This pooled analysis from the MNSSTER-V dataset evaluated rotavirus vaccine effectiveness (VE) against rotavirus-positive and all-cause acute gastroenteritis (AGE) mortality in children under 5 years seeking hospital care across 22 countries (July 2007–August 2023), using a test-negative case-control design.
Among children ≥3 months who received any routine vaccines, ≥1 dose of rotavirus vaccine had an adjusted VE of **75.8%** (95% CI 28.4–91.8) against rotavirus-positive AGE mortality (n=13,630), but only **20.8%** (95% CI −47.0 to 57.3) against all-cause AGE mortality (n=20,005), with 183 all-cause and 25 rotavirus-positive AGE deaths recorded across 16 countries.
- Only 25 rotavirus-positive deaths were available, giving wide confidence intervals and limited statistical precision for the primary VE estimate. - The all-cause AGE mortality VE was non-significant, likely reflecting the many non-rotavirus causes of AGE death that the vaccine cannot address. - Outcome data were unavailable for 2 of 24 countries, and analyses were restricted to countries reporting ≥1 AGE death, which may limit generalizability.
Rotavirus vaccination reduces rotavirus-specific AGE death risk by roughly three-quarters in hospitalized children under 5 — strengthening the case for improving vaccine delivery, especially in high-mortality settings. The lack of significant effect on all-cause AGE mortality underscores that rotavirus vaccines target only one of several lethal AGE pathogens.
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