Prevalence and diversity of NoV in environmental samples from Africa.

<p>Prevalence and diversity of NoV in environmental samples from Africa.</p

Map of Africa indicating the countries from which prevalence and diversity data was obtained (light blue) and countries where only NoV genotype data was available (dark blue).

<p>BF—Burkina Faso, BW—Botswana, CF—Central African Republic, CM—Cameroon, DJ—Djibouti, EG—Egypt, ET—Ethiopia, GH—Ghana, KE—Kenia, LY—Libya, MA—Morocco, MW—Malawi, NG—Nigeria, SN—Senegal, TN—Tunisia, TZ—Tanzania, ZA—South Africa. Reprinted from d-maps.com under a CC BY license, with permission from Daniel Dalet, original copyright 2007–2015 (<a href="http://d-maps.com/carte.php?num_car=737&lang=en" target="_blank">http://d-maps.com/carte.php?num_car=737&lang=en</a>).</p

Circulation of NoV GII.4 variants between 1998 and 2013 in 12 African countries.

<p>Circulation of NoV GII.4 variants between 1998 and 2013 in 12 African countries.</p

Summary of NoV prevalence and diversity data from 19 studies conducted in 1976–1979, and between 1997 and 2013 in 14 African countries.

<p>Summary of NoV prevalence and diversity data from 19 studies conducted in 1976–1979, and between 1997 and 2013 in 14 African countries.</p

Additional NoV genotyping data from African studies which did not meet the inclusion criteria for prevalence estimates or only reported genotyping data.

<p>Additional NoV genotyping data from African studies which did not meet the inclusion criteria for prevalence estimates or only reported genotyping data.</p

Estimated reductions in hospitalizations and deaths from childhood diarrhea following implementation of rotavirus vaccination in Africa

<p><b>Introduction</b>: Rotavirus is the leading cause of hospitalizations and deaths from diarrhea. 33 African countries had introduced rotavirus vaccines by 2016. We estimate reductions in rotavirus hospitalizations and deaths for countries using rotavirus vaccination in national immunization programs and the potential of vaccine introduction across the continent.</p> <p><b>Areas covered</b>: Regional rotavirus burden data were reviewed to calculate hospitalization rates, and applied to under-5 population to estimate baseline hospitalizations. Rotavirus mortality was based on 2013 WHO estimates. Regional pre-licensure vaccine efficacy and post-introduction vaccine effectiveness studies were used to estimate summary effectiveness, and vaccine coverage was applied to calculate prevented hospitalizations and deaths. Uncertainties around input parameters were propagated using boot-strapping simulations. In 29 African countries that introduced rotavirus vaccination prior to end 2014, 134,714 (IQR 112,321–154,654) hospitalizations and 20,986 (IQR 18,924–22,822) deaths were prevented in 2016. If all African countries had introduced rotavirus vaccines at benchmark immunization coverage, 273,619 (47%) (IQR 227,260–318,102) hospitalizations and 47,741 (39%) (IQR 42,822–52,462) deaths would have been prevented.</p> <p><b>Expert commentary</b>: Rotavirus vaccination has substantially reduced hospitalizations and deaths in Africa; further reductions are anticipated as additional countries implement vaccination. These estimates bolster wider introduction and continued support of rotavirus vaccination programs.</p

Estimated impact of rotavirus vaccine on hospitalizations and deaths from rotavirus diarrhea among children <5 in Asia

<p><b>Background</b>: Of the 215,000 global deaths from rotavirus estimated in 2013, 41% occur in Asian countries. However, despite a recommendation for global rotavirus vaccination since 2009, only eight countries in Asia have introduced the rotavirus vaccine into their national immunization program as of September 2017. To help policy makers assess the potential value of vaccination, we projected the reduction in rotavirus hospitalizations and deaths following a hypothetical national introduction of rotavirus vaccines in all countries in Asia using data on national-level rotavirus mortality, <5 population, rotavirus hospitalizations rates, routine vaccination coverage, and vaccine effectiveness.</p> <p><b>Methods</b>: To quantify uncertainty, we generated 1,000 simulations of these inputs.</p> <p><b>Results</b>: Our model predicted 710,000 fewer rotavirus hospitalizations, a 49% decrease from the 1,452,000 baseline hospitalizations and 35,000 fewer rotavirus deaths, a 40% decrease from the 88,000 baseline deaths if all 43 Asian countries had introduced rotavirus vaccine. Similar reductions were projected in subanalyses by vaccine introduction status, subregion, and birth cohort size.</p> <p><b>Conclusion</b>: Rotavirus vaccines will substantially reduce morbidity and mortality due to rotavirus infections in Asia.</p