{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:01:09Z","timestamp":1790827269349,"version":"4.1.0"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Centers for Disease Control and Prevention Foundation, Atlanta, GA, USA"},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1165083"],"award-info":[{"award-number":["OPP1165083"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"U.S. Department of Health & Human Services | Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["MOA#871-15SC"],"award-info":[{"award-number":["MOA#871-15SC"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Nat Med"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In 2016, India introduced Rotavac (G9P[11]), an indigenous oral rotavirus vaccine administered at 6, 10 and 14\u2009weeks of age through the Universal Immunization Program. Evaluating its effectiveness under routine programmatic conditions is critical, given the variable performance of rotavirus vaccines in low- and middle-income countries. Here we assessed Rotavac\u2019s real-world effectiveness and impact across 31 hospitals in 9 states between 2016 and 2020 using a test-negative case\u2013control design. Overall, 24,624 children were enrolled in surveillance (62% male and 38% female). Of 8,372 children aged 6\u201359\u2009months eligible for effectiveness analysis (1,790 rotavirus-positive cases and 5,437 rotavirus-negative controls), 6,646 received 3 doses and 581 were unvaccinated. The adjusted vaccine effectiveness of 3 doses against severe rotavirus gastroenteritis was 54% (95% confidence interval (CI) 45% to 62%), with 1,574 vaccinated cases versus 5,072 vaccinated controls. Among children aged 6\u201323\u2009months (1,486 vaccinated cases and 4,595 vaccinated controls), genotype-specific adjusted vaccine effectiveness was 51% (95% CI 36% to 62%) for G3P[8], 81% (95% CI 73% to 87%) for G1P[8] and 64% (95% CI 21% to 83%) for G1P[6]. Following vaccine introduction, rotavirus positivity among hospitalized children declined from 40% to 20%. These findings confirm that Rotavac provides substantial protection against severe rotavirus disease, including nonvaccine strains, and performs comparably to internationally licensed vaccines in similar settings.<\/jats:p>","DOI":"10.1038\/s41591-025-03998-9","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T09:03:42Z","timestamp":1759827822000},"page":"3871-3878","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of the indigenous rotavirus vaccine Rotavac in the Universal Immunization Program in India during 2016\u20132020"],"prefix":"10.1038","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6646-7338","authenticated-orcid":false,"given":"Nayana P.","family":"Nair","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9484-1200","authenticated-orcid":false,"given":"Samarasimha N.","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidhartha","family":"Giri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tintu","family":"Varghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varunkumar","family":"Thiyagarajan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayaprakash","family":"Muliyil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Hemavathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shainey Alokit","family":"Khakha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan D.","family":"Gupte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaqueline E.","family":"Tate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umesh D.","family":"Parashar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5787-7223","authenticated-orcid":false,"given":"Venkata Raghava","family":"Mohan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3656-564X","authenticated-orcid":false,"given":"Gagandeep","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Collaborators of the rotavirus vaccine effectiveness and impact assessment network","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Bidari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sowmiya","family":"Senthamizh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhasini","family":"Mekala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GV","family":"Rama Devi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GS","family":"Rama Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna Babu","family":"Goru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Manikyamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Bhaskar","family":"Reddy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Padmalatha","family":"Pamu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kameswari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gorthi Rajendra","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manohar","family":"Badur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geeta","family":"Gathwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poonam","family":"Dalal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suraj","family":"Chawla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil Kumar","family":"Goel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Rawal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Preeti","family":"Raikwar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhu","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adarsh","family":"Bansal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi P.","family":"Kanojia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Bansal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kushaljit Singh","family":"Sodhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akshay","family":"Saxena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayashree","family":"Muralidharan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mini P.","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavneet","family":"Bharti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajesh","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shayam","family":"Kaushik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pancham","family":"Kumar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Chaudhary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyoti","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subal Kumar","family":"Pradhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saroj Kumar","family":"Satpathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrutunjay","family":"Dash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasashree","family":"Choudhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Bikrant","family":"Kumar Prusty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamata Devi","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmal Kumar","family":"Mohakud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manas Kumar","family":"Nayak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subrant Kumar","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajib Kumar","family":"Ray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasantajyoti","family":"Mohanty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subrat Kumar","family":"Majhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samarendra","family":"Mahapatro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Patnaik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asit","family":"Mansingh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mannancheril Abraham","family":"Mathew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachi","family":"Chaudhary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj Kumar","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharti","family":"Malhotra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alok Kumar","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailja","family":"Vajpayee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pramod","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikas","family":"Katewa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Kothari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prabhu","family":"Prakash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalpat","family":"Rajpurohit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Goyal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhupesh","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asolie","family":"Chase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koshy C.","family":"George","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakti","family":"Lamichhane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit","family":"Koirala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayanta Kumar","family":"Goswami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balasubramanian","family":"Sundaram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumanth","family":"Amperayani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senthilnathan","family":"Subramanian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish Kumar Chethrapilly","family":"Purusothaman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyadharishini","family":"Dorairaj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridevi A.","family":"Naaraayan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramasubramaniam","family":"Pitchumani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kulandaivel","family":"Murugiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev Kumar","family":"Verma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vipin M.","family":"Vashishtha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineeta","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil Kumar","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahima","family":"Mittal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"3998_CR1","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1001\/jamapediatrics.2018.1960","volume":"172","author":"C Troeger","year":"2018","unstructured":"Troeger, C. et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatr. 172, 958\u2013965 (2018).","journal-title":"JAMA Pediatr."},{"key":"3998_CR2","doi-asserted-by":"crossref","first-page":"e1195","DOI":"10.1016\/S2214-109X(20)30262-X","volume":"8","author":"E Burnett","year":"2020","unstructured":"Burnett, E., Parashar, U. D. & Tate, J. E. Real-world effectiveness of rotavirus vaccines, 2006\u201319: a literature review and meta-analysis. Lancet Glob. Health 8, e1195\u2013e1202 (2020).","journal-title":"Lancet Glob. Health"},{"key":"3998_CR3","doi-asserted-by":"crossref","first-page":"346","DOI":"10.3390\/vaccines10030346","volume":"10","author":"T Varghese","year":"2022","unstructured":"Varghese, T., Kang, G. & Steele, A. D. Understanding rotavirus vaccine efficacy and effectiveness in countries with high child mortality. Vaccines 10, 346 (2022).","journal-title":"Vaccines"},{"key":"3998_CR4","doi-asserted-by":"crossref","first-page":"e0183392","DOI":"10.1371\/journal.pone.0183392","volume":"12","author":"A Clark","year":"2017","unstructured":"Clark, A. et al. Estimating global, regional and national rotavirus deaths in children aged <5 years: current approaches, new analyses and proposed improvements. PLoS ONE 12, e0183392 (2017).","journal-title":"PLoS ONE"},{"key":"3998_CR5","doi-asserted-by":"crossref","first-page":"8154","DOI":"10.1016\/j.vaccine.2020.10.084","volume":"38","author":"CG Kumar","year":"2020","unstructured":"Kumar, C. G. et al. Epidemiology of rotavirus diarrhea among children less than 5 years hospitalized with acute gastroenteritis prior to rotavirus vaccine introduction in India. Vaccine 38, 8154\u20138160 (2020).","journal-title":"Vaccine"},{"key":"3998_CR6","doi-asserted-by":"crossref","first-page":"2136","DOI":"10.1016\/S0140-6736(13)62630-6","volume":"383","author":"N Bhandari","year":"2014","unstructured":"Bhandari, N. et al. Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants: a randomised, double-blind, placebo-controlled trial. Lancet 383, 2136\u20132143 (2014).","journal-title":"Lancet"},{"key":"3998_CR7","doi-asserted-by":"crossref","first-page":"5817","DOI":"10.1016\/j.vaccine.2019.07.104","volume":"37","author":"A Malik","year":"2019","unstructured":"Malik, A. et al. Introducing rotavirus vaccine in the Universal Immunization Programme in India: from evidence to policy to implementation. Vaccine 37, 5817\u20135824 (2019).","journal-title":"Vaccine"},{"key":"3998_CR8","first-page":"S38","volume":"53","author":"TJ John","year":"2016","unstructured":"John, T. J. India\u2019s research contributions towards polio eradication (1965\u20132015). Indian Pediatr. 53, S38\u2013S43 (2016).","journal-title":"Indian Pediatr."},{"key":"3998_CR9","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3390\/pathogens10040416","volume":"10","author":"T Varghese","year":"2021","unstructured":"Varghese, T. et al. Rotavirus strain distribution before and after introducing rotavirus vaccine in India. Pathogens 10, 416 (2021).","journal-title":"Pathogens"},{"key":"3998_CR10","volume":"21","author":"HA Ali","year":"2022","unstructured":"Ali, H. A. et al. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J. Equity Health 21, 82 (2022).","journal-title":"Int J. Equity Health"},{"key":"3998_CR11","doi-asserted-by":"crossref","first-page":"f3726","DOI":"10.1136\/bmj.f3726","volume":"346","author":"MM Patel","year":"2013","unstructured":"Patel, M. M. et al. Effectiveness of monovalent rotavirus vaccine in Bolivia: case\u2013control study. BMJ 346, f3726 (2013).","journal-title":"BMJ"},{"key":"3998_CR12","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1016\/S1473-3099(14)70940-5","volume":"14","author":"MJ Groome","year":"2014","unstructured":"Groome, M. J. et al. Effectiveness of monovalent human rotavirus vaccine against admission to hospital for acute rotavirus diarrhoea in South African children: a case\u2013control study. Lancet Infect. Dis. 14, 1096\u20131104 (2014).","journal-title":"Lancet Infect. Dis."},{"key":"3998_CR13","doi-asserted-by":"crossref","first-page":"3035","DOI":"10.1016\/j.vaccine.2014.03.064","volume":"32","author":"K Cotes-Cantillo","year":"2014","unstructured":"Cotes-Cantillo, K. et al. Effectiveness of the monovalent rotavirus vaccine in Colombia: a case\u2013control study. Vaccine 32, 3035\u20133040 (2014).","journal-title":"Vaccine"},{"key":"3998_CR14","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/S1473-3099(14)71060-6","volume":"15","author":"N Bar-Zeev","year":"2015","unstructured":"Bar-Zeev, N. et al. Effectiveness of a monovalent rotavirus vaccine in infants in Malawi after programmatic roll-out: an observational and case\u2013control study. Lancet Infect. Dis. 15, 422\u2013428 (2015).","journal-title":"Lancet Infect. Dis."},{"key":"3998_CR15","doi-asserted-by":"crossref","first-page":"S213","DOI":"10.1093\/cid\/civ1183","volume":"62","author":"N Bar-Zeev","year":"2016","unstructured":"Bar-Zeev, N. et al. Population impact and effectiveness of monovalent rotavirus vaccination in urban Malawian children 3 years after vaccine introduction: ecological and case\u2013control analyses. Clin. Infect. Dis. 62, S213\u2013S219 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR16","doi-asserted-by":"crossref","first-page":"S161","DOI":"10.1093\/cid\/civ1207","volume":"62","author":"PA Gasta\u00f1aduy","year":"2016","unstructured":"Gasta\u00f1aduy, P. A. et al. Effectiveness of monovalent rotavirus vaccine after programmatic implementation in Botswana: a multisite prospective case\u2013control study. Clin. Infect. Dis. 62, S161\u2013S167 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR17","doi-asserted-by":"crossref","first-page":"S121","DOI":"10.1093\/cid\/civ1208","volume":"62","author":"PA Gasta\u00f1aduy","year":"2016","unstructured":"Gasta\u00f1aduy, P. A. et al. Effectiveness of monovalent and pentavalent rotavirus vaccines in Guatemala. Clin. Infect. Dis. 62, S121\u2013S126 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR18","doi-asserted-by":"crossref","first-page":"S208","DOI":"10.1093\/cid\/civ1016","volume":"62","author":"JE Tate","year":"2016","unstructured":"Tate, J. E. et al. Effectiveness of pentavalent rotavirus vaccine under conditions of routine use in Rwanda. Clin. Infect. Dis. 62, S208\u2013S212 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR19","doi-asserted-by":"crossref","first-page":"S200","DOI":"10.1093\/cid\/ciw014","volume":"62","author":"G Armah","year":"2016","unstructured":"Armah, G. et al. Impact and effectiveness of monovalent rotavirus vaccine against severe rotavirus diarrhea in Ghana. Clin. Infect. Dis. 62, S200\u2013S207 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR20","doi-asserted-by":"crossref","first-page":"S140","DOI":"10.1093\/cid\/civ1209","volume":"62","author":"S Gheorghita","year":"2016","unstructured":"Gheorghita, S. et al. Impact of rotavirus vaccine introduction and vaccine effectiveness in the republic of Moldova. Clin. Infect. Dis. 62, S140\u2013S146 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR21","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.1093\/cid\/civ1026","volume":"62","author":"KD Pringle","year":"2016","unstructured":"Pringle, K. D. et al. Sustained effectiveness of rotavirus vaccine against very severe rotavirus disease through the second year of life, Bolivia 2013\u20132014. Clin. Infect. Dis. 62, S115\u2013S120 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR22","first-page":"183","volume":"215","author":"KA Abeid","year":"2017","unstructured":"Abeid, K. A. et al. Monovalent rotavirus vaccine effectiveness and impact on rotavirus hospitalizations in Zanzibar, Tanzania: data from the first 3 years after introduction. J. Infect. Dis. 215, 183\u2013191 (2017).","journal-title":"J. Infect. Dis."},{"key":"3998_CR23","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1093\/cid\/ciz664","volume":"70","author":"S Khagayi","year":"2020","unstructured":"Khagayi, S. et al. Effectiveness of monovalent rotavirus vaccine against hospitalization with acute rotavirus gastroenteritis in Kenyan children. Clin. Infect. Dis. 70, 2298\u20132305 (2020).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR24","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1093\/cid\/ciw045","volume":"62","author":"G Sahakyan","year":"2016","unstructured":"Sahakyan, G. et al. Impact and effectiveness of monovalent rotavirus vaccine in Armenian Children. Clin. Infect. Dis. 62, S147\u2013S154 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR25","doi-asserted-by":"crossref","first-page":"e1002282","DOI":"10.1371\/journal.pmed.1002282","volume":"14","author":"K Zaman","year":"2017","unstructured":"Zaman, K. et al. Effectiveness of a live oral human rotavirus vaccine after programmatic introduction in Bangladesh: a cluster-randomized trial. PLOS Med. 14, e1002282 (2017).","journal-title":"PLOS Med."},{"key":"3998_CR26","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.4269\/ajtmh.17-0705","volume":"98","author":"KL Rosettie","year":"2018","unstructured":"Rosettie, K. L. et al. Indirect rotavirus vaccine effectiveness for the prevention of rotavirus hospitalization: a systematic review and meta-analysis. Am. J. Tropical Med. Hyg. 98, 1197\u20131201 (2018).","journal-title":"Am. J. Tropical Med. Hyg."},{"key":"3998_CR27","doi-asserted-by":"crossref","first-page":"6735","DOI":"10.1016\/j.vaccine.2020.08.049","volume":"38","author":"HA Mujuru","year":"2020","unstructured":"Mujuru, H. A. et al. Cost estimates of diarrhea hospitalizations among children <5 years old in Zimbabwe. Vaccine 38, 6735\u20136740 (2020).","journal-title":"Vaccine"},{"key":"3998_CR28","doi-asserted-by":"crossref","first-page":"449","DOI":"10.3390\/vaccines10030449","volume":"10","author":"A Chissaque","year":"2022","unstructured":"Chissaque, A. et al. Effectiveness of monovalent rotavirus vaccine in Mozambique, a country with a high burden of chronic malnutrition. Vaccines 10, 449 (2022).","journal-title":"Vaccines"},{"key":"3998_CR29","doi-asserted-by":"crossref","first-page":"A140","DOI":"10.1016\/j.vaccine.2014.05.073","volume":"32","author":"R Rheingans","year":"2014","unstructured":"Rheingans, R. et al. Estimated impact and cost-effectiveness of rotavirus vaccination in India: effects of geographic and economic disparities. Vaccine 32, A140\u2013A150 (2014).","journal-title":"Vaccine"},{"key":"3998_CR30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001358","volume":"3","author":"S Antoni","year":"2023","unstructured":"Antoni, S. et al. Rotavirus genotypes in children under five years hospitalized with diarrhea in low and middle-income countries: results from the WHO-coordinated Global Rotavirus Surveillance Network. PLOS Glob. Public Health 3, e0001358 (2023).","journal-title":"PLOS Glob. Public Health"},{"key":"3998_CR31","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/S1473-3099(14)70832-1","volume":"14","author":"E Leshem","year":"2014","unstructured":"Leshem, E. et al. Distribution of rotavirus strains and strain-specific effectiveness of the rotavirus vaccine after its introduction: a systematic review and meta-analysis. Lancet Infect. Dis. 14, 847\u2013856 (2014).","journal-title":"Lancet Infect. Dis."},{"key":"3998_CR32","doi-asserted-by":"crossref","first-page":"97","DOI":"10.2217\/fmb-2017-0128","volume":"13","author":"EP Parker","year":"2017","unstructured":"Parker, E. P. et al. Causes of impaired oral vaccine efficacy in developing countries. Future Microbiol. 13, 97\u2013118 (2017).","journal-title":"Future Microbiol."},{"key":"3998_CR33","doi-asserted-by":"crossref","first-page":"7233","DOI":"10.1016\/j.vaccine.2019.09.071","volume":"37","author":"D Cowley","year":"2019","unstructured":"Cowley, D. et al. Immunogenicity of four doses of oral poliovirus vaccine when co-administered with the human neonatal rotavirus vaccine (RV3-BB). Vaccine 37, 7233\u20137239 (2019).","journal-title":"Vaccine"},{"key":"3998_CR34","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-018-5809-7","volume":"18","author":"S Reddy","year":"2018","unstructured":"Reddy, S. et al. Safety monitoring of ROTAVAC vaccine and etiological investigation of intussusception in India: study protocol. BMC Public Health 18, 898 (2018).","journal-title":"BMC Public Health"},{"key":"3998_CR35","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-019-6406-0","volume":"19","author":"S Giri","year":"2019","unstructured":"Giri, S. et al. Rotavirus gastroenteritis in Indian children\u2009<\u20095\u2009years hospitalized for diarrhoea, 2012 to 2016. BMC Public Health 19, 69 (2019).","journal-title":"BMC Public Health"},{"key":"3998_CR36","doi-asserted-by":"crossref","first-page":"e024840","DOI":"10.1136\/bmjopen-2018-024840","volume":"9","author":"NP Nair","year":"2019","unstructured":"Nair, N. P. et al. Rotavirus vaccine impact assessment surveillance in India: protocol and methods. BMJ Open 9, e024840 (2019).","journal-title":"BMJ Open"},{"key":"3998_CR37","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jcv.2013.06.022","volume":"58","author":"R Gautam","year":"2013","unstructured":"Gautam, R., Lyde, F., Esona, M. D., Quaye, O. & Bowen, M. D. Comparison of PremierTM Rotaclone\u00ae, ProSpecTTM, and RIDASCREEN\u00ae rotavirus enzyme immunoassay kits for detection of rotavirus antigen in stool specimens. J. Clin. Virol. 58, 292\u2013294 (2013).","journal-title":"J. Clin. Virol."},{"key":"3998_CR38","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-017-2832-1","volume":"10","author":"A Lagare","year":"2017","unstructured":"Lagare, A. et al. Diagnostic accuracy of VIKIA\u00ae Rota-Adeno and PremierTM Rotaclone\u00ae tests for the detection of rotavirus in Niger. BMC Res Notes 10, 505 (2017).","journal-title":"BMC Res Notes"},{"key":"3998_CR39","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1086\/605031","volume":"200","author":"G Kang","year":"2009","unstructured":"Kang, G. et al. Multicenter, hospital-based surveillance of rotavirus disease and strains among indian children aged <5 years. J. Infect. Dis. 200, S147\u2013S153 (2009).","journal-title":"J. Infect. Dis."},{"key":"3998_CR40","doi-asserted-by":"crossref","first-page":"A10","DOI":"10.1016\/j.vaccine.2014.03.001","volume":"32","author":"S Babji","year":"2014","unstructured":"Babji, S. et al. Multi-center surveillance of rotavirus diarrhea in hospitalized children <5 years of age in India, 2009\u20132012. Vaccine 32, A10\u2013A12 (2014).","journal-title":"Vaccine"},{"key":"3998_CR41","unstructured":"Manual of Rotavirus Detection and Characterization Methods (World Health Organization, 2009, accessed 24 September 2025); https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/70122\/WHO_IVB_08.17_eng.pdf?sequence=1"},{"key":"3998_CR42","doi-asserted-by":"crossref","first-page":"S106","DOI":"10.1093\/cid\/civ1014","volume":"62","author":"JE Tate","year":"2016","unstructured":"Tate, J. E. et al. Use of patients with diarrhea who test negative for rotavirus as controls to estimate rotavirus vaccine effectiveness through case\u2013control studies. Clin. Infect. Dis. 62, S106\u2013S114 (2016).","journal-title":"Clin. Infect. Dis."},{"key":"3998_CR43","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","volume":"167","author":"TJ VanderWeele","year":"2017","unstructured":"VanderWeele, T. J. & Ding, P. Sensitivity analysis in observational research: introducing the E-value. Ann. Intern Med 167, 268\u2013274 (2017).","journal-title":"Ann. Intern Med"},{"key":"3998_CR44","doi-asserted-by":"crossref","first-page":"3661","DOI":"10.1002\/sim.6607","volume":"34","author":"PC Austin","year":"2015","unstructured":"Austin, P. C. & Stuart, E. A. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat. Med 34, 3661\u20133679 (2015).","journal-title":"Stat. Med"},{"key":"3998_CR45","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-017-0989-z","volume":"16","author":"D Hungerford","year":"2018","unstructured":"Hungerford, D. et al. Rotavirus vaccine impact and socioeconomic deprivation: an interrupted time-series analysis of gastrointestinal disease outcomes across primary and secondary care in the UK. BMC Med. 16, 10 (2018).","journal-title":"BMC Med."}],"updated-by":[{"DOI":"10.1038\/s41591-025-04062-2","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000}}],"container-title":["Nature Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03998-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03998-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03998-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T17:14:08Z","timestamp":1763140448000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41591-025-03998-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":45,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["3998"],"URL":"https:\/\/doi.org\/10.1038\/s41591-025-03998-9","relation":{},"ISSN":["1078-8956","1546-170X"],"issn-type":[{"value":"1078-8956","type":"print"},{"value":"1546-170X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,7]]},"assertion":[{"value":"27 December 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 October 2025","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1038\/s41591-025-04062-2","URL":"https:\/\/doi.org\/10.1038\/s41591-025-04062-2","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"N.P.N. is the recipient of a fellowship from the Indian Council of Medical Research, New Delhi. G.K. is now an employee of the Bill and Melinda Gates Foundation. The other authors declare no competing interests. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The funders had no role in study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit the paper for publication. The corresponding author had full access to all the data from the study and had final responsibility for the decision to submit for publication. No authors were affiliated with Bharat Biotech.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}