The results of this systematic review are strengthened by consistency across all studies, which contributed to a quality assessment of high or moderate for most outcomes (Table 2). However, there was a dearth of studies reporting the region-specific effectiveness of rotavirus vaccine against severe rotavirus diarrhea and hospitalizations. In addition, the regions of Eastern/Southeastern Asia and Southern Asia were less represented by included studies, and there were only 3 studies reporting an effect on diarrhea-attributable mortality—all of which were conducted in Latin America and the Caribbean where the vaccine is highly efficacious (Tables 1 and 2). Further research assessing the mortality effect of rotavirus vaccination, as well as the overall protective effects in Asia, is thus warranted.
The lack of studies meeting our inclusion criteria also precluded further stratification of our analysis by characteristics of the national immunization program, such as coverage level or vaccine type. All included studies used either RV1 or RV5 with the exception of one Indian study assessing the efficacy of a newly introduced monovalent human-bovine reassortant vaccine (116E) and one Ghanaian study of a rhesus/rhesus-human reassortant tetravalent vaccine (RotaShield, RRV-TV).9,35 As countries increasingly adopt rotavirus vaccine recommendations into their national immunization programs, mounting data should enable future analysis of the relative efficacy and effectiveness of the available vaccine types by region.
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