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Prospects for routine childhood vaccination against rotavirus in India.

Rotavirus is the leading cause of severe acute gastroenteritis (AGE) in children under 5 years of age worldwide. In both developing and industrialized countries, about one-third of AGE hospitalizations in children under 5 are attributable to rotavirus infection. While rotavirus AGE is ubiquitous, more than 90% of the estimated 453 000 annual rotavirus deaths occur in developing countries, primarily because access to appropriate medical care is suboptimal in these settings and the healthcare costs involved. Because rotavirus is a ‘democratic’ pathogen that infects all children worldwide, rich or poor, in the first five years of life, interventions to improve environmental hygiene, water quality and health behaviour are considered unlikely to have a significant impact on reducing disease transmission. These factors, together with early epidemiological observations that infants naturally infected with rotavirus are at reduced risk for subsequent rotavirus infection and disease, led to efforts to develop vaccines for effective prevention of rotavirus AGE. We review the biological features of rotavirus that are relevant for vaccination, the experience with rotavirus vaccination programmes globally, and the prospects for routine vaccination of Indian children against rotavirus.