In countries that have adopted rotavirus vaccine in their childhood immunisation Modulators programmes,

evidence of impact has been striking [10]. Importantly, evidence of reduction of diarrhoea deaths following routine rotavirus vaccination has recently been published from Mexico [11]. Finally, a recent study of Rotarix from Mexico and Brazil has documented that the benefit of routine rotavirus vaccination (reduction see more in childhood diarrhoea hospitalisations and deaths) far outweighs a small, short term risk of intussusception that may be associated with use of this live, oral vaccine [12]. In 2009, following review of vaccine performance in Africa and resource-poor settings in Latin America, a global recommendation for rotavirus vaccine use was issued [13]. This recommendation was in part Birinapant in vivo informed by the results of a phase III, placebo-controlled clinical trial of RIX4414 undertaken in Malawi and South Africa [14]. In this study, vaccination with RIX4414 significantly reduced severe rotavirus gastroenteritis episodes in the first year of life in both settings, although efficacy was lower in Malawi (49.4% [95% CI 19.2–68.3]) compared

with South Africa (76.9% [56.0–88.4]). Notable findings in Malawi included a high incidence of severe rotavirus disease, a wide diversity of circulating rotavirus strains and a high exposure to natural rotavirus infection early in infancy [14]. This manuscript reports on vaccine performance and circulating rotavirus strains in Malawian children for an extended period of up to 24 months of age. A phase III, double-blind, randomized, placebo-controlled multicentre study was undertaken in South Africa and Malawi as previously reported [14]. In Malawi, children were enrolled

in four health centres in Blantyre, the largest city in the Southern region of the country. Healthy infants were randomized at their first Expanded Program on Immunisation (EPI) clinic visit into three groups. One group received three doses of placebo at 6, 10, and 14 weeks of age and a second group received three doses of RIX4414 at the same age. The third group received placebo at 6 weeks and RIX4414 below at 10 and 14 weeks. The study was designed to reflect, as far as possible, the conditions under which rotavirus vaccine would be administered under “real-life” conditions in a typical African infant population. Thus, all EPI vaccines including oral poliovirus vaccine (OPV) were co-administered; HIV-infected or -exposed infants were included; and no restriction on breastfeeding around the time of vaccination was imposed. Enrolment was conducted between October 2006 and July 2007. Subjects were initially followed-up until 12 months of age [14].