An international panel of experts meeting in Liverpool in March 2024 has warned that major gaps remain in protecting young children from rotavirus in low- and middle-income countries (LMICs), despite significant advances in prevention, according to a report published in npj Vaccines in 2026. Co-hosted by the University of Liverpool and the University of the Witwatersrand with support from the Gates Foundation, the convening reviewed why oral rotavirus vaccines work well in high-income settings but are substantially less effective in many LMICs, and set a research roadmap to close that divide.
Rotavirus remains a leading cause of severe diarrhoeal disease and hospitalisation in children under five worldwide. Although current oral vaccines have cut deaths and admissions dramatically, their reduced effectiveness in many LMICs leaves children at continued risk and points to unanswered questions about the immune mechanisms that protect against infection.
A central conclusion was that serum immunoglobulin A (IgA), the most used marker of vaccine response, does not fully explain who is protected. Participants highlighted emerging evidence that mucosal immunity — including tissue-resident memory T cells, local mucosal responses and non-neutralising antibodies — likely plays a major role and should be studied as alternative correlates of protection.
The convening also identified maternal and environmental factors that may blunt vaccine performance in LMICs. Malnutrition, environmental enteric dysfunction, differences in the gut microbiome, concurrent infections and host genetics were named as important influences. Maternal antibodies, while protecting infants early on, may also reduce replication of oral vaccine viruses and weaken vaccine-induced responses.
New laboratory and clinical tools are accelerating research. Human intestinal organoids, controlled human infection models and reverse genetics platforms can help researchers test vaccine formulations, probe immune mechanisms at the mucosal surface and explore population-level differences in vaccine effectiveness.
The meeting set five priorities for future effort: optimise vaccine schedules, test nutritional and gut-health interventions, develop next-generation parenteral vaccines, improve oral formulations, and standardise experimental models and immune assays. Experts stressed that progress will require stronger international collaboration, wider access to advanced research tools in LMICs and sustained investment. The authors conclude that a clearer understanding of mucosal immunity is critical to designing more effective rotavirus vaccines and reducing global inequities in childhood diarrhoeal disease (Bronowski et al., npj Vaccines, 2026).
Original Source: https://www.emjreviews.com/microbiology-infectious-diseases/news/next-generation-rotavirus-vaccines-move-into-focus/
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Publish Date: 2026-06-21 16:03:00
