Rotavirus vaccine has curbed deaths in India by a third, deterred antibiotic misuse, finds US study
New Delhi: The vaccine against rotavirus, the latest entrant to the Union government’s Universal Immunisation Programme (UIP), has reduced the prevalence of cases by nearly 33.7 percent, deaths by 38.3 percent and total antibiotic misuse due to rotavirus infection by about 21.8 percent, in children under five years of age.
India piloted the rotavirus vaccine in few states on 26 March, 2016, becoming the first nation from the World Health Organisation (WHO)’s South East Asia region to introduce the vaccine.
These findings have emerged in an important analysis titled ‘Effect of rotavirus vaccination on the burden of rotavirus disease and associated antibiotic use in India: A dynamic agent-based simulation analysis’. The study, conducted by US based-researchers, was published online this month in the journal Vaccine.
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The ScienceDirect website (database of peer-reviewed scientific, technical and health-related literature) states that the issue will be published 17 September.
The analysis has been carried out as part of the Value of Vaccination Research Network (VoVRN), an initiative by Harvard university.
Endemic in India, rotavirus is a leading cause of severe diarrhoea and requires hospitalisation. The country has the second-highest burden of disease globally, after Nigeria.
India launched a childhood immunisation programme for rotavirus in 2016, starting with four states—Haryana, Odisha, Andhra Pradesh and Himachal Pradesh—which was expanded to cover all states by 2019.
Before India introduced vaccination through UIP, an estimated 11.37 million cases of rotavirus diarrhoea and 78,000 associated deaths occurred annually among children under five years of age, according to the Indian Council of Medical Research (ICMR).
Under UIP, one of the two vaccines—Rotavac (oral vaccine) by Bharat Biotech and Rotasiil (oral vaccine) by the Serum Institute of India—are offered to infants in a three-dose schedule at 6, 10 and 14 weeks of age to provide protection against severe diarrhoea due to rotavirus.
“Our findings show that UIP is a powerful programme that can not only save millions of children from infectious diseases, but also bring major public health benefits by reducing inappropriate antibiotic use and slowing the progression of antibiotic resistance in India,” Arindam Nandi, co-author on the analysis, and a health economist who is associated with One Health, an integrated approach that calls for different sectors to come together to solve health and conservation challenges, told ThePrint.
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Overall disease burden reduced by 33.7%
As part of the analysis, researchers associated with Princeton University and One Health Trust—a public health research organisation with offices in Washington DC, New Delhi, and Bengaluru—built a dynamic agent-based model of rotavirus progression in children under five years of age within each district of India.
Simulations were run for various scenarios of vaccination coverage in the context of India’s UIP. Population data was obtained from the National Family Household Surveys (NFHS) 4 and 5, and was used to calibrate the models.
The researchers noted that according to NFHS 5, current full (three-dose) rotavirus vaccination coverage of children under five years of age is highly variable, both by state and by wealth quintile—a statistical value that divides a population into five groups, each representing 20 percent of the population.
A band across India comprising northern states and some eastern states has the highest rates of vaccination, ranging from 21.5 percent in Uttar Pradesh to 45.4 percent in Himachal Pradesh.
According to NFHS 5, which has vaccination data for 2019-21, the overall rotavirus vaccination coverage in India was about 17.8 percent.
Prior to vaccination, rotavirus incidence in India averaged approximately one case per child per year but researchers noted that the national drop of 0.34 cases per child per year was a significant decrease.
The reduction in rotavirus cases per 1,000 children per year ranged from a minimum of 199.5 in Bihar to a maximum of 588.6 in Himachal Pradesh. The reduction of deaths per 1,000 children per year ranged from 0.4 in Sikkim to 1.8 in Madhya Pradesh.
Overall, the vaccination brought down the disease burden by 33.7 percent, and total deaths due to rotavirus by 38.3 percent.
But a previous work by the same researchers had shown that the UIP is not funded adequately. The 2018 UIP budget for vaccinating children, pregnant women and adults was $1.17 billion. In comparison, $1.73 billion would be needed to vaccinate 90 percent of children in all Indian districts with the recommended schedule of routine childhood vaccines, the researchers had noted.
“Considering the direct lifesaving benefits of childhood vaccinations and broader health benefits as estimated in this rotavirus study, it is important for UIP to close the funding gap and reach all target children,” Nandi stressed.
Impact on antibiotic misuse
Dr T. Jacob John, a paediatrician and virologist who was previously associated with Christian Medical College (CMC), Vellore, told ThePrint that even though antibiotics should not be given in case of rotavirus infections and most other viral diarrhoea cases, its misuse is rampant in such instances.
According to the analysis, an important and possibly underappreciated effect of rotavirus vaccination is the extent of averted antibiotic misuse.
Given particularly harmful effects of antibiotics on young children, the estimated reduction in rotavirus-driven antibiotic use in India from 9.6 percent to 7.7 percent of total antibiotic consumption in this demographic (a drop of total antibiotic use by 1.9 percent) is particularly significant.
According to the predictions of the analysis, if vaccination coverage levels are uniformly increased to 68.2 percent, antibiotic consumption in this demographic would be reduced by close to 9.6 percent, representing additional and potentially vast averted disease burden from antibiotic misuse.
In 2019, an estimated 1.3 million deaths worldwide were attributable to antimicrobial resistance (AMR), including nearly 3 lakh deaths in India attributable to AMR and 10,42,500 deaths associated with AMR in the country.
AMR occurs when bacteria, viruses, fungi and parasites no longer respond to medicines, making people sicker and increasing the risk of spread of infections that are difficult to treat, which may lead to illness and death.
The latest paper noted that antibiotic overuse, including misuse for viral diseases such as rotavirus infection and certain respiratory illnesses, remains a major driver for AMR.
“Our findings show that large-scale national vaccination efforts can provide substantial global health benefits by reducing antibiotic overuse and associated progression of AMR,” the researchers noted in the paper.
As of now, UIP covers vaccination against 11 diseases nationally—diphtheria, pertussis, tetanus, polio, measles, rubella, severe form of childhood tuberculosis, rotavirus diarrhoea, hepatitis B, meningitis, and pneumonia caused by Haemophilus Influenzae type B and pneumococcal pneumonia.
Additionally, vaccination against Japanese encephalitis is offered in endemic districts in select states.
(Edited by Radifah Kabir)
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