title: Rotavirus immunization: Global coverage and local barriers for implementation.
abstract: Rotavirus (RV) is a major agent of gastroenteritis and an important cause of child death worldwide. Immunization (RVI) has been available since 2006, and the Federation of International Societies of Gastroenterology Hepatology and Nutrition (FISPGHAN) identified RVI as a top priority for the control of diarrheal illness. A FISPGHAN working group on acute diarrhea aimed at estimating the current RVI coverage worldwide and identifying barriers to implementation at local level.
  
  
  
  A survey was distributed to national experts in infectious diseases and health-care authorities (March 2015-April 2016), collecting information on local recommendations, costs and perception of barriers for implementation.
  
  
  
  Forty-nine of the 79 contacted countries (62% response rate) provided a complete analyzable data. RVI was recommended in 27/49 countries (55%). Although five countries have recommended RVI since 2006, a large number (16, 33%) included RVI in a National Immunization Schedule between 2012 and 2014. The costs of vaccination are covered by the government (39%), by the GAVI Alliance (10%) or public and private insurance (8%) in some countries. However, in most cases, immunization is paid by families (43%). Elevated cost of vaccine (49%) is the main barrier for implementation of RVI. High costs of vaccination (rs=-0.39, p=0.02) and coverage of expenses by families (rs=0.5, p=0.002) significantly correlate with a lower immunization rate. Limited perception of RV illness severity by the families (47%), public-health authorities (37%) or physicians (24%) and the timing of administration (16%) are further major barriers to large- scale RVI programs.
  
  
  
  After 10years since its introduction, the implementation of RVI is still unacceptably low and should remain a major target for global public health. Barriers to implementation vary according to setting. Nevertheless, public health authorities should promote education for caregivers and health-care providers and interact with local health authorities in order to implement RVI.
authors.affiliation: Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lo Vecchio
authors.affiliation: Department of Clinical and Experimental Medical Sciences, University Hospital of Udine, Udine, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Liguoro
authors.affiliation: Departamento de Pediatria Médica, Hospital de São João, Porto, Portugal.
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.affiliation: KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.
authors.forename: James A
authors.initials: JA
authors.lastname: Berkley
authors.affiliation: Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chris
authors.initials: C
authors.lastname: Boey
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Cohen
authors.affiliation: Instituto de nutrición y tecnología de los alimentos, INTA, Universidad de Chile, Santiago, Chile.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Cruchet
authors.affiliation: Department of Pediatrics, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salazar-Lindo
authors.affiliation: Medical and Scientific Affairs, Innovara, Inc., MA, United States.
authors.forename: Samir
authors.initials: S
authors.lastname: Podder
authors.affiliation: Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, United Kingdom.
authors.forename: Bhupinder
authors.initials: B
authors.lastname: Sandhu
authors.affiliation: Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Sherman
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy. Electronic address: alfguari@unina.it.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control; D014943:Global Health; D006801:Humans; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D011795:Surveys and Questionnaires; D000073887:Vaccination Coverage
chemical_list: D022243:Rotavirus Vaccines
keywords: Diarrhea; Immunization; Implementation; Rotavirus; Vaccine