In the meantime, vaccination against

the leading killers of children, such as rotavirus, can protect children who are unable to readily access treatment [5]. Among 38 HIV-infected children at enrollment, we did not observe efficacy against RVGE, although the numbers were too small to yield meaningful results. In Kenya, there were no significant increases in serious adverse events among HIV-infected recipients of PRV, as reported elsewhere [12]. Rotavirus is not more common among hospitalized HIV-infected children than HIV-negative children, nor does rotavirus infection cause a greater severity of illness in HIV-infected children [30], [31] and [32]. However, due to the greater incidence of gastroenteritis among HIV-infected children, the incidence of rotavirus-related gastroenteritis, and hospitalizations, is CB-839 research buy likely greater among HIV-infected children [32] and [33]. While there is some evidence for prolonged shedding Cabozantinib concentration of rotavirus after natural infection in HIV-infected children, there does not seem to be an elevated risk of clinical disease after vaccination, and as with live-attenuated OPV and measles vaccines, rotavirus vaccines

are not contraindicated in HIV-infected children [30], [32] and [34]. While further evaluation of efficacy and safety of PRV among HIV-infected children is warranted, currently the benefit of preventing rotavirus infection in this fragile group of children at high risk of death likely outweighs potential, unproven risk. Despite PRV’s efficacy in the first year of life, the vaccine showed no efficacy during the second year of life in Kenya. The high anti-rotavirus IgA seroresponse rate in the placebo group (37.9%) between dose 1 (approximately 7 weeks of age) and one month post-dose 3 (approximately 21 weeks of age) suggests that due to the high pressure of rotavirus infection in infancy, few children would Farnesyltransferase remain susceptible to severe rotavirus gastroenteritis in the second

year of life [35] and [36]. This is supported by the lower incidence rate in the second year of life. It is also likely that rotavirus vaccines indeed have lower protection in the second year of life for African children [7] and [37]. This finding might be related to the overall lower immune response and efficacy of oral vaccines, including rotavirus vaccines, in low-income settings, which due to waning antibody levels could result in sub-protective concentrations in the second year of life [6] and [38]. Multiple hypotheses have been given for this including coadministration of OPV, younger age of vaccination and interference with maternal antibodies, concurrent breast-feeding leading to exposure of vaccine to neutralizing antibodies in breast-milk and suppressed immune response due to malnutrition and concurrent illness [39], [40], [41] and [42].