Rotavirus infection poses a substantial threat to human health globally. The virus is a major cause of acute gastroenteritis in young children, resulting in ~215,000 deaths each year. Although rotavirus vaccines are very effective in preventing severe disease in high income countries, vaccine efficacy in low-middle income countries is often <50%. A suggested reason for this poor efficacy is higher levels of maternal antibodies in these areas; maternal antibodies have been reported to interfere with other infant vaccines. However, whereas Appaiahgari demonstrated an association between maternal antibody and rotavirus vaccine efficacy in 182 Indian infants, Chilengi did not identify a statistically significant relationship in 216 infants in Zambia. Importantly, neither study had any clinical follow up to show whether infants were protected from rotavirus gastroenteritis. The significance of maternal antibody interference is therefore unclear.

We aim to determine whether maternal antibodies are associated with reduced rotavirus vaccine efficacy using a large cohort of children followed for 18 months post-vaccination.