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The first candidate vaccine was shown to be efficacious, but still somewhat reactogenic causing a low rate of fever and some diarrhoea [25]. After acquisition by GlaxoSmithKline Biologicals (Rixensart, Belgium), the vaccine strain was cloned (it was shown to contain two plaque variants) and passaged a further 12 times in Rixensart, renamed RIX4414, and eventually, after licensure, Rotarix?. The rationale of a human rotavirus G1P[8] strain vaccine was to induce serotype-specific immunity against the most common human G-type and P-type rotaviruses. As for safety, it was regarded that a human rotavirus vaccine was unlikely to cause intussusception, because wild-type human rotavirus apparently is not associated with intussusception [26]. A tissue-culture-adapted strain RIX4414 is attenuated in comparison to wild-type G1 rotavirus in that it has lost its potential to cause RVX-208 diarrhoea, but, as it retains high infectivity for humans, it is actually not known whether its potential to induce intussusception is different from that of wild-type. In early phase I�CII trials in Finnish infants at 2?months of age the first dose of RIX4414 induced an 88% rotavirus IgA antibody response, and the second dose increased seroconversion to 96%. Meanwhile, the geometric mean titre was not increased. Therefore the second dose does not produce a booster effect, but, effectively, a successful first dose induces an immunity that prevents the uptake of the second dose. This block of learn more the second dose could be attributed to vaccine-induced serotype-specific anti-G1 antibodies. The immunogenicity of RIX4414 was BMS-777607 concentration dependent on the vaccine titre in the dose range 104�C106 [27]. The uptake of RIX4414 in Latin America and South Africa was lower (in this order) than in Finland, probably because of higher levels of maternally acquired anti-G1 rotavirus antibodies at the time of the vaccination. To compensate in part for the lower immunogenicity in these parts the final titre of Rotarix vaccine was set at 105.3?PFU/mL. RIX4414 vaccine virus was effectively shed in the stools, demonstrating its multiplication in the intestines. After the first dose about 60% of the recipients shed the vaccine virus as detected by enzyme immunoassay, but after the second dose there was virtually no shedding because in most cases the second dose did not ��take�� [27]. The shedding may be prolonged in case of immunodeficiencies such as IgA deficiency. Transmission of the vaccine can happen, but is an uncommon event. As expected from the high uptake, European clinical trials showed high protective efficacy of Rotarix in the first year after vaccination, and only slightly less in the second year [28]. An Asian trial also showed sustained efficacy for 2?years [29]. In contrast, vaccine efficacy in South Africa and Malawi, as well as in Vietnam and Bangladesh, was largely restricted to the first year after vaccination [30,31] (Table 2).