Evaluation of rhesus rotavirus monovalent and tetravalent reassortant vaccines in US children. US Rotavirus Vaccine Efficacy Group.
OBJECTIVE
To determine the safety and relative efficacy of two reassortant rhesus rotavirus vaccines over two rotavirus seasons.


METHODS
A prospective, double-masked, placebo-controlled trial.


METHODS
Twenty-three centers in the United States.


METHODS
A total of 1006 healthy infants between 4 and 26 weeks of age were enrolled, and 898 received three doses of vaccine or placebo.


METHODS
Reactogenicity was determined by comparing the incidence of fever, diarrhea, and/or vomiting for 5 days after each dose of vaccine. Rotavirus IgA and neutralizing antibody to rhesus rotavirus and four rotavirus serotypes were measured in a subset of subjects. Relative efficacy was determined by comparing the incidence of rotavirus gastroenteritis after three doses of vaccine or placebo over two rotavirus seasons.


RESULTS
Adverse reactions were mild and limited to a small but significant increase in the incidence of fever after the first dose of tetravalent but not monovalent vaccine. The relative efficacy against rotavirus disease over the 2 years of observation was 40% (98.3% confidence interval, 7% to 62%) for the monovalent and 57% (98.3% confidence interval, 29% to 74%) for the tetravalent vaccine. In post hoc analyses, the relative efficacy against very severe rotavirus gastroenteritis was 73% and 82% for monovalent and tetravalent vaccine recipients, respectively. Also, a 67% and 78% reduction in medical visits for rotavirus gastroenteritis was observed. Both vaccines protected against disease caused by serotype 1 rotavirus, but only the tetravalent vaccine reduced the incidence of disease caused by non-serotype 1 rotavirus infection detected in the second season. It is unclear, however, whether this result represents serotype-specific protection or a difference in the duration of protection.


CONCLUSIONS
Vaccination with both vaccines was safe and significantly reduced the incidence of rotavirus gastroenteritis, but only the tetravalent vaccine provided protection against disease caused by non-serotype 1 rotaviruses during the second year of follow-up.
Bernstein
D I
DI
Division of Clinical Virology, J. N. Gamble Institute of Medical Research, Cincinnati, Ohio 45219, USA.
Glass
R I
RI
Rodgers
G
G
Davidson
B L
BL
Sack
D A
DA
D000914:Antibodies, Viral / Q000096:biosynthesis; D000956:Antigens, Viral / Q000032:analysis; D003968:Diarrhea, Infantile / Q000382:microbiology / Q000517:prevention & control*; D004311:Double-Blind Method; D006801:Humans; D007115:Immunization Schedule; D007125:Immunogenetics; D007223:Infant; D011446:Prospective Studies; D012401:Rotavirus / Q000276:immunology*; D012400:Rotavirus Infections / Q000276:immunology / Q000517:prevention & control*; D022243:Rotavirus Vaccines; D013223:Statistics as Topic; D014481:United States; D014611:Vaccination; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology*; D014765:Viral Vaccines / Q000008:administration & dosage / Q000276:immunology*
D000914:Antibodies, Viral; D000956:Antigens, Viral; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated; D014765:Viral Vaccines; C052014:rhesus rotavirus vaccine