Editing Rotavirus (section)

== Prevention ==
{{Main|Rotavirus vaccine}}
Rotaviruses are highly contagious and cannot be treated with antibiotics or other drugs. Because improved [[sanitation]] does not decrease the prevalence of rotaviral disease, and the rate of hospitalisations remains high despite the use of oral rehydrating medicines, the primary public health intervention is vaccination.<ref name="pmid19252423">{{cite journal |author=Bernstein DI |title=Rotavirus overview |journal=The Pediatric Infectious Disease Journal |volume=28 |issue= Suppl 3|pages=S50–S53 |year= 2009 |pmid=19252423 |doi=10.1097/INF.0b013e3181967bee |s2cid=30544613 |doi-access=free }}</ref> In 1998, a [[rotavirus vaccine]] was licensed for use in the United States. [[Clinical trials]] in the United States, Finland, and Venezuela had found it to be 80–100% effective at preventing severe diarrhoea caused by ''rotavirus A'', and researchers had detected no [[statistical significance|statistically significant]] serious [[adverse drug reaction|adverse effects]].<ref name="pmid10219046">{{cite journal |title=Rotavirus vaccine for the prevention of rotavirus gastroenteritis among children. Recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR. Recommendations and Reports |volume=48 |issue=RR-2 |pages=1–20 |year=1999 |pmid=10219046 }}</ref><ref name="pmid11444025">{{cite book
|author=Kapikian AZ
|title=Gastroenteritis Viruses
|chapter=A rotavirus vaccine for prevention of severe diarrhoea of infants and young children: development, utilization and withdrawal
|volume=238
|pages=153–171; discussion 171–179
|year=2001
|pmid=11444025
|doi=10.1002/0470846534.ch10
|series=Novartis Foundation Symposia
|isbn=978-0-470-84653-7
}}</ref> The manufacturer, however, withdrew it from the market in 1999, after it was discovered that the vaccine may have contributed to an increased risk for [[Intussusception (medical disorder)|intussusception]], a type of [[bowel obstruction]], in one of every 12,000 vaccinated infants.<ref name="pmid15687880">{{cite journal |author=Bines |first=JE |author-link=Julie Bines |year=2005 |title=Rotavirus vaccines and intussusception risk |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0267-1379&volume=21&issue=1&spage=20 |journal=Current Opinion in Gastroenterology |volume=21 |issue=1 |pages=20–25 |pmid=15687880 |access-date=21 January 2008 |archive-date=11 May 2013 |archive-url=https://web.archive.org/web/20130511014221/http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0267-1379&volume=21&issue=1&spage=20 |url-status=dead }}</ref> The experience provoked intense debate about the relative risks and benefits of a rotavirus vaccine.<ref name="pmid16099078">{{cite journal |author=Bines J |title=Intussusception and rotavirus vaccines |journal=Vaccine |volume=24 |issue=18 |pages=3772–3776 |year=2006 |pmid=16099078 |doi=10.1016/j.vaccine.2005.07.031}}</ref>

In 2006, two new vaccines against ''{{nowrap|rotavirus A}}'' infection were shown to be safe and effective in children,<ref name="pmid18202442">{{cite journal
|author=Dennehy PH
|title=Rotavirus vaccines: an overview
|journal=Clinical Microbiology Reviews
|volume=21
|issue=1
|pages=198–208
|year=2008
|pmid=18202442
|doi=10.1128/CMR.00029-07
|pmc=2223838
}}</ref> and in 2009, the WHO recommended that rotavirus vaccine be included in all national immunisation programmes.<ref name="pmid20370550">{{cite journal |vauthors=Tate JE, Patel MM, Steele AD, Gentsch JR, Payne DC, Cortese MM, Nakagomi O, Cunliffe NA, Jiang B, Neuzil KM, de Oliveira LH, Glass RI, Parashar UD |s2cid=28963507 |title=Global impact of rotavirus vaccines |journal=Expert Review of Vaccines |volume=9 |issue=4 |pages=395–407 |year= 2010 |pmid=20370550 |doi=10.1586/erv.10.17}}</ref>

The incidence and severity of rotavirus infections has declined significantly in countries that have acted on this recommendation.<ref name="pmid21734466">{{cite journal |vauthors=Giaquinto C, Dominiak-Felden G, Van Damme P, Myint TT, Maldonado YA, Spoulou V, Mast TC, Staat MA |s2cid=23996836 |title=Summary of effectiveness and impact of rotavirus vaccination with the oral pentavalent rotavirus vaccine: a systematic review of the experience in industrialized countries |journal=Human Vaccines |volume=7 |issue=7 |pages=734–748 |year =2011 |pmid=21734466 |doi=10.4161/hv.7.7.15511 |url=http://www.landesbioscience.com/journals/hv/abstract.php?id=15511|doi-access=free }}</ref><ref name="pmid20622508" /><ref name=":2" /> A 2014 review of available clinical trial data from countries routinely using rotavirus vaccines in their national immunisation programs found that rotavirus vaccines have reduced rotavirus hospitalisations by 49–92% and all cause diarrhoea hospitalisations by 17–55%.<ref>{{Cite journal|vauthors=Tate JE, Parashar UD|date=2014|title=Rotavirus Vaccines in Routine Use|journal=Clinical Infectious Diseases|volume=59|issue=9|pages=1291–1301|doi=10.1093/cid/ciu564|pmid=25048849|doi-access=free|pmc=11980788}}</ref> In Mexico, which in 2006 was among the first countries in the world to introduce rotavirus vaccine, diarrhoeal disease death rates dropped during the 2009 rotavirus season by more than 65 percent among children age two and under.<ref>{{cite journal|vauthors=Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, Esparza-Aguilar M, Johnson B, Gomez-Altamirano CM, Parashar U, Patel M |s2cid=27287753|title=Effect of Rotavirus Vaccination on Death From Childhood Diarrhea in Mexico|journal=The New England Journal of Medicine|year=2010|volume=362|issue=4|pages=299–305|doi=10.1056/NEJMoa0905211|pmid=20107215|display-authors=2|doi-access=free}}</ref> In Nicaragua, which in 2006 became the first developing country to introduce a rotavirus vaccine, severe rotavirus infections were reduced by 40 percent and emergency room visits by a half.<ref name="pmid22753550">{{cite journal |vauthors=Patel M, Pedreira C, De Oliveira LH, Umaña J, Tate J, Lopman B, Sanchez E, Reyes M, Mercado J, Gonzalez A, Perez MC, Balmaceda A, Andrus J, Parashar U |s2cid=7723807 |title=Duration of protection of pentavalent rotavirus vaccination in Nicaragua |journal=Pediatrics |volume=130 |issue=2 |pages=e365–e372 |year=2012 |pmid=22753550 |doi=10.1542/peds.2011-3478 }}</ref> In the United States, rotavirus vaccination since 2006 has led to drops in rotavirus-related hospitalisations by as much as 86 percent.<ref name="pmid35632617">{{cite journal |vauthors=Omatola CA, Olaniran AO |title=Rotaviruses: From Pathogenesis to Disease Control-A Critical Review |journal=Viruses |volume=14 |issue=5 |date=April 2022 |page=875 |pmid=35632617 |pmc=9143449 |doi=10.3390/v14050875|doi-access=free }}</ref> The vaccines may also have prevented illness in non-vaccinated children by limiting the number of circulating infections.<ref name="pmid35632617" /><ref>{{cite journal|vauthors=Patel MM, Parashar UD, etal |title=Real World Impact of Rotavirus Vaccination|journal=Pediatric Infectious Disease Journal|year=2011|volume=30|issue=1|doi=10.1097/INF.0b013e3181fefa1f|pages=S1–S5|pmid=21183833|s2cid=1893099 |doi-access=free}}</ref> In developing countries in Africa and Asia, where the majority of rotavirus deaths occur, a large number of safety and efficacy trials as well as recent post-introduction impact and effectiveness studies of Rotarix and RotaTeq have found that vaccines dramatically reduced severe disease among infants.<ref name=":2" /><ref>{{Cite journal|date=2010|veditors=Steele AD, Armah GE, Page NA, Cunliffe NA|title=Rotavirus Infection in Africa: Epidemiology, Burden of Disease, and Strain Diversity|journal=Journal of Infectious Diseases|volume=202|issue=Suppl 1|pages=S1–S265|doi=10.1086/653545|pmid=20684687|vauthors=Neuzil KM, Armah GE, Parashar UD, Steele AD |doi-access=free}}</ref><ref>{{Cite journal|date=2009|veditors=Nelson EA, Widdowson MA, Kilgore PE, Steele D, Parashar UD|title=Rotavirus in Asia: Updates on Disease Burden, Genotypes and Vaccine Introduction|url=http://www.sciencedirect.com/science/journal/0264410X/27/supp/S5|journal=Vaccine|volume=27|issue=Suppl 5|pages=F1–F138}}</ref><ref>{{cite journal|author=World Health Organization|title=Rotavirus vaccines: an update|journal=Weekly Epidemiological Record|year= 2009|volume=51–52|issue=84|pages=533–540|url=https://www.who.int/wer/2009/wer8451_52.pdf|access-date=8 May 2012}}</ref> In September 2013, the vaccine was offered to all children in the UK, aged between two and three months.<ref>{{cite web|url=http://www.dh.gov.uk/health/2012/11/rotavirus/ |title= New vaccine to help protect babies against rotavirus|publisher=UK Department of Health|date=10 November 2012 |access-date= 10 November 2012}}</ref> A 2022 study found that the number of rotavirus cases in infants in England under one year of age was reduced by 77–88%. In all age groups, the number of laboratory-confirmed rotavirus infections was reduced by 69–83%.<ref name="pmid34043765">{{cite journal |vauthors=Gower CM, Stowe J, Andrews NJ, Dunning J, Ramsay ME, Ladhani SN |title=Sustained Declines in Age Group-Specific Rotavirus Infection and Acute Gastroenteritis in Vaccinated and Unvaccinated Individuals During the 5 Years Since Rotavirus Vaccine Introduction in England |journal=Clinical Infectious Diseases |volume=74 |issue=3 |pages=437–445 |date=February 2022 |pmid=34043765 |doi=10.1093/cid/ciab460}}</ref>  In Europe, hospitalisation rates following infection by rotaviruses have decreased by 65% to 84% following the introduction of the vaccine.<ref name="pmid25795258">{{cite journal |vauthors=Karafillakis E, Hassounah S, Atchison C |title=Effectiveness and impact of rotavirus vaccines in Europe, 2006–2014 |journal=Vaccine |volume=33 |issue=18 |pages=2097–2107 |year=2015 |pmid=25795258 |doi=10.1016/j.vaccine.2015.03.016 |doi-access=free }}</ref> Globally, vaccination has reduced hospital admissions and emergency department visits by a median of 67%.<ref name="pmid28430997">{{cite journal |vauthors=Burnett E, Jonesteller CL, Tate JE, Yen C, Parashar UD |title=Global Impact of Rotavirus Vaccination on Childhood Hospitalizations and Mortality from Diarrhea |journal=The Journal of Infectious Diseases |volume=215 |issue=11 |pages=1666–1672 |year=2017 |pmid=28430997 |doi=10.1093/infdis/jix186 |pmc=5543929}}</ref>

Rotavirus vaccines are licensed in over 100 countries, and more than 80 countries have introduced routine rotavirus vaccination, almost half with the support of the [[GAVI]] vaccine alliance.<ref>{{Cite web|url=http://rotacouncil.org/toolkit/rotavirus-burden-vaccine-introduction-map/|title=Rotavirus Deaths & Rotavirus Vaccine Introduction Maps – ROTA Council|website=rotacouncil.org|access-date=29 July 2016|archive-url=https://web.archive.org/web/20160712033209/http://rotacouncil.org/toolkit/rotavirus-burden-vaccine-introduction-map/|archive-date=12 July 2016}}</ref> To make rotavirus vaccines available, accessible, and affordable in all countries—particularly low- and middle-income countries in Africa and Asia where the majority of rotavirus deaths occur, [[PATH (global health organization)|PATH]] (formerly Program for Appropriate Technology in Health), the WHO, the U.S. [[Centers for Disease Control and Prevention]], and GAVI have partnered with research institutions and governments to generate and disseminate evidence, lower prices, and accelerate introduction.<ref name="pmid21957215">{{cite journal |author=Moszynski P |s2cid=7567316 |title=GAVI rolls out vaccines against child killers to more countries |journal=BMJ |volume=343 |pages=d6217 |year=2011 |pmid=21957215 |doi=10.1136/bmj.d6217 }}</ref>

The vaccine may prevent [[Diabetes mellitus type 1|type 1 diabetes]].<ref>{{Cite news|url=https://www.reuters.com/article/us-health-diabetes-rotavirus-idUSKCN1PG2L8|title=Rotavirus vaccination tied to lower rates of type 1 diabetes|date=2019-01-22|work=Reuters|access-date=2019-02-10}}</ref><ref>{{Cite news|url=https://www.nytimes.com/2019/01/30/well/live/rotavirus-vaccine-may-protect-against-type-1-diabetes.html|title=Rotavirus Vaccine May Protect Against Type 1 Diabetes|last=Bakalar|first=Nicholas|date=2019-01-30|work=The New York Times|access-date=2019-02-10|issn=0362-4331}}</ref>