However, 98% of the estimated rotavirus deaths averted among these countries occur in those with the highest rates of childhood death and lowest vaccine efficacy. For instance, the 10 countries with the highest rates of rotavirus mortality per capita (>300/100,000) are in Africa and the Middle East. These would experience

the greatest benefit from the introduction of rotavirus vaccines. So despite lower efficacy, the public health impact will be enormous in those countries with the greatest burden. Regional variations in the cost-effectiveness and public health impact of rotavirus vaccination were observed in this analysis. These regional differences in cost-effectiveness and health outcomes are more influenced by underlying disease burden than by vaccine efficacy. For example, despite lower estimated vaccine efficacy in the African and Eastern Mediterranean populations, the vaccine has the greatest MK1775 public health impact

selleck compound – measured by DALYs averted per 1000 children vaccinated – and is the most cost-effective in these regions that carry the highest rotavirus mortality rates. In contrast, countries included in the Western Pacific region have the lowest average mortality rate, and although higher vaccine efficacy estimates were applied to this population, the health impact is smaller and the cost-effectiveness ratio is higher compared to other regions. Of global health importance PD184352 (CI-1040) is the overall impact of rotavirus vaccines on all-cause severe diarrheal morbidity and mortality. Applying the figure of 24.8% vaccine efficacy against all-cause severe gastroenteritis deaths

(pooled estimate as described above), yields estimates of the impact of vaccine that are 20% higher than the base case results of 2.46 million rotavirus deaths averted. The difference may be explained, in part, by undetected rotavirus in the populations from which these all-cause diarrhea efficacy results were derived, due to late presentation in the course of the diarrheal episode and/or limited diagnostic sensitivity of the ELISA system used. The variance may also be due to an overestimate of vaccine efficacy against all-cause severe gastroenteritis in the clinical trials. For example, if all-cause efficacy was measured only through the rotavirus season and then annualized, the estimate would be falsely high. Results from the scenario that modeled the indirect effects of vaccination suggest that the impact may be greater than estimated in the base case. The 25% increase in deaths averted is dependent upon the simplifying assumptions used in modeling this scenario. It is not surprising that impact expands, since more children are benefiting from vaccination compared to the base case. In addition to improving overall impact, indirect protection may also increase equity by providing protection to higher risk children who would not otherwise be vaccinated.