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Rotavirus vaccination in Europe: drivers and barriers

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Summary

Rotavirus gastroenteritis is a vaccine-preventable disease that confers a high medical and economic burden in more developed countries and can be fatal in less developed countries. Two vaccines with high efficacy and good safety profiles were approved and made available in Europe in 2006. We present an overview of the status of rotavirus vaccination in Europe. We discuss the drivers (including high effectiveness and effect of universal rotavirus vaccination) and barriers (including low awareness of disease burden, perception of unfavourable cost-effectiveness, and potential safety concerns) to the implementation of universal rotavirus vaccination in Europe. By February, 2014, national universal rotavirus vaccination had been implemented in Belgium, Luxembourg, Austria, Finland, Greece, Luxembourg, Norway, and the UK. Four other German states have issued recommendations and reimbursement is provided by sickness funds. Other countries were at various stages of recommending or implementing universal rotavirus vaccination.

Introduction

Rotavirus gastroenteritis is a disease that can be prevented by vaccination. Two vaccines, RotaTeq (Merck and Co, Whitehouse Station, NJ, USA; Sanofi Pasteur MSD, Lyon, France) and Rotarix (GlaxoSmithKline, Rixensart, Belgium), are available in Europe. Both are live, attenuated rotavirus vaccines given orally that have shown high efficacy and good safety profiles in large clinical trials. These findings have been confirmed in clinical practice, although the vaccines have shown lower efficacy in field trials in less developed countries.1, 2, 3, 4, 5, 6, 7, 8

Rotarix is a monovalent human vaccine originating from a G1P[8] strain. RotaTeq is a pentavalent vaccine containing five human-bovine reassortant strains (G1, G2, G3, G4, and P1A[8]).9 Both vaccines aim to prime broad immune responses followed by progressively broader protection, developing through successive natural rotavirus infections.10

Because the vaccines became available in Europe in 2006, universal rotavirus vaccination has been implemented in Austria, Belgium, Luxembourg, Finland, Greece, Luxembourg, Norway, and the UK. Several other countries are at various stages of issuing national recommendations or integrating rotavirus vaccination into their national immunisation programmes. We provide an overview of the status of rotavirus vaccination in Europe in February, 2014, and discuss the drivers and barriers to the implementation of universal rotavirus vaccination.

Section snippets

Status of rotavirus vaccination in 2014

The inclusion of vaccination with either rotavirus vaccine in national immunisation programmes has been recommended worldwide by WHO since 2009.8 Since 2006, the Centers for Disease Control and Prevention Advisory Committee on Immunisation Practices has recommended routine rotavirus vaccination of infants in the USA.11 The same year, vaccination was implemented in this group. Universal rotavirus vaccination was also introduced in Australia in 2007 and in almost 20 American countries, including

Countries with high vaccination coverage

High vaccination coverage is defined as more than 90%. The Austrian Advisory Committee on Immunisation recommended universal rotavirus vaccination in Austria in 2006, and it was introduced in 2007, with full reimbursement for the vaccines.15 Local epidemiological data showing a high disease burden in Austrian children were an important driver for the implementation of universal rotavirus vaccination.16

On the basis of the recommendations from the Superior Health Council of Belgium, rotavirus

Countries with moderate vaccination coverage

Moderate vaccination coverage is defined as between 20% and 40%. Universal rotavirus vaccination is not presently recommended by the national health authorities of Portugal. However, the Portuguese Paediatric Society has been recommending rotavirus vaccination for all children since 2009, endorsing European recommendations.19 In the absence of national recommendations, rotavirus vaccination in Portugal is mainly driven by paediatricians.

In 2010, the German Standing Vaccination Committee

Countries with low vaccination coverage

Low vaccination coverage is defined as less than 10%. Although national rotavirus vaccination is not recommended in Poland, rotavirus vaccines are on the list of new vaccines considered for public funding by the Advisory Expert Committee for Immunisation Programme and Chief Sanitary Inspectorate. The main barriers to the inclusion of rotavirus vaccination in the national immunisation programme are competition with other vaccines and the cost of the vaccines. Polish experts and societies,

Countries with no available vaccination coverage data

In Bosnia and Herzegovina, universal rotavirus vaccination has not yet been considered, mainly because of cost and other health priorities. Disease burden and effectiveness of the vaccines are being considered as drivers for universal rotavirus vaccination.

In Cyprus, rotavirus vaccines are available in private practice, and the Cyprus Paediatric Association encourages the use of the vaccine. However, the cost prevents wider use of the vaccine and introduction into the national immunisation

Rotavirus vaccination coverage rates in Europe

In 2010, coverage rates for rotavirus vaccination varied across Europe and were generally indicative of the strength of the country-specific vaccine recommendations, from virtually no vaccination in the Netherlands and Italy to coverage rates above 90% in Austria, Belgium, Luxembourg, and Finland (figure).40, 41, 42, 43 Of the countries with a universal immunisation programme, Austria, Finland, and Luxembourg provide free vaccine and Belgium reimburses 85% of the vaccine cost.

In Germany, the

Barriers and drivers to the implementation of rotavirus vaccination in Europe

As for any new vaccine, rotavirus vaccines compete with other vaccines for one budget. Important factors in the implementation of universal rotavirus vaccination have been the mortality or morbidity associated with the disease and the cost-effectiveness, safety, and quality of the vaccines.

Conclusion

7 years after the introduction of rotavirus vaccines in Europe, the status of rotavirus vaccination remains largely country-specific. A continuum was observed in the statuses of the 32 European countries presented here. As of February, 2014, eight European countries have implemented universal rotavirus vaccination, and many other countries are at various stages of recommending or implementing it. In this very dynamic area, the recommendations will evolve rapidly. Common barriers that remain

Search strategy and selection criteria

A survey of European experts was done in February and March, 2012. Experts from 32 European countries were asked to give information on whether rotavirus vaccination was included or being considered for inclusion in their country's national immunisation programmes, and what the drivers and barriers were. Data have been updated in February, 2014. References cited here have two possible origins: either they were identified in official documents or they were communicated by the

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