Rotavirus Update

Dear colleagues,

We are pleased to bring you the latest update on activities conducted and supported by the Rotavirus Vaccine Program (RVP). Among this issue's highlights are new efforts that emphasize an integrative approach to control diarrheal disease and updates on clinical trials in developing countries aimed at evaluating rotavirus vaccines among the world's poorest populations.

As always, we welcome your feedback and thank you for your continued support.

Sincerely,

John R. Wecker, PhD
Director, Rotavirus Vaccine Program

Diarrheal disease remains major concern despite low rotavirus awareness
An approach that combines proven interventions with new technologies may counter low levels of awareness and waning efforts to promote diarrheal disease control, according to a recent survey conducted by RVP. Focus group discussions and one-on-one interviews with health care workers and public health officials in India, Thailand, Indonesia, Nicaragua, and Ukraine revealed that, while diarrheal disease remains a significant public health concern, efforts to boost awareness about proven interventions such as oral rehydration solution (ORS) have abated.

The survey also indicated that knowledge of rotavirus is very low and, among those who are familiar with rotavirus, there is a misperception that improvements in water quality and hygiene practices will effectively prevent infection. Regardless of hygiene practices or access to clean water, however, nearly every child in the world will be infected with rotavirus before age five. As a result, a vaccine remains the only viable measure to prevent severe rotavirus illness.

Complete results of the survey, along with recommendations for an integrated approach to enhance diarrheal disease control, are being prepared for publication.

Collaboration promotes comprehensive approach to enhance diarrheal disease control
Building off insight gained from audience research among public health officials and physicians (see article above), RVP is working with UNICEF, NicaSalud, and the Ministry of Health in Nicaragua to promote an integrated approach to diarrheal disease control in the country. The initiative combines new and enhanced interventions to control diarrheal disease, including rotavirus vaccines, zinc supplementation, and low-osmolarity oral rehydration solution, with traditional interventions such as breastfeeding and improvements in hygiene and sanitation. Training materials for health care workers are under development, along with a website that will bring essential resources to national decision-makers.

Similar activities toward enhanced diarrheal disease control are also underway in Cambodia, where RVP and the Cambodia Pediatric Association recently co-sponsored a workshop to educate trainers on the integrated approach.

Partners visit African sites for future clinical trial activities
Representatives from the US Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), PATH, and Merck visited potential trial sites in Ghana, Guinea-Bissau, and Kenya in recent weeks as RVP and Merck prepare for clinical trials in Africa. The trials will test the safety and efficacy of Merck's rotavirus vaccine RotaTeq® in impoverished populations. During the visits, the study team met with local investigators, public health officials and other community leaders, in addition to visiting local clinics, laboratories, and hospitals.

Global rotavirus surveillance activities expand to several countries
Disease surveillance in low- and middle-income countries is essential to estimating national and global rotavirus incidence, as well as determining the potential impact of rotavirus vaccines. Under the leadership of CDC and WHO, many countries will initiate rotavirus surveillance this year, adding to ongoing RVP-supported surveillance in several regions.

In sub-Saharan Africa, WHO and CDC recently approved protocols for the establishment of rotavirus surveillance in Cameroon, Ghana, Zambia, Uganda, and Kenya.

Protocols from Egypt, Tunisia, Pakistan, Morocco, and Iran were also recently approved for surveillance funding, with some activities already underway.

Additionally, surveillance activities in Bolivia have officially begun. A recent article in the Immunization Newsletter published by the Pan American Health Organization (PAHO) provides further details on sentinel, hospital-based rotavirus surveillance activities throughout Latin America.

Recommendations from cost-effectiveness meeting support standardized methodology
A recent meeting on the economic burden of rotavirus disease and cost-effectiveness of vaccines brought together economists and epidemiologists from organizations including WHO, CDC, PATH, PAHO, Emory University, and the London School of Hygiene and Tropical Medicine. Attendees also included representatives from Ghana, South Africa, Kenya, and Hong Kong. Participants reviewed the results of costing and cost-effectiveness studies for South Africa, Ghana, Vietnam, Bangladesh, Peru, and Hong Kong and made key recommendations to inform activities going forward.

Along with continued use of WHO guidelines for estimating the costs of diarrheal disease, participants recommended modifying the existing protocol for simpler and more rapid cost assessments. Where possible, it was recommended that these assessments take place alongside surveillance activities, where cost data could be collected more easily. To support the comparability of results across countries, participants recommended a set of guidelines to standardize cost and cost-effectiveness methods, including common guidelines for interpreting and presenting results in the context of a country's ability to finance vaccines as part of its national immunization program.

Lisbon to host International Rotavirus Symposium in June
Policymakers, scientists, public health officials, and international partners will be on hand to discuss the latest advances in rotavirus research, progress toward vaccine development, and issues in vaccine finance and introduction at the 7th Annual International Rotavirus Symposium, scheduled for June 12 to 13 in Lisbon, Portugal. The event will precede the 12th International Congress for Infectious Diseases, scheduled for June 15 to 18 at the same venue. Visit the symposium's website for further details.

Open positions with PATH immunization programs
Recent progress in vaccine development and introduction has kept us quite busy over the past few months, and PATH's activities in this arena continue to expand. New positions are available with some of PATH's vaccine programs, and we are searching for qualified and motivated candidates for the following roles:

• Epidemiologist (position #1763)
  
• Clinical Trials Officer (#1830)
  
• Clinical Trials Coordinator (#1842)
  
• Communications Officer (#1831)

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