The Lancet
http://www.thelancet.com/journals/lancet/issue/current
Aug 21, 2010  Volume 376  Number 9741  Pages 565-656

Comment
Rotavirus: realising the potential of a promising vaccine
E Anthony S Nelson, Roger I Glass

Preview
In 2006, two studies that described the efficacy and safety of two new oral rotavirus vaccines were joint winners of The Lancet’s Paper of the Year.1–3 These trials had been done in infants in high-income and middle-income countries in the Americas and Europe, but no efficacy data were available for infants in low-income populations in Africa and Asia where 85% of the more than 500 000 deaths from rotavirus occur.4 Unlike parenteral vaccines, live oral vaccines have behaved differently in high-income and low-income populations because of various immunological factors such as higher titres of transplacental or breast-milk antibodies, host problems related to micronutrient malnutrition, interfering gut flora (tropical enteropathy), intercurrent infections, or an altered distribution of circulating strains.