Evidence of rotavirus vaccine impact in sub-Saharan Africa: Systematic review and meta-analysis

• Published in: PloS one Vol. 15; no. 4; p. e0232113
• Main Authors: Godfrey, Opolot, Zhang, Weidong, Amponsem-Boateng, Cecilia, Bonney Oppong, Timothy, Zhao, QingLin, Li, Dankang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.04.2020; Public Library of Science (PLoS)
• Subjects: Africa South of the Sahara - epidemiology; Age; Analysis; Bias; Biology and life sciences; Children; Database industry; Developing countries; Diarrhea; Diarrhea - prevention & control; Diarrhea - virology; Disease; Epidemiology; Health aspects; Health surveillance; Humans; Immunization; Immunization Programs; Infection; Infections; LDCs; Medical ethics; Medical research; Medicine and Health Sciences; Meta-analysis; Mortality; Online databases; People and Places; Physical Sciences; Populations; Prejudice; Public health; Research and Analysis Methods; Rotavirus; Rotavirus - drug effects; Rotavirus Infections - epidemiology; Rotavirus Infections - prevention & control; Rotavirus Infections - virology; Rotavirus Vaccines - administration & dosage; Science Policy; Studies; Vaccination; Vaccines; Vaccines, Attenuated - administration & dosage; Viruses; Africa South of the Sahara; South Africa; Sub-Saharan Africa; China; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232113

Over 34 countries in Africa have introduced rotavirus vaccine to their national immunization programs: monovalent (Rotarix®, RV1) and pentavalent (RotaTeq®, RV5) after South Africa introduced it in 2009. Since then several studies assessing the impact of the vaccine have been conducted. The principal aim of this study was to evaluate the impact of rotavirus vaccine in sub-Saharan Africa. A Literature search was performed using Mendeley, PubMed, ScienceDirect, grey literature and Web of Science databases of published studies from January 1, 2017, as years of recent publications on rotavirus vaccine impact in sub-Saharan Africa. A meta-analysis was conducted for rotavirus infection in children under 5 years using proportions of pre and post-vaccine introduction in these populations. Random-effect estimates were considered since the samples were from universal populations. Out of the 935 articles identified, 17 studies met the inclusion for systematic review and meta-analysis. The pooled proportion for pre-vaccination period was 42%, 95% (CI: 38-46%), and reduced to 21%, 95% (CI: 17-25%) during post-vaccination period. Rotavirus diarrhea significantly reduced in children < 12 months as compared to children 12-24 months old. Seasonal peaks of rotavirus diarrhea were between June-September. However, data is limited to one year of post-vaccine introduction, and bias may present due to early vaccine impact. We observed that the introduction of the rotavirus vaccine was partly responsible for the significant reduction in the burden of rotavirus-associated diarrhea in sub-Saharan Africa. Therefore, there is a need to encourage the remaining countries to introduce the vaccine to their routine national immunization programs.