Another Rotavirus Vaccine Bites the Dust


Jacob Puliyel MD (nsnbc) : Clinical trial of the new rotavirus vaccine from the Serum Institute of India shows that the vaccine increases the incidence of diarrhea instead of decreasing it.

Niger_child with rotavirus infection_(archives)The vaccine was field tested in Niger in Western Africa. The results were published in the prestigious New England Journal of Medicine (NEJM). The authors report that vaccine efficacy was 66.7% against severe rotavirus diarrhea. What was not highlighted was that diarrhea caused by other agents increased significantly and the vaccinated children had more diarrhea than those not vaccinated.

The New England Journal of Medicine has this week published a letter in response to the original article which shows that there was a significantly higher rate of gastroenteritis and diarrhea in the vaccinated group compared to those given the placebo – an inert dummy vaccine. The NEJM letter points out that this vaccine could aggravate the problem it is meant to solve in resource-poor countries. An anti-diarrhea vaccine that increases the incidence of diarrhea is unlikely to find a market.

This is not the first rotavirus vaccine that is under a cloud for not being upfront with trial data.

Adverse Effects with Rotavac (Bharat Biotech India)

Another vaccine Rotavac, manufactured by Bharat Biotech was recently in the news for not disclosing adverse events in a vaccine trial. This vaccine was tested in 3 centers in India. It appears there was a significant increase in the incidence of intussusceptions – a potentially life threatening complication where the intestine telescopes into itself and can become gangrenous – at the Vellore center. This data from Vellore has not been published in spite of repeated requests for it from various quarters including from the Indian Prime Minister’s office.

In response to a public interest litigation (PIL) filed  in the Delhi High Court, lawyers for the opposite side  argued that “… site specific data on safety is inappropriate for release as per protocol and its inappropriate interpretation or publication which would lead to disinformation about the product (that has been) developed by government with great effort and expense, and will give unfair advantage to multinational products which were never tested in India, (and) yet (were) licensed.”

This vaccine Rotavac has now been licensed in India and the vaccine is being administered in a Phase IV trial without informing parents of the risks observed in the randomized control trial in Vellore – a clear violation of basic ethical values.

This phenomenon of incomplete and inaccurate reporting of crucial clinical trial data is not limited to Indian manufacturers of vaccines. The GSK recently tested its vaccine in Bangladesh and the outcome was similar.

 Rotarix (GSK) in Bangladesh

PLoS Medicine recently published the results of the Rotarix trial in Bangladesh.  The PLoS Comments by Jain and Mittal point out that the purpose of the vaccine is to reduce the overall burden of disease from diarrhea and diarrhea deaths. However there were more cases of children reporting diarrhea among those vaccinated with Rotarix in Bangladesh, although this increase in diarrhea was not statistically significant. The fact remains that this vaccine did not reduce diarrhea among the vaccinated – in spite of its exorbitant cost.  The authors have not responded to the comments till now.

 It all boils down to making a profit. Misrepresenting research findings, cherry picking data, and concealment of adverse events in clinical trials are now seemingly acceptable practices.

Jacob Puliyel MD – nsnbc 22.07.2017

Jacob Puliyel MD is a member of the National Technical Advisory Group on Immunization Government of India. The views expressed are his own. He can be contacted by email at puliyel(at)gmail.com – or by phone at 09868035091.



Source Article from https://nsnbc.me/2017/07/22/another-rotavirus-vaccine-bites-the-dust/

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