The Seventh International Symposium on Rotavirus and Rotavirus Vaccines,held in Lisbon,Portugal, demonstrated that opportunity can indeed arise out of crisis. The crisis came seven years ago,when a newly licensed childhood vaccine for rotavirus,known as RotaShield,was abruptly withdrawn from the United States market in response to reports of an apparent association between RotaShield and intussusception (IS),a sometimes fatal bowel obstruction.
 
While signaling that U.S.public health authorities placed a high value on vaccine safety,the reaction simultaneously had a sweeping impact on vaccine introduction throughout the developing world. It stopped the motion toward rotavirus vaccine introduction in developing countries,where 80% of the annual 600,000 childhood fatalities from rotavirus take place,and where the risk of dying from rotavirus was far higher than the perceived risk of vaccine-induced IS.
 
But from this crisis,new initiatives emerged: increased surveillance of the virus to enable robust determinations of the burden of disease and of strain diversity; vigorous pursuit of alternative vaccines by pharmaceutical companies; cost-benefit analysis of the disease and vaccination programs; and in-depth epidemiological analysis of RotaShield and IS in the United States,reported during the 6th International Symposium on Rotavirus, July 2004.
 
The sum of this activity and commitment on the part of hundreds of scientists,public health experts,physicians, economists,government and business leaders,and donors has born fruit.
 

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