WHO recommends introduction of rotavirus in all national immunization programmes

WHO headquarters has published an updated position paper on rotavirus vaccination that replaces the most recent recommendations of 2009. In addition to providing recommendations, this paper summarizes recent developments and the potential of rotavirus vaccines to reduce mortality among young children.

Rotaviruses infect nearly every child by the age of 3–5 years and are globally the leading cause of severe, dehydrating diarrhoea in children under 5 years. Differences in rotavirus epidemiology, as well as differences in health care availability and childhood co-morbidity, drive a marked inequality in rotavirus disease burden between low and high-income countries.

WHO recommendations

The updated position paper includes the following WHO recommendations:

• Rotavirus vaccines should be included in all national immunization programmes and considered a priority, particularly in countries with high RVGE-associated fatality rates.
• The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal diseases with the scaling up of both prevention (promotion of early and exclusive breastfeeding, handwashing, improved water supply and sanitation) and treatment packages. 
• Plans for introduction of rotavirus vaccines should consider the epidemiology of the disease by age, the coverage and actual age at vaccination and an evaluation of the estimated public health impact and potential risks. In addition, cost–effectiveness assessment, issues of affordability of the vaccine, financial and operational impact on the immunization delivery system, and careful examination of current immunization practices should be taken into account.
• Introduction of rotavirus vaccine should be accompanied by measures to ensure high vaccination coverage and timely administration of each dose. 
• The epidemiological impact of rotavirus vaccination should be monitored. High-quality surveillance should be conducted in selected countries and defined populations, including high child mortality settings. However, lack of population-based surveillance should not be an impediment to the introduction of rotavirus vaccine.

Introduction of rotavirus vaccine in the WHO European Region

WHO/Europe supports middle-income countries and those eligible for support from the Global Alliance for Vaccines and Immunization (GAVI):

• to raise the awareness of immunization programme stakeholders about the disease and its vaccines;
• to improve countries' capacity to make evidence-based decisions on the introduction of rotavirus vaccines;
• to strengthen countries' capacity and provide tools to collect local evidence on the disease burden, circulation of rotavirus genotypes and the cost–effectiveness of vaccination; and
• to ensure implementation of a comprehensive approach to prevent and control diarrhoeal diseases.