ArticleVaccine2018
Direct and possible indirect effects of vaccination on rotavirus hospitalisations among children in Malawi four years after programmatic introduction.
Article in Vaccine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- Pooled it
- Effectiveness of RotarixWellcome open research · 2020Pooled it
- Trial
- Indirect Effects of Universal Infant Rotavirus Vaccination: A Narrative Systematic Review.Vaccines · 2025Review
- Evidence needs and community involvement in policy decisions for vaccine-preventable diarrhoeal infections among children under the age of five years: Stakeholder engagement in Ethiopia, Kenya, and Malawi.PLOS global public health · 2025Article
- Cost-effectiveness analysis of alternative infant and neonatal rotavirus vaccination schedules in Malawi.PLOS global public health · 2025Article
- Impact of rotavirus vaccination in Malawi from 2012 to 2022 compared to model predictions.NPJ vaccines · 2024Article
- Impact of rotavirus vaccination in Malawi from 2012 to 2022 compared to model predictions before, during, and after the COVID-19 pandemic.medRxiv : the preprint server for health sciences · 2024Article
- A Perspective on the Strategy for Advancing ETVAXMicroorganisms · 2023Article
- Rotavirus Genotypes in Hospitalized Children With Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction in Blantyre, Malawi, 1997-2019.The Journal of infectious diseases · 2022Article
- Understanding Rotavirus Vaccine Efficacy and Effectiveness in Countries with High Child Mortality.Vaccines · 2022Review
- Article
- Serological Humoral Immunity Following Natural Infection of Children with High Burden Gastrointestinal Viruses.Viruses · 2021Review
- Importance of non-pharmaceutical interventions in lowering the viral inoculum to reduce susceptibility to infection by SARS-CoV-2 and potentially disease severity.The Lancet. Infectious diseases · 2021Review
- Update on rotavirus vaccine underperformance in low- to middle-income countries and next-generation vaccines.Human vaccines & immunotherapeutics · 2021Review
- Community transmission of rotavirus infection in a vaccinated population in Blantyre, Malawi: a prospective household cohort study.The Lancet. Infectious diseases · 2021Article
- Measuring Rotavirus Vaccine Impact in Sub-Saharan Africa.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Article
- Mortality reduction benefits and intussusception risks of rotavirus vaccination in 135 low-income and middle-income countries: a modelling analysis of current and alternative schedules.The Lancet. Global health · 2019Article
- Current and new rotavirus vaccines.Current opinion in infectious diseases · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
15 authors at 7 institutions in 4 countries.
Funding
Abstract
introductionDespite increased use of vaccine in routine immunisation, rotavirus remains a major cause of acute gastroenteritis (AGE) in low-income countries. We describe rotavirus prevalence and hospitalisation in Malawi pre and four years post vaccine introduction; provide updated vaccine effectiveness (VE) estimates; and assess rotavirus vaccine indirect effects.
methodsChildren under five years of age presenting to a referral hospital in Blantyre with AGE were recruited. Stool samples were tested for rotavirus using Enzyme Immunoassay. The change in rotavirus prevalence was evaluated using Poisson regression. Time series analysis was used to further investigate trends in prevalence over time. VE against rotavirus diarrhoea of any severity was estimated using logistic regression. Indirect effects were estimated by evaluating rotavirus prevalence in unvaccinated children over time, and by comparing observed reductions in incidence of rotavirus hospitalisation to those expected based on vaccine coverage and trial efficacy estimates.
results2320 children were included. Prevalence of rotavirus in hospitalised infants (<12 months) with AGE decreased from 69/139(49.64%) prior to vaccine introduction to 197/607(32.45%) post-vaccine introduction (adjusted RR 0.67[95% CI 0.55, 0.82]). Prevalence in children aged 12-23 months demonstrated a less substantial decline: 15/37(40.54%) pre- and 122/352(34.66%) post-vaccine introduction (adjusted RR 0.85, 95% CI 0.57, 1.28). Adjusted VE was 61.89%(95% CI 28.04-79.82), but lower in children aged 12-23 months (31.69% [95% CI -139.03 to 80.48]). In hospitalised infants with rotavirus disease, the observed overall effect of the vaccine was 9% greater than expected according to vaccine coverage and efficacy estimates. Rotavirus prevalence among unvaccinated infants declined post-vaccine introduction (RR 0.70[95% CI 0.55-0.80]).
conclusionsFollowing rotavirus vaccine introduction in Malawi, prevalence of rotavirus in hospitalised children with AGE has declined significantly, with some evidence of an indirect effect in infants. Despite this, rotavirus remains an important cause of severe diarrhoea in Malawian children, particularly in the second year of life.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.