How much could rotavirus vaccines reduce diarrhea-associated mortality in northern Ghana? A model to assess impact

BACKGROUND: Effective rotavirus vaccines could substantially reduce the approximately 500,000 deaths due to rotavirus disease per year worldwide, although the impact will depend on vaccine effectiveness, timing of administration, and coverage. We modeled vaccine impact on rotavirus-associated mortality in rural Ghana.

METHODS: All deaths due to acute diarrhea among children during 1998-2004 in the Kassena-Nankana District of Ghana were identified, and the number of deaths due to rotavirus disease was estimated using hospital laboratory surveillance data. Assuming rotavirus vaccine would be included in the current Expanded Program on Immunization schedule, we estimated the reduction in rotavirus-associated mortality with use of the current coverage and timing of diphtheria, tetanus, and pertussis vaccine administration and various age-restricted schedules.

RESULTS: Of the 381 deaths due to diarrhea, 131 (34%) were estimated to be caused by rotavirus infection. On the basis of current diphtheria, tetanus, and pertussis vaccine coverage and timing, a 90% efficacious 3-dose rotavirus vaccine would prevent 70% of deaths due to rotavirus infection if administered without age restrictions, 53% if only initiated among children <12 weeks of age, and 52% if the course also was completed by 32 weeks of age.

CONCLUSIONS: Rotavirus vaccine has the potential to substantially reduce rotavirus-associated mortality in rural Ghana. Although timely vaccination should be encouraged, extending the current age recommendation for initiation of rotavirus vaccination could increase the coverage and impact of vaccination.