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Publication date: 
August 13, 2018


Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years.


To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine.

Design, Setting, and Participants

This report builds on findings from the Global Burden of Disease study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations.


Diarrhea due to rotavirus infection.

Main Outcomes and Measures

Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country.


Rotavirus infection was responsible for an estimated 128,500 deaths (95% uncertainty interval [UI], 104,500-155,600) among children younger than 5 years throughout the world in 2016, with 104,733 deaths occurring in sub-Saharan Africa (95% UI, 83,406-128,842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28,000 deaths (95% UI, 14,600-46,700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years.

Conclusions and Relevance

Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.


Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, Armah G, Bines JE, Brewer TG, Colombara DV, Kang G, Kirkpatrick BD, Kirkwood CD, Mwenda JM, Parashar UD, Petri WA, Riddle MS, Steele AD, Thompson RL, Walson JL, Sanders JW, Mokdad AH, Murray CJL, Hay SI, Reiner, RC. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatrics. 13 Aug 2018. doi:10.1001/jamapediatrics.2018.1960