The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


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Immunizing children against rotavirus in Palestine can save money and prevent severe cases of gastroenteritis

An economic analysis in Palestine found that including rotavirus in the routine immunization program is a cost-effective intervention in children under 5 years old. The study estimated that between 2016–2025, rotavirus vaccination in Palestine has the potential to avert approximately 101,000 severe episodes of rotavirus gastroenteritis cases. Avoiding these treatment costs could lead to estimated savings of approximately $14 million for the health system and approximately $22 million for the society (in 2018 US dollars).

Debellut F, Jaber S, Bouzya Y et al.. 2020. Introduction of rotavirus vaccination in Palestine: An evaluation of the costs impact and cost-effectiveness of ROTARIX and ROTAVAC. PLoS ONE. 15(2).

Rotavirus vaccination saves money and prevents millions of cases, hospitalizations, and deaths

This study provided an updated model of the cost-effectiveness of rotavirus vaccination in children younger than 5 years across 73 countries previously or currently eligible for Gavi support. The researchers found evidence that rotavirus vaccination is still a cost-effective investment in Gavi countries, projected to save approximately $484 million (around $48 million per year) from the government perspective and $878 million (around $90 million per year) from the societal perspective between 2018 and 2027, by preventing 158.6 million cases of rotavirus gastroenteritis, 80.7 million outpatient visits, 7.9 million hospitalizations, 14.7 million Disability-Adjusted Life Years, and nearly 600,000 deaths.

Debellut F, Clark A, Pecenka C et al.. 2019. Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study. Lancet Global Health. 7(12).

Gut infections in early childhood can hinder physical growth and development, leading to lower IQ scores

A review of gut infections and effects on physical growth and development found that for children living in impoverished areas of the world, episodes of diarrhea during the first two years of life not only negatively affected their physical growth, but could result in a 10 points lower IQ than average by age 7.

Guerrant RL, DeBoer MD, Moore SR et al.. 2013. The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease. Nature Reviews Gastroenterology & Hepatology. 10(4).

Vaccinating against cholera is cost-effective, especially for high-risk populations and areas with high fatality rates

A comprehensive review of the economics of cholera and cholera prevention concluded that vaccination using oral cholera vaccines can be cost-effective, especially when herd effects are taken into account and when vaccination is administered to populations and age groups with high incidence rates (e.g., children) and to areas with high cholera case fatality rates.

Hsiao A, Hall AH, Mogasale V et al.. 2018. The health economics of cholera: a systematic review. Vaccine. 36(30).

Vaccinating children in high-risk slum areas in Bangladesh can effectively control cholera and save lives

A study using local epidemiological and economic data found that vaccinating children 1-14 years old in high-risk slum areas in Dhaka, Bangladesh using a locally-produced oral cholera vaccine provided through periodic campaigns would be a highly cost-effective means of controlling endemic cholera — reducing cholera incidence in the entire population by 45% over 10 years and costing US$440-635 per DALY averted. Vaccinating all persons aged one and above would reduce incidence much further (by 91%) but would be less cost-effective.

Khan AI, Levin A, Chao DL, DeRoeck D et al.. 2018. The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: A disease modeling and economic analysis. PLoS NTD. 12(10).

Immunizing infants against rotavirus in Japan led to fewer hospitalizations due to herd immunity

In Nagoya, Japan, hospitalizations due to rotavirus (RV) decreased sharply in children 2-4 years of age once the percent of infants vaccinated against RV climbed to around 80%. Few of these older children had likely received the vaccine, suggesting that they were protected as a result of herd immunity.

Yoshikawa T, Matsuki T, Sato K et al.. 2018. Impact of rotavirus vaccination on the burden of acute gastroenteritis in Nagoya city, Japan. Vaccine. 36(4).

Rotavirus hospitalizations cause significant economic burden due to work and school absenteeism

Children hospitalized with rotavirus in Norway were absent from daycare for 6.3 days, on average, and 73% of their parents missed work — for a mean of almost 6 days. These data, which can be used in economic evaluations of rotavirus vaccination, show that work absenteeism resulting from having a child hospitalized with rotavirus poses a considerable economic burden on society.

Edwards CH, Bekkewold T, Flem E.. 2017. Lost workdays and healthcare use before and after hospital visits due to rotavirus and other gastroenteritis among young children in Norway. Vaccine. 35(28).

Marginalized populations derive the most benefit from immunization against rotavirus

Children in the poorest 20% of households in Laos have a 4-5 times greater risk of dying from rotavirus than the richest 20%. Consequently, rotavirus vaccination was almost five times more cost-effective in the lowest income groups in the Central Region than in the richest households in the wealthier North region. Thus, rotavirus vaccination has a greater potential for health gains and greater cost-effectiveness among marginalized populations.

Rheingans R, Anderson JD, Bagamian KH, et al.. 2018. Effects of geographic and economic heterogeneity on rotavirus diarrhea burden and vaccination impact and cost-effectiveness in the Lao People’s Democratic Republic. Vaccine. 36(51).

Rotavirus vaccine introduction reduces hospitalizations for infants and children

A study in four hospitals in Botswana found that over a two-year period following the introduction of rotavirus vaccine, hospitalizations from all causes of diarrhea fell by one-third in infants (0-11 months old), and by nearly one-quarter in all children under five years of age. Ninety percent of infants 4-11 months old in the study population received at least one dose of the vaccine, and 75% received both doses during this period. The vaccine’s impact was most apparent during the rotavirus season when the average number of hospitalizations from diarrhea fell 43% among infants and by one-third among all children under five.

Enane LA, Gastanaduy PA, Goldfarb DM, et al.. 2016. Impact of rotavirus vaccination on hospitalizations and deaths from childhood gastroenteritis in Botswana. Clinical Infectious Diseases. 2016(62).

Rotavirus vaccine in conflict areas saves lives and is cost-effective, even with low coverage rates

A two-dose schedule of rotavirus vaccine was estimated to be cost-effective in Somalia, where more than 20 years of civil conflict have significantly damaged the health system and vaccine coverage is exceedingly low. Researchers estimate that in 2012, routine use of rotavirus vaccine, even at low coverage rates, would have averted nearly 25% of deaths due to rotavirus diarrhea in Somali children under one year of age.

Gargano, L. M., Tate, J. E., Parashar, U. D., et al.. 2015. Comparison of impact and cost-effectiveness of rotavirus supplementary and routine immunization in a complex humanitarian emergency, Somali case study.. Conflict and health. 9(5).