Introducing rotavirus vaccination to the Hong Kong Childhood Immunisation Programme

Dr KL Hon (ehon@hotmail.com) Full paper in PDF Most children are infected with rotavirus by the age of 5 years, causing approximately 2 million hospitalisations and 352 000 to 592 000 deaths every year.1 The World Health Organization recommends that rotavirus vaccination should be included in all immunisation programmes.2 Infection rates in Hong Kong are steady throughout the year but peak between December and January.3 Although rotavirus vaccines have been licensed and available in Hong Kong since 2006, they have not been included in the Hong Kong Childhood Immunisation Programme (HKCIP) and are therefore only available via private health care. Factors to consider Burden of disease, other prevention and control measures, and public health priorities A 2-year, prospective, hospital-based surveillance study of rotavirus disease published in 2005 estimated that 4.6% of all general paediatric admissions in Hong Kong were associated with rotavirus.4 The incidence rate of rotavirus-associated admissions in children aged [lesser than]5 years was 8.1 to 8.8 admissions/1000 children; in those [lesser than]1 year of age, the rate was higher, at 15.4 to 18.4 admissions/1000 children.4 These rates are higher than those in other developed countries prior to the implementation of rotavirus vaccination (eg, 5 admissions/1000 children in the United Kingdom5; 3.7/1000 in Sweden6; and 7.6[-]10.1/1000 in the United States7). RotaTeq is a pentavalent vaccine containing five reassortant rotaviruses developed from human-bovine origin of the common circulating strains (G1, G2, G3, G4, and P1[8]).11 Three doses of RV5 are given orally at 2, 4, and 6 months of age.12 Rotarix, a monovalent vaccine, contains the attenuated G1P[8] human rotavirus strain and consists of two doses given orally at 2 and 4 months of age.13 Intussusception is a rare adverse effect that led to the withdrawal of RotaShield, with an excess risk of approximately 1 to 2 cases per 10 000 recipients.14RotaTeq and RV1 were only licensed after evaluation of large clinical trials ([greater than]60 000 infants) that were sufficiently powered to detect the rates of intussusception observed for RotaShield.14 Findings of international post-licencing safety studies suggest that intussusception in vaccine recipients occurs at a rate of between 1/20 000 and 1/100 000 in high- and middle-income countries.15 The benefits of rotavirus vaccination (including prevention of severe diarrhoea and death) exceed the risk of intuss