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Re-evaluation of population-level protection conferred by a rotavirus vaccine using the 'fried-egg' approach in a rural setting in Bangladesh.

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cam.depositDate2021-12-16
cam.issuedOnline2021-08-26
dc.contributor.authorAziz, Asma Binte
dc.contributor.authorZaman, K
dc.contributor.authorKim, Deok Ryun
dc.contributor.authorPark, Ju Yeon
dc.contributor.authorIm, Justin
dc.contributor.authorAli, Mohammad
dc.contributor.authorAhmmed, Faisal
dc.contributor.authorIslam, Md Taufiqul
dc.contributor.authorKhanam, Farhana
dc.contributor.authorChowdhury, Fahima
dc.contributor.authorAhmed, Tasnuva
dc.contributor.authorHoque, Masuma
dc.contributor.authorLiu, Xinxue
dc.contributor.authorPak, Gi Deok
dc.contributor.authorTadesse, Birkneh Tilahun
dc.contributor.authorJeon, Hyon Jin
dc.contributor.authorKang, Sophie
dc.contributor.authorKhan, Ashraful Islam
dc.contributor.authorKim, Jerome H
dc.contributor.authorMarks, Florian
dc.contributor.authorQadri, Firdausi
dc.contributor.authorClemens, John David
dc.contributor.orcidMarks, Florian [0000-0002-6043-7170]
dc.date.accessioned2021-12-18T00:31:17Z
dc.date.available2021-12-18T00:31:17Z
dc.date.issued2021-09-24
dc.date.updated2021-12-16T22:01:25Z
dc.description.abstractBACKGROUND: Vaccine herd protection assessed in a cluster-randomized trial (CRT) may be masked by disease transmission into the cluster from outside. However, herd effects can be unmasked using a 'fried-egg' approach whereby the analysis, restricted to the innermost households of clusters, 'yolk', creates an insulating 'egg-white' periphery. This approach has been demonstrated to unmask vaccine herd protection in reanalyses of cholera and typhoid vaccine CRTs. We applied this approach to an earlier CRT in Bangladesh of rotavirus vaccine (RV) whose overall analysis had failed to detect herd protection. Herein we present the results of this analysis. METHODS: In the study area, infants in 142 villages were randomized to receive two doses of RV with routine EPI vaccines (RV villages) or only EPI vaccines (non-RV villages). We analyzed RV protection against acute rotavirus diarrhoea for the entire cluster (P100) and P75, P50, P25 clusters, representing 75%, 50% and 25% of the innermost households for each cluster, respectively. RESULTS: During 2 years of follow-up, there was evidence of 27% overall (95 %CI: 7, 43) and 42% total protection (95 %CI: 23, 56) in the P100 cluster, but it did not increase when moved in smaller yolks. There was no evidence of indirect vaccine protection in the yolks at any cluster size. CONCLUSION: Our reanalysis of the CRT using the fried- egg approach did not detect RV herd protection. Whether these findings reflect a true inability of the RV to confer herd protection in this setting, or are due to limitations of the approach, requires further study.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.79064
dc.identifier.eissn1873-2518
dc.identifier.issn0264-410X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/331612
dc.language.isoeng
dc.publisherElsevier BV
dc.publisher.departmentDepartment of Medicine
dc.publisher.urlhttp://dx.doi.org/10.1016/j.vaccine.2021.08.048
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCRT
dc.subjectFried-egg
dc.subjectHerd protection
dc.subjectRotavirus
dc.subjectRotavirus vaccine
dc.subjectBangladesh
dc.subjectCholera
dc.subjectHumans
dc.subjectImmunity, Herd
dc.subjectInfant
dc.subjectRotavirus
dc.subjectRotavirus Vaccines
dc.titleRe-evaluation of population-level protection conferred by a rotavirus vaccine using the 'fried-egg' approach in a rural setting in Bangladesh.
dc.typeArticle
dcterms.dateAccepted2021-08-12
prism.endingPage5882
prism.issueIdentifier40
prism.publicationDate2021
prism.publicationNameVaccine
prism.startingPage5876
prism.volume39
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
pubs.licence-identifierapollo-deposit-licence-2-1
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1016/j.vaccine.2021.08.048

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