Benefit Versus Risk
Although the evidence for the risk of intussusception has evolved, the benefits of rotavirus immunization have been rapidly and consistently demonstrated in developed and developing settings. Despite reduced vaccine efficacy in developing setting trials, reductions in mortality in children <5 years from acute "all-cause" gastroenteritis of 43–55% were demonstrated after RV1 implementation in Mexico. In developed settings, where mortality is less common, hospital admissions for gastroenteritis in the United States and Australia, respectively, have reduced by 80% and 71% for rotavirus-coded gastroenteritis and 48% and 38% for non-rotavirus–coded admissions. Evidence of herd immunity has also been demonstrated, with unimmunized children experiencing decreased risk of hospital admission and death.
These are balanced with a small increased risk of intussusception (Table 1). In the US context, the benefit risk ratio for deaths prevented versus intussusception deaths precipitated favors vaccination by 71:1. Although this equation will vary in different settings depending upon gastroenteritis mortality, background rate of intussusception and access to health care, the balance strongly favors rotavirus vaccination in all settings it has been considered.