A review of rotavirus vaccine use in Asia and the Pacific regions: challenges and future prospects

<b>Introduction</b>: Rotavirus infection causes a significant proportion of diarrhea disease burden in children &lt;5 years of age in Asia and the Pacific regions. The World Health Organization recommends that rotavirus vaccination should be included in national immunization programs to prevent rotavirus gastroenteritis (RVGE). <b>Areas covered</b>: A literature review was performed to identify and summarize published evidence on RVGE epidemiology and status of rotavirus vaccine use, including the impact and cost-effectiveness of rotavirus vaccination programs in Asia and the Pacific regions (49 countries) during the period 2000–2018. <b>Expert opinion</b>: Rotavirus vaccination programs have successfully reduced the burden of RVGE in many countries. However, such programs still do not exist in most Asia-Pacific countries, and therefore the burden of RVGE remains high in children &lt;5 years of age. Challenges to vaccine implementation include a lack of surveillance data; safety concerns around intussusception; a general lack of awareness about RVGE disease epidemiology and vaccines among physicians, policy-makers, and parents; insufficient cost-effectiveness analyses; and potential issues with vaccine affordability including vaccination costs and lack of political will. Recommendations to overcome these challenges include developing cost-effectiveness analyses for more diverse national and regional settings, providing non-governmental support for low-income countries, and improving advocacy efforts. <b>Plain language summary</b> <b>What is the context?</b> <b><i>•</i></b> Rotavirus (RV) infection causes acute gastroenteritis (GE) in children under 5 years of age. <b><i>•</i></b> Rotavirus vaccination (RVV) implementation has been slow in Asia and the Pacific (AP) regions, which could be responsible for the region falling behind in their fight against RVGE. <b>What is new?</b> <b><i>•</i></b> RVV via national immunization programs (NIPs) is available in 8/49 countries and through the private market or non-governmental support in other countries. Coverage rates vary between countries, possibly driven by the mechanism through which RVV is available. <b><i>•</i></b> A substantial positive impact of RVV on RVGE disease burden with a very low risk of intestinal intussusception for up to 7 days after RVV has been documented in the AP regions. <b><i>•</i></b> Economic evaluation studies, mainly cost-effectiveness analyses, predict a significant reduction in treatment costs related to RVGE and its complications showing that RVV is good value for money. <b>What is the impact?</b> <b><i>•</i></b> The prospect of continued safe and effective use of RVV in the AP regions is promising. <b><i>•</i></b> Challenges to RVV implementation include establishing evidence of burden of disease, poor awareness of rotavirus vaccines, limited evidence from cost-effectiveness analyses from several countries, issues of affordability of the vaccine and a lack of political will. <b><i>•</i></b> Recommendations for RVV implementation into the NIPs include conducting clinical and cost-effectiveness studies in countries where these are not available, establishing reliable surveillance mechanisms, providing non-governmental support for low-income countries and improving advocacy efforts. <b><i>•</i></b> Maintenance of high vaccination coverage is needed in countries that have implemented national RVV programs. <b>Graphical abstract</b>