Population effectiveness of the pentavalent and monovalent rotavirus vaccines: A systematic review and meta-analysis of observational studies

Daniel Hungerford*, Katie Smith, Angela Tucker, Miren Iturriza-Gómara, Roberto Vivancos, Catherine McLeonard, Nigel Cunliffe, Neil French

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)


Background: Rotavirus was the leading cause of acute gastroenteritis (AGE) in infants and young children prior to the introduction of routine vaccination. Since 2006 there have been two licensed vaccines available with successful clinical trials leading the World Health Organization to recommend rotavirus vaccination for all children worldwide. In order to inform immunisation policy we have conducted a systematic review and meta-analysis of observation studies to assess population effectiveness against acute gastroenteritis. Methods: We systematically searched PubMed, Medline, Web of Science, Cinhal and Academic Search Premier and grey literature sources for studies published between January 2006 and April 2014. Studies were eligible for inclusion if they were observational measuring population effectiveness of rotavirus vaccination against health care attendances for rotavirus gastroenteritis or AGE. To evaluate study quality we use used the Newcastle-Ottawa Scale for non-randomised studies, categorising studies by risk of bias. Publication bias was assessed using funnel plots. If two or more studies reported a measure of vaccine effectiveness (VE), we conducted a random effects meta-analysis. We stratified analyses by World Bank country income level and used study quality in sensitivity analyses. Results: We identified 30 studies, 19 were from high-income countries and 11 from middle-income countries. Vaccine effectiveness against hospitalization for laboratory confirmed rotavirus gastroenteritis was highest in high-income countries (89% VE; 95% CI 84-92%) compared to middle-income countries (74% VE; 95% CI 67-80%). Vaccine effectiveness was higher for those receiving the complete vaccine schedule (81% VE; 95% CI 75-86%) compared to partial schedule (62% VE; 95% CI 55-69%). Two studies from high-income countries measured VE against community consultations for AGE with a pooled estimate of 40% (95% CI 13-58%; 2 studies). Conclusions: We found strong evidence to further support the continued use of rotavirus vaccines. Vaccine effectiveness was similar to that reported in clinical trials for both high and middle-income countries. There is limited data from Low income settings at present. There was lower effectiveness against milder disease. Further studies, should continue to report effectiveness against AGE and less-severe rotavirus disease because as evidenced by pre-vaccine introduction studies this is likely to contribute the greatest burden on healthcare resources, particularly in high-income countries.

Original languageEnglish
Article number569
JournalBMC Infectious Diseases
Issue number1
Publication statusPublished - 15 Aug 2017

Bibliographical note

Funding Information:
NC, NF, MIG, RV and DH are in receipt of research grant support from GlaxoSmithKline (GSK) Biologicals (EPI Rota-048); MIG is in receipt of research grant support from Sanofi Pasteur–MSD (SPMSD); NC has received honoraria for participation in GSK Rotavirus Vaccine Advisory Board Meetings.

Funding Information:
1Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK. 2Field Epidemiology Service, National Infection Service, Public Health England, Liverpool L1 1JF, UK. 3The Centre for Global Vaccine Research, University of Liverpool, Liverpool L69 7BE, UK. 4Health Education North West, Liverpool L3 4BL, UK. 5NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK. 6NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK. 7Department of Medical Microbiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK. 8Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

Publisher Copyright:
© 2017 The Author(s).


  • Gastroenteritis
  • Meta-Analysis
  • Rotavirus
  • Systematic review
  • Vaccine effectiveness


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