Evaluation of Rotavirus Vaccine Effectiveness by Severity of Rotavirus Disease: Findings From the MNSSTER-V Project

BACKGROUND: Since the introduction of rotavirus vaccines, acute gastroenteritis (AGE) hospitalizations due to rotavirus have decreased globally; however, vaccine effectiveness (VE) differs by country, age and disease severity. We evaluated rotavirus VE by disease severity in different age groups and under-5 childhood mortality (U5M) strata. METHODS: The Vesikari score is a common measure of AGE disease severity. A modified Vesikari Score (mVS) was calculated for 18,426 children with medically attended AGE across 16 countries from the Multi-National Subpopulations Study To Evaluate Rotavirus Vaccines dataset. Using a test-negative case-control design (cases had rotavirus-positive AGE and controls had rotavirus-negative AGE), we calculated complete rotavirus series VE against different severity categories among children 6-59 months old, stratified by age and country U5M level, respectively. RESULTS: VE increased with increasing disease severity: 38% (95% confidence interval [CI]:17-53) for mild/moderate disease versus 58% (95% CI: 50-64) for severe/very severe disease, and this pattern persisted with stratification by age and U5M. Among children with severe/very severe disease, VE was higher in infants aged 6-11 months (62%, 95% CI: 51-70) compared with children aged 24-59 months (11%, 95% CI: -78 to 56), and lower among children in the highest U5M strata (44%, 95% CI: 26-58) compared to children in the high U5M strata (60%, 95% CI: 47-69). CONCLUSIONS: Rotavirus vaccines provide the greatest protection against very severe rotavirus disease. VE remains lower in countries with higher U5M levels, even among children with very severe rotavirus disease, highlighting the need for improved vaccine performance in countries with high disease burden.

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Journal
The Pediatric Infectious Disease Journal
Published
2026-07-28
DOI
https://doi.org/10.1097/inf.0000000000005331
Primary Topic
Viral gastroenteritis research and epidemiology
Type
article
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article

Evaluation of Rotavirus Vaccine Effectiveness by Severity of Rotavirus Disease: Findings From the MNSSTER-V Project

Jazmina Umaña, Michelle J. Groome, Renat Latipov, Neha Balachandran et al.
The Pediatric Infectious Disease Journal
Viral gastroenteritis research and epidemiology
article

Evaluation of Rotavirus Vaccine Effectiveness by Severity of Rotavirus Disease: Findings From the MNSSTER-V Project

Jazmina Umaña, Michelle J. Groome, Renat Latipov, Neha Balachandran, Christophe Luhata Lungayo, Helah Safi, Julia Liliane Raboba, Volga Iñiguez, Margaret Mokomane, Stela Gheorghița, Mary C. Moran, Cissy Nalunkuma, Gloria Rey‐Benito, Kofi N'Zue, Isidore Bonkoungou, Nguyen Van Trang, Christabel Enweronu‐Laryea, Jacqueline E. Tate, Jason M. Mwenda, Goitom Weldegebriel, Jordan Cates, Jeannine Uwimana, Hammarskjold Makhuza, on Behalf of the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V) Project Working Group, Richard Omore, Umesh D. Parashar, Ingrid Contreras-Roldán, Anvar Nazurdinov, Fausta Michael, Eleanor Burnett, Inácio Mandomando
article en

Abstract

BACKGROUND: Since the introduction of rotavirus vaccines, acute gastroenteritis (AGE) hospitalizations due to rotavirus have decreased globally; however, vaccine effectiveness (VE) differs by country, age and disease severity. We evaluated rotavirus VE by disease severity in different age groups and under-5 childhood mortality (U5M) strata. METHODS: The Vesikari score is a common measure of AGE disease severity. A modified Vesikari Score (mVS) was calculated for 18,426 children with medically attended AGE across 16 countries from the Multi-National Subpopulations Study To Evaluate Rotavirus Vaccines dataset. Using a test-negative case-control design (cases had rotavirus-positive AGE and controls had rotavirus-negative AGE), we calculated complete rotavirus series VE against different severity categories among children 6-59 months old, stratified by age and country U5M level, respectively. RESULTS: VE increased with increasing disease severity: 38% (95% confidence interval [CI]:17-53) for mild/moderate disease versus 58% (95% CI: 50-64) for severe/very severe disease, and this pattern persisted with stratification by age and U5M. Among children with severe/very severe disease, VE was higher in infants aged 6-11 months (62%, 95% CI: 51-70) compared with children aged 24-59 months (11%, 95% CI: -78 to 56), and lower among children in the highest U5M strata (44%, 95% CI: 26-58) compared to children in the high U5M strata (60%, 95% CI: 47-69). CONCLUSIONS: Rotavirus vaccines provide the greatest protection against very severe rotavirus disease. VE remains lower in countries with higher U5M levels, even among children with very severe rotavirus disease, highlighting the need for improved vaccine performance in countries with high disease burden.

The Pediatric Infectious Disease Journal
South African Medical Research Council (ZA), Universidad Mayor de San Andrés (BO), University of Ghana (GH), University of Botswana (BW), National Center for Immunization and Respiratory Diseases (US), University of the Witwatersrand (ZA), Tajik State Medical University (TJ), Cherokee Nation (US), Sefako Makgatho Health Sciences University (ZA), Rubaga Hospital (UG), Kenya Medical Research Institute (KE), University of Kigali (RW), University of Kinshasa (CD), World Health Organization Regional Office for the Americas (US), Universidad de Managua (NI), World Health Organization - Zimbabwe (ZW), National Institute Of Hygiene And Epidemiology (VN), Ministry of Health, Community Development, Gender, Elderly and Children (TZ), Manhiça Health Research Centre (MZ), National Public Health Laboratory (NP), Association Vahatra (MG), Société de Développement des Forêts (CI), Centre Hospitalier Universitaire de Kigali (RW), Instituto Nacional de Saúde (MZ), Barcelona Institute for Global Health (ES), Harare Central Hospital (ZW), National Center for Infectious Diseases (US), Universidade Nova de Lisboa (PT), Universidad del Valle de Guatemala (GT)
Good health and well-being
Openalex Percentile: Top 9%
Viral gastroenteritis research and epidemiology
DOISourceOpenAlex
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