vaccine efficacy are not fully understood, since available data show that the current vaccines induce cross-protections against the prevalent strains encountered in the clinical trials. However, there is a need to have surveillance in place to monitor for strain changes following vaccination in African and Asian countries, to detect any newly emergent strains, and importantly, be able to interpret the data and attribute it to vaccine use, since natural changes in prevalence of rotavirus strains are common [21]. Rotavirus diarrhoea is an important

cause of childhood morbidity and mortality world wide and particularly old so in developing countries with high child mortality. Data on rotavirus diarrhoea and the efficacy of vaccination in developing countries is rapidly increasing, and there is increasing evidence to suggest that the vaccines will have a significant effect on childhood morbidity and mortality, despite the lower efficacy of the vaccines, in developing country populations in Asia and Africa. However, further data are required to fully understand and document the impact of rotavirus vaccines in these populations. There are programmatic challenges related to the age restrictions for delivering vaccines that might affect the overall impact of vaccines in populations where timely delivery of the vaccine is difficult. Data that would allow relaxation of the age restrictions and adjuncts that might improve vaccine performance would certainly contribute to improving the impact of these vaccines.

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