This makes it difficult

for health workers to decide whether or not a child is eligible for rotavirus vaccination. Furthermore, in these countries, a number of programmatic issues may make it difficult to deliver vaccines in a timely fashion. These include geographical or social factors that make access to fixed facilities difficult, the periodicity of the outreach sessions where this delivery modality is used, and inability to conduct immunization sessions regularly due to resource constraints. A review of data from surveys has indeed shown that in many developing countries, there may be significant delays in administering the scheduled selleck compound vaccinations [17]. Unless greater efforts are made to train health care workers, improve record keeping and strengthen immunization systems to facilitate

timely vaccine delivery, the coverage with these vaccines is likely to be even lower than other EPI vaccines. Together with the lower efficacy of the vaccine in developing countries, a low coverage could result in failure to realize the full benefit of these vaccines in the populations that have the highest morbidity and mortality from rotavirus diarrhoea. Till recently the risk of intussusception with the newer rotavirus vaccines was more theoretical and in 2009 the WHO Global Advisory Committee on Vaccine Safety suggested that the age restrictions for use of the vaccines may be relaxed to improve coverage. However, the committee also encouraged national programmes that opted to provide the first dose C646 nmr >15 weeks and the last dose >32 weeks of age to monitor the safety and efficacy of the vaccine. In many developing countries, delivering not vaccine doses beyond recommended

ages would probably not be a deliberate choice but a consequence of systemic weakness. Such countries will also find it difficult to establish systems to monitor safety and respond adequately to adverse events. Recently, signals showing an increased risk of intussusception with the newer rotavirus vaccines were reported from Australia and Latin America [18] and [19]. While the observed rates of intussusception were far lower than what was observed with Rotashield®, and the benefits from vaccination far outweighed the risks, the risk of intussusception from the newer vaccines was no longer a theoretical one. In Australia, when exposure windows associated with all doses of rotavirus vaccine from 1 to 9 months of age were combined, there was no evidence of an increased risk of intussusception following vaccination for either vaccine. However, in infants 1 to <3 months of age, there was suggestive evidence of excess intussusception cases 1–7 and 1–21 days following the first dose of both vaccines [18].