Peer-reviewed article
Oral rotavirus vaccine effectiveness among malnourished children in 19 countries: Findings from the MNSSTER-V project.
Eleanor Burnett, Ismail Ticklay, Jazmina Umana, Inacio Mandomando, Annick Lalaina Robinson et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how well rotavirus vaccines protect malnourished children compared to well-nourished children across 19 medium to high child mortality countries. Children with stunting (chronic malnutrition affecting height) had weaker protection from the rotavirus vaccine than children without stunting. The findings show that malnutrition reduces how effective the vaccine is at preventing rotavirus illness requiring hospitalization.
Key points
- Complete series rotavirus vaccine effectiveness was 59% in children without stunting, 42% in children with moderate-to-severe stunting, and 31% in children with severe stunting
- Chronic malnutrition (stunting) significantly reduced vaccine effectiveness compared to other malnutrition indicators
- Vaccine effectiveness estimates were similar between malnourished and well-nourished groups when using birthweight and other anthropometric measures, suggesting stunting is the key malnutrition factor affecting vaccine response
- The study included data from the MNSSTER-V dataset across multiple medium to high child mortality settings
- Addressing and preventing malnutrition may improve rotavirus vaccine protection at the population level
Limitations
The document does not specify which 19 countries were included or provide details on the specific vaccine products evaluated. The study relies on observational data from post-licensure evaluations rather than randomized trials, which may be subject to confounding or bias.
Abstract
OBJECTIVES: Rotavirus vaccine clinical trials and post-licensure evaluations found malnourished children may have lower protection against rotavirus diarrhea hospitalizations than well-nourished children. On a population level, rotavirus vaccines are less protective in high child mortality settings. METHODS: We analyzed rotavirus vaccine effectiveness (VE) among malnourished and well-nourished children categorized using four anthropometric malnutrition indicators, birthweight, and reported malnutrition from medium to high child mortality countries in the Multi-National Subpopulations Study to Evaluate Rotavirus Vaccines (MNSSTER-V) dataset. We calculated child-level z-scores for weight-for-age, length-for-age, weight-for-length, and mid-upper arm circumference (MUAC), and the site-level proportion implausible z-scores. Sites with published VE estimates by nutritional status or those with <3% implausible values were included in the final analysis. Z-scores <-2 were considered moderate-to-severe malnutrition and <-3 were considered severe malnutrition. We calculated complete series rotavirus VE in each malnourished and well-nourished group using an unconditional adjusted logistic regression model, where VE = (1 - odds ratio of vaccination among cases and controls) × 100, where cases and controls were children who tested rotavirus positive and negative, respectively. RESULTS: Complete series VE was more protective among children without stunting (normal length-for-age) (59%; 95% confidence interval [CI]: 49-67) compared to children with moderate-to-severe stunting (42%; 95% CI: 19-58) and severe stunting (31%; 95%CI: -14 to 58). Adjusted VE point estimates were similar among malnourished and well-nourished children using the other anthropometric and birthweight indicators. CONCLUSIONS: Our findings clearly show that chronic malnutrition negatively impacted rotavirus VE. Efforts to address and prevent malnutrition generally may further reduce the burden of rotavirus morbidity and mortality.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Oral rotavirus vaccine (complete series)
- Population
- Malnourished and well-nourished children in 19 medium to high child mortality countries
Key finding
Vaccine effectiveness for complete series was 59% (95% CI: 49-67) among children without stunting
Burnett et al. · PubMed (US National Library of Medicine) · 4 Jan 2026