Rotavirus Vaccine Cuts Rotavirus-Positive Gastroenteritis Deaths by Nearly 76% in Global Study
核心洞察
A multinational analysis of 27,252 children found that at least one rotavirus vaccine dose reduced rotavirus (搜索)-positive gastroenteritis mortality by approximately 75.8% (95% CI, 28.4–91.8).
The vaccine's effect against all-cause acute gastroenteritis (搜索) mortality was smaller and not statistically significant, at about 20.8% (95% CI, −47.0 to 57.3).
Children in rural hospitals and African countries faced disproportionate risk, with rural children nearly twice as likely to have received no vaccine doses compared with urban peers.
Receiving at least one dose of a rotavirus vaccine reduced the risk of death from rotavirus (搜索)-positive acute gastroenteritis (搜索) by approximately 75.8% (95% CI, 28.4–91.8) among children younger than five years, according to a multinational analysis of more than 27,000 children. The findings, published in Lancet Child & Adolescent Health, draw on the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V), which pooled test-negative case-control data from 24 countries collected between July 2007 and August 2023.
Investigators, led by Mary C. Moran, PhD, MPH, of the CDC (搜索)'s Division of Viral Diseases, included 27,252 children younger than 5 years who sought hospital or emergency department care for acute gastroenteritis (搜索) across 22 countries. Sixteen of those countries reported at least one in-hospital death, contributing a combined 183 all-cause acute gastroenteritis deaths and 25 rotavirus (搜索)-positive deaths to the analysis. Compared with unvaccinated children, those who received at least one rotavirus vaccine dose were nearly 14 times less likely to die of acute gastroenteritis (OR, 13.94; 95% CI, 7.21–26.94).
Despite the substantial reduction in rotavirus (搜索)-positive mortality, the vaccine's effect against all-cause acute gastroenteritis (搜索) mortality was smaller and not considered statistically significant, at about 20.8% (95% CI, −47.0 to 57.3).
Disparities in Risk and Vaccination Coverage
The study identified disparities tied to geography and vaccination status. Twelve of the 16 countries reporting deaths were in Africa, and children treated at rural hospitals were nearly twice as likely to have received no rotavirus vaccine doses compared with those in urban settings (10% vs 5.8%). Among children who died with confirmed rotavirus (搜索) infection, a larger share had received no rehydration therapy and no vaccine doses compared with children who died from other causes of gastroenteritis.
Implications for Vaccination Strategy and Health Infrastructure
Moran and coauthors noted that because younger infants generally face the highest risk of dying from rotavirus (搜索) and acute gastroenteritis (搜索), the findings reinforce the importance of on-schedule vaccination in all settings. They also noted that higher coverage could offer indirect protection to children with chronic conditions who face elevated diarrhea mortality risk.
In an accompanying study, Daniel Hungerford, PhD, and Latif Ndeketa, MBBS, PhD, both of the University of Liverpool, called the findings the strongest multicountry evidence to date that rotavirus (搜索) vaccines substantially reduce rotavirus-associated diarrhea mortality in high-burden settings.
The study authors also flagged an open question raised by prior research: rotavirus vaccine effectiveness against severe disease is known to decline in the second year of life in low- and middle-income countries, a pattern not seen in wealthier nations. It remains unclear whether protection against death follows the same trajectory. Hungerford and Ndeketa argued that closing that gap will require pairing vaccination with birth-dose strategies, injectable alternatives to oral vaccines, and sustained investment in nutrition, sanitation, and health system infrastructure.
Policy Context
The publication lands amid a notable shift in US vaccine policy. An executive order signed by President Donald Trump moves rotavirus (搜索) vaccination—along with hepatitis A, hepatitis B, meningococcal disease, influenza, and COVID-19 vaccines—from a universal childhood recommendation to a "shared clinical decision-making" category, leaving initiation and timing to conversations between families and clinicians rather than routine default administration.
The order narrows the list of vaccines recommended for all children from 17 to 11 and directs the Department of Health and Human Services to formalize the revised schedule within 90 days. Critics of the policy change have warned that reclassifying rotavirus (搜索) vaccination could reduce coverage and, by extension, increase hospitalizations and deaths from a virus that still accounts for an estimated 25% of diarrhea deaths in children younger than 5 years worldwide, despite more than 140 countries including the vaccine in routine immunization programs.