Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian children in the second year of life
Nita Bhandari, Temsunaro Rongsen-Chandola, Ashish Bavdekar, Jacob John, Kalpana Antony, Sunita Taneja, Nidhi Goyal, Anand Kawade, Gagandeep Kang, Sudeep Singh Rathore, Sanjay Juvekar, Jayaprakash Muliyil, Alok Arya, Hanif Shaikh, Vinod Abraham, Sudhanshu Vrati, Michael Proschan, Robert Kohberger, Georges Thiry, Roger Glass, Harry B Greenberg, George Curlin, Krishna Mohan, G V J A Harshavardhan, Sai Prasad, T S Rao, John Boslego, Maharaj Kishan Bhan, India Rotavirus Vaccine Group, Krishna M Ella, Madhu Mahesh, Farhana Afzal Rafiqi, Girish Dayma, Anand Pandit, Anuradha Bose, Vinohar Balraj, Deepak More, Pankaj Ghatbandhe, Taranjeet Kaur, Sharan Basava, Sudhir Babji, Amit Mohindru, Manju Bagdwal, Elizabeth Horigan, Margaret Wecker, Jorge Flores, David Alli, Kårstein Måseide, Unni Hirdman Rørslett, Tor A Strand, Balaji K Ananth, Mathuram Santosham, Olivier Fontaine, Lawrence Moulton, Satinder Aneja, Nik Zarifah Nik Hussain Reed, Veeresh-war Bhatnagar, Arun KumarGupta, Madhulika Kabra, Siddharth Ramji, Amita Sapru, Prabhakar Moses, Nita Bhandari, Temsunaro Rongsen-Chandola, Ashish Bavdekar, Jacob John, Kalpana Antony, Sunita Taneja, Nidhi Goyal, Anand Kawade, Gagandeep Kang, Sudeep Singh Rathore, Sanjay Juvekar, Jayaprakash Muliyil, Alok Arya, Hanif Shaikh, Vinod Abraham, Sudhanshu Vrati, Michael Proschan, Robert Kohberger, Georges Thiry, Roger Glass, Harry B Greenberg, George Curlin, Krishna Mohan, G V J A Harshavardhan, Sai Prasad, T S Rao, John Boslego, Maharaj Kishan Bhan, India Rotavirus Vaccine Group, Krishna M Ella, Madhu Mahesh, Farhana Afzal Rafiqi, Girish Dayma, Anand Pandit, Anuradha Bose, Vinohar Balraj, Deepak More, Pankaj Ghatbandhe, Taranjeet Kaur, Sharan Basava, Sudhir Babji, Amit Mohindru, Manju Bagdwal, Elizabeth Horigan, Margaret Wecker, Jorge Flores, David Alli, Kårstein Måseide, Unni Hirdman Rørslett, Tor A Strand, Balaji K Ananth, Mathuram Santosham, Olivier Fontaine, Lawrence Moulton, Satinder Aneja, Nik Zarifah Nik Hussain Reed, Veeresh-war Bhatnagar, Arun KumarGupta, Madhulika Kabra, Siddharth Ramji, Amita Sapru, Prabhakar Moses
Abstract
Rotavirus gastroenteritis is one of the leading causes of diarrhea in Indian children less than 2 years of age. The 116E rotavirus strain was developed as part of the Indo-US Vaccine Action Program and has undergone efficacy trials. This paper reports the efficacy and additional safety data in children up to 2 years of age. In a double-blind placebo controlled multicenter trial, 6799 infants aged 6-7 weeks were randomized to receive three doses of an oral human-bovine natural reassortant vaccine (116E) or placebo at ages 6, 10, and 14 weeks. The primary outcome was severe (≥11 on the Vesikari scale) rotavirus gastroenteritis. Efficacy outcomes and adverse events were ascertained through active surveillance. We randomly assigned 4532 and 2267 subjects to receive vaccine and placebo, respectively, with over 96% subjects receiving all three doses of the vaccine or placebo. The per protocol analyses included 4354 subjects in the vaccine and 2187 subjects in the placebo group. The overall incidence of severe RVGE per 100 person years was 1.3 in the vaccine group and 2.9 in the placebo recipients. Vaccine efficacy against severe rotavirus gastroenteritis in children up to 2 years of age was 55.1% (95% CI 39.9 to 66.4; p<0.0001); vaccine efficacy in the second year of life of 48.9% (95% CI 17.4 to 68.4; p=0.0056) was only marginally less than in the first year of life [56.3% (95% CI 36.7 to 69.9; p<0.0001)]. The number of infants needed to be immunized to prevent one episode of severe RVGE in the first 2 years of life was 40 (95% CI 28.0 to 63.0) and for RVGE of any severity, it was 21 (95% CI 16.0 to 32.0). Serious adverse events were observed at the same rates in the two groups. None of the eight intussusception events occurred within 30 days of a vaccine dose and all were reported only after the third dose. The sustained efficacy of the 116E in the second year of life is reassuring.
Clinical trial registry: The trial is registered with Clinical Trial Registry-India (# CTRI/2010/091/000102) and Clinicaltrials.gov (# NCT01305109).
Keywords: Gastroenteritis; Rotavirus; Vaccine efficacy.
Copyright © 2014. Published by Elsevier Ltd.
Source: PubMed