Georgia achieves first-year target for rotavirus vaccination

WHO

Georgia has vaccinated 60% of eligible infants with 2 doses of rotavirus vaccine, thus achieving the target level of coverage for the first year after introduction. According to an evaluation conducted by the Ministry of Labour, Health, and Social Affairs at the end of March 2014, the introduction of rotavirus vaccine in Georgia’s national immunization programme has gone smoothly.

The evaluation was intended to identify strengths and areas for improvement in rotavirus-vaccine introduction, and to improve planning for the introduction of pneumococcal vaccine later in 2014. 6 evaluation teams composed of national specialists and international experts from WHO/Europe, WHO headquarters and the Centers for Disease Control and Prevention, United States of America visited 11 districts across the country and interviewed immunization personnel, vaccine providers and parents.

Basis for success

The teams concluded that the programme’s success was due to:

  • good advance planning;
  • comprehensive training of medical workers, conducted at national, district and health facility levels;
  • dissemination of information; and
  • broad advocacy and communication activities before the introduction of rotavirus vaccine.

Why rotavirus?

Rotavirus vaccine was introduced in Georgia’s national immunization programme in March 2014 for several reasons.

  • Data from rotavirus sentinel surveillance confirmed a high burden of rotavirus disease in the country: rotavirus accounted for almost 40% of hospitalizations of children under 5 years of age for diarrhoea.
  • A cost–effectiveness study showed that introduction of rotavirus vaccine would be highly cost-effective in Georgia. The estimated incremental ratio was US$ 25 per disability-adjusted life-year averted, which is much lower than the gross domestic product per capita, the threshold recommended by WHO.
  • Other factors considered were WHO recommendations to include rotavirus vaccination into routine immunization programme and the availability of support from the GAVI Alliance.

Additional outcomes

Although the target for coverage was achieved at the national level, the evaluation revealed that coverage was significantly lower in some districts and health facilities. Many infants were left unprotected against rotavirus because parents brought them for vaccination too late: beyond the age limits for rotavirus vaccine. More effort is therefore needed to ensure that all eligible children benefit equally from the vaccine.

The results of the post-introduction evaluation were presented and discussed at a meeting of an interagency coordination committee led by the Deputy Minister of Labour, Health, and Social Affairs, Dr Mariam Jashi. Committee members and international experts discussed the evaluation’s findings and agreed on additional activities to improve the timelines of vaccination and to further increase uptake of traditional and new vaccines.

Background

Rotaviruses infect nearly every child by the age of 5 years and are globally the leading cause of severe, dehydrating diarrhoea in such children. This infection plays a considerable role in countries where diarrhoeal illness causes significant mortality. In countries where mortality from diarrhoeal disease is low, rotavirus infections are still common and carry large health care and societal costs.

In an updated position paper published in February 2013, WHO recommends that all national immunization programmes use rotavirus vaccines. Vaccination offers the possibility of reducing the rotavirus disease burden, which could save lives in lower-income countries and reduce hospital admission and costs related to hospital-acquired infections in higher-income countries.

WHO/Europe works with Member States to accelerate the introduction of rotavirus vaccine into their national immunization programmes, and to establish a regional surveillance network to collect local data on disease burden and monitor the impact of vaccination. Rotavirus vaccines are included in the routine immunization schedules of 12 countries in the WHO European Region.