First rotavirus vaccine licensed: Is there really a need?

The first rotavirus vaccine was licensed in the United States on 31 August 1998 for the prevention of severe rotavirus diarrhea in children. Despite t his landmark in new vaccines, many pediatricians and public health professi onals in Europe are uncertain of the need for this vaccine for the routine immunization of infants. In Europe, ample evidence suggests that rotavirus is the most common cause of hospitalizations for severe diarrhea among chil dren, but proper studies documenting the disease burden of rotavirus or the cost-effectiveness of a rotavirus immunization program have only been cond ucted in the United Kingdom following epidemiologic models used in the Unit ed States. Al children are infected with rotavirus during their first few y ears of life, 30-50% of diarrheal hospitalizations among children <5 years are due to this agent, and, by the age of 5 years, between 1 in 40 and 1 in 77 children in Europe and the United States may be hospitalized for rotavi rus. The first vaccine is a live, oral preparation combining four different serotypes of rotavirus and administered in three doses with other childhoo d immunizations. The good efficacy against severe rotavirus diarrhea, the l ow risk of adverse side effects and the positive cost-effectiveness equatio n have led the two major immunization advisory groups in the U.S. to recomm end this vaccine for routine use in American infants. European physicians a nd policymakers should re-examine the epidemiology and disease burden of ro tavirus diarrhea now that an effective method of prevention is at hand.