Rotavirus and rotavirus vaccines.

Two new rotavirus vaccines have recently been licensed that will provide the intervention needed to diminish the huge burden of rotavirus disease among all children. In many upper and middle income countries, these vaccines will soon be available for the routine immunization of children. The impact should be a rapid and measurable reduction in hospitalizations and doctor visits for acute diarrhea in children, especially in the winter rotavirus season. While few deaths occur in these settings, the illness has consequences in terms of both medical costs and indirect costs, including parents work time lost. In the developing world, clinical trials are still needed to ensure that the vaccines being licensed will work as expected in children living in poor settings. In these settings, other enteric flora, micronutrient malnutrition, higher titers of maternal antibody and other factors still poorly defined have compromised other live oral vaccines and have required the developers to alter vaccine formulation, dose, or schedule. Until these trials are completed, we can only hope that the efficacy will be comparable and that the vaccine will prove to be life-savers. Once the efficacy and safety have been established, rotavirus vaccines could provide a major boost to programs for child survival.