The human rotavirus vaccine Rotarix™ in infants: an integrated analysis of safety and reactogenicity

Hubert Buyse, Carlota Vinals, Naveen Karkada, Htay Htay Han, Hubert Buyse, Carlota Vinals, Naveen Karkada, Htay Htay Han

Abstract

An integrated analysis of safety and reactogenicity data was undertaken for 28 randomized, placebo-controlled, double-blind Phase II and III trials (DBRCTs) of the oral live-attenuated human rotavirus vaccine, Rotarix™ (GlaxoSmithKline Vaccines). Healthy infants aged 6-20 wk received 2 or 3 doses of vaccine (n=56562) or placebo (n=45512) at 4- to 8-wk intervals. Solicited adverse events (AEs) were recorded for 8 d after each dose of vaccine or placebo. Unsolicited AEs, serious AEs (SAEs), and deaths were evaluated over 31-d post-vaccination follow-up periods. 95% confidence intervals (CIs) for the relative risk (RR) across studies excluding "1.0" signified potential imbalances between the 2 groups. The incidence of each solicited AE of any or Grade 3 severity was similar between groups. The incidence of all unsolicited AEs of any (RR=0.99 [95% CI: 0.94-1.04]; P=0.72) or Grade 3 severity (RR=0.91 [95% CI: 0.77-1.08]; P=0.31) was similar between groups. A significantly higher proportion of SAEs were reported in the placebo group compared with the vaccine group (RR=0.9 [95% CI: 0.82-0.98]; P=0.01). The incidence of death was low and similar between the 2 groups (0.13% in the vaccine group and 0.11% in the placebo group; RR=1.14 [95% CI: 0.78-1.68]; P=0.54). Very few cases of intussusception were reported (11 and 7 in the vaccine and placebo groups, respectively; RR=1.39 [95% CI: 0.49-4.27]; P=0.66). In conclusion, results of this analysis of DBRCTs show that the human rotavirus vaccine Rotarix™ has a reactogenicity and safety profile similar to placebo.

Keywords: Rotarix™; human rotavirus vaccine; intussusceptions; reactogenicity; rotavirus gastroenteritis; vaccine safety.

References

    1. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis. 2003;9:565–72. doi: 10.3201/eid0905.020562.
    1. Parashar UD, Gibson CJ, Bresee JS, Glass RI. Rotavirus and severe childhood diarrhea. Emerg Infect Dis. 2006;12:304–6. doi: 10.3201/eid1202.050006.
    1. Parashar UD, Burton A, Lanata C, Boschi-Pinto C, Shibuya K, Steele D, Birmingham M, Glass RI. Global mortality associated with rotavirus disease among children in 2004. J Infect Dis. 2009;200(Suppl 1):S9–15. doi: 10.1086/605025.
    1. Grimwood K, Lambert SB, Milne RJ. Rotavirus infections and vaccines: burden of illness and potential impact of vaccination. Paediatr Drugs. 2010;12:235–56. doi: 10.2165/11537200-000000000-00000.
    1. Meeting of the immunization Strategic Advisory Group of Experts, April 2009--conclusions and recommendations. Wkly Epidemiol Rec. 2009;84:220–36.
    1. Vesikari T, Karvonen A, Prymula R, Schuster V, Tejedor JC, Cohen R, Meurice F, Han HH, Damaso S, Bouckenooghe A. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. Lancet. 2007;370:1757–63. doi: 10.1016/S0140-6736(07)61744-9.
    1. Linhares AC, Velázquez FR, Pérez-Schael I, Sáez-Llorens X, Abate H, Espinoza F, López P, Macías-Parra M, Ortega-Barría E, Rivera-Medina DM, et al. Human Rotavirus Vaccine Study Group Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomised, double-blind, placebo-controlled phase III study. Lancet. 2008;371:1181–9. doi: 10.1016/S0140-6736(08)60524-3.
    1. Phua KB, Lim FS, Lau YL, Nelson EA, Huang LM, Quak SH, Lee BW, van Doorn LJ, Teoh YL, Tang H, et al. Rotavirus vaccine RIX4414 efficacy sustained during the third year of life: a randomized clinical trial in an Asian population. Vaccine. 2012;30:4552–7. doi: 10.1016/j.vaccine.2012.03.030.
    1. Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, Ngwira B, Victor JC, Gillard PH, Cheuvart BB, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med. 2010;362:289–98. doi: 10.1056/NEJMoa0904797.
    1. Kawamura N, Tokoeda Y, Oshima M, Okahata H, Tsutsumi H, Van Doorn LJ, Muto H, Smolenov I, Suryakiran PV, Han HH. Efficacy, safety and immunogenicity of RIX4414 in Japanese infants during the first two years of life. Vaccine. 2011;29:6335–41. doi: 10.1016/j.vaccine.2011.05.017.
    1. Centers for Disease Control and Prevention (CDC) Withdrawal of rotavirus vaccine recommendation. MMWR Morb Mortal Wkly Rep. 1999;48:1007.
    1. Centers for Disease Control and Prevention (CDC) Suspension of rotavirus vaccine after reports of intussusception--United States, 1999. MMWR Morb Mortal Wkly Rep. 2004;53:786–9.
    1. U.S. Food and Drug Administration. Information pertaining to labeling revision for RotaTeq, June 15, 2007. Accessed June 2013.
    1. Cheuvart B, Friedland LR, Abu-Elyazeed R, Han HH, Guerra Y, Verstraeten T. The human rotavirus vaccine RIX4414 in infants: a review of safety and tolerability. Pediatr Infect Dis J. 2009;28:225–32. doi: 10.1097/INF.0b013e31819715fa.
    1. Lanzieri TM, Costa I, Shafi FA, Cunha MH, Ortega-Barria E, Linhares AC, Colindres RE. Trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years of age in Brazil before and after human rotavirus vaccine introduction, 1998-2007. Pediatr Infect Dis J. 2010;29:673–5. doi: 10.1097/INF.0b013e3181da8f23.
    1. Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, Esparza-Aguilar M, Johnson B, Gomez-Altamirano CM, Parashar U, Patel M. Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. N Engl J Med. 2010;362:299–305. doi: 10.1056/NEJMoa0905211.
    1. Lanzieri TM, Linhares AC, Costa I, Kolhe DA, Cunha MH, Ortega-Barria E, Colindres RE. Impact of rotavirus vaccination on childhood deaths from diarrhea in Brazil. Int J Infect Dis. 2011;15:e206–10. doi: 10.1016/j.ijid.2010.11.007.
    1. Macartney KK, Porwal M, Dalton D, Cripps T, Maldigri T, Isaacs D, Kesson A. Decline in rotavirus hospitalisations following introduction of Australia’s national rotavirus immunisation programme. J Paediatr Child Health. 2011;47:266–70. doi: 10.1111/j.1440-1754.2010.01953.x.
    1. Raes M, Strens D, Vergison A, Verghote M, Standaert B. Reduction in pediatric rotavirus-related hospitalizations after universal rotavirus vaccination in Belgium. Pediatr Infect Dis J. 2011;30:e120–5. doi: 10.1097/INF.0b013e318214b811.
    1. Richardson V, Parashar U, Patel M. Childhood diarrhea deaths after rotavirus vaccination in Mexico. N Engl J Med. 2011;365:772–3. doi: 10.1056/NEJMc1100062.
    1. Bayard V, DeAntonio R, Contreras R, Tinajero O, Castrejon MM, Ortega-Barría E, Colindres RE. Impact of rotavirus vaccination on childhood gastroenteritis-related mortality and hospital discharges in Panama. Int J Infect Dis. 2012;16:e94–8. doi: 10.1016/j.ijid.2011.09.003.
    1. Braeckman T, Van Herck K, Meyer N, Pirçon JY, Soriano-Gabarró M, Heylen E, Zeller M, Azou M, Capiau H, De Koster J, et al. RotaBel Study Group Effectiveness of rotavirus vaccination in prevention of hospital admissions for rotavirus gastroenteritis among young children in Belgium: case-control study. BMJ. 2012;345:e4752. doi: 10.1136/bmj.e4752.
    1. Velázquez FR, Colindres REC, Grajales C, Hernández MT, Mercadillo MG, Torres FJ, Cervantes-Apolinar M, DeAntonio-Suarez R, Ortega-Barria E, Blum M, et al. Postmarketing surveillance of intussusception following mass introduction of the attenuated human rotavirus vaccine in Mexico. Pediatr Infect Dis J. 2012;31:736–44. doi: 10.1097/INF.0b013e318253add3.
    1. Patel MM, Haber P, Baggs J, Zuber P, Bines JE, Parashar UD. Intussusception and rotavirus vaccination: a review of the available evidence. Expert Rev Vaccines. 2009;8:1555–64. doi: 10.1097/INF.0b013e318253add3.
    1. Patel MM, López-Collada VR, Bulhões MM, De Oliveira LH, Bautista Márquez A, Flannery B, Esparza-Aguilar M, Montenegro Renoiner EI, Luna-Cruz ME, Sato HK, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. 2011;364:2283–92. doi: 10.1056/NEJMoa1012952.
    1. Buttery JP, Danchin MH, Lee KJ, Carlin JB, McIntyre PB, Elliott EJ, Booy R, Bines JE, PAEDS/APSU Study Group Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine. 2011;29:3061–6. doi: 10.1016/j.vaccine.2011.01.088.
    1. Desai R, Parashar UD, Lopman B, de Oliveira LH, Clark AD, Sanderson CF, Tate JE, Matus CR, Andrus JK, Patel MM. Potential intussusception risk versus health benefits from rotavirus vaccination in Latin America. Clin Infect Dis. 2012;54:1397–405. doi: 10.1093/cid/cis191.
    1. Desai R, Cortese MM, Meltzer MI, Shankar M, Tate JE, Yen C, Patel MM, Parashar UD. Potential intussusception risk versus benefits of rotavirus vaccination in the United States. Pediatr Infect Dis J. 2013;32:1–7. doi: 10.1097/INF.0b013e318270362c.

Source: PubMed

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