Volume 98, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; however, the protection they confer to unvaccinated individuals through indirect effects remains unknown. We systematically reviewed the literature and quantified indirect rotavirus vaccine effectiveness (VE) for preventing rotavirus hospitalization in children aged less than 5 years. From 148 identified abstracts, 14 studies met our eligibility criteria. In our main analysis using a random-effects model, indirect rotavirus VE was 48% (95% confidence interval [CI]: 39–55%). In a subgroup analysis by country income level, indirect VE was greater in high-income countries (52%; 95% CI: 43–60%) than in low- and middle-income countries (LMICs) (25%; 95% CI: 5–41%). In a sensitivity analysis using a quality-effects model, the indirect VE in LMICs was not statistically significant (25%; 95% CI: 0–44%). Our findings highlight the importance of increasing rotavirus vaccine coverage, particularly in LMICs where evidence for indirect VE is limited and rotavirus burden is high.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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  • Received : 07 Sep 2017
  • Accepted : 31 Dec 2017
  • Published online : 12 Feb 2018

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