A global fund for the health MDGs?

1500 www.thelancet.com Vol 373 May 2, 2009 A disadvantage of early vaccination in infancy can be reduced immunogenicity because of acquired immune responses that are less mature, and interference from maternal antibodies. However, newer vaccines supported for potential introduction into some developing countries pose safety as well as effi cacy questions about timing. More than 30% of children in most countries surveyed by Clark and Sanderson were vaccinated later than the current recommended safety cutoff for the fi rst dose of rotavirus vaccine, which is 12 weeks. An increased risk of intussusception was seen in US infants who received their fi rst dose of Rotashield after 12 weeks of age. Information from postlicensure safety surveillance in developed coun tries for the newer rotavirus vaccines will hopefully enable the 12 week cutoff to be removed but, until this time, many children could be prevented from receiving a rotavirus vaccine. Additionally, onset of rotaviral disease in developing countries is earlier than that in developed countries, which underlines the importance of early vaccination. There is some cause for optimism. Countries as diverse as Rwanda, Egypt, and Peru provide high coverage with timely administration. Many countries use opportunistic immunisation to minimise missed opportunities. Potentially generalisable lessons can be learnt from these successes.