They estimated that a child who did not experience any diarrhea would grow 0.42 cm more per year than a child with an average prevalence of diarrhea [7]. Roy found that children mTOR inhibitor who had experienced an episode of diarrhea in the previous year were significantly more likely to be categorized as malnourished using mid-upper arm circumference (MUAC) as the anthropometric indicator [15]. Qadri et al. found that children who had experienced an episode of acute gastroenteritis (AGE) caused by enterotoxigenic Escherichia coli (ETEC) were more likely to be malnourished or growth

stunted at two years of age compared to children who had not had ETEC diarrhea [16]. Another study by Black et al. found that ETEC diarrhea impacted weight gain, while Shigella diarrhea impacted find more growth in length or height [7]. Rotavirus vaccines are now recommended by the WHO for use in all national immunization programs, and introduction of the vaccines is strongly recommended in countries where deaths from diarrheal diseases account for greater than 10% of all under-five deaths [17] and [18]. The pentavalent rotavirus vaccine (PRV), RotaTeq™, was developed by Merck, and is a human–bovine reassortant vaccine

that is administered as a live-attenuated oral vaccine [19]. PRV was tested in a Phase 3 clinical trial called the Rotavirus Efficacy and Safety Trial (REST) that enrolled almost 70,000 children in high- or middle-income countries in the US, Finland, and nine other countries [19]. A complete three-dose series of PRV was found to have efficacy of 74% against rotavirus gastroenteritis of any severity, and 98% efficacy against severe disease caused by serotypes G1–G4 [19]. PRV has subsequently been found to have lower efficacy in developing country settings, with efficacy in Asia observed at about 48% and in Bangladesh at about

43% against severe rotavirus gastroenteritis (defined as Vesikari score ≥11) [20], [21] and [22]. Because rotavirus vaccines are intended to prevent next episodes of severe rotavirus gastroenteritis, and these episodes may result in growth retardation, we hypothesized that vaccination with PRV would reduce malnutrition rates at varying time points during the vaccination series and up to three years of age as compared to vaccination with placebo. To the best of our knowledge, there is no published research documenting the impact of rotavirus vaccination on malnutrition. In order to address this important research gap, this study sought to examine the impact of vaccination with PRV on indicators of malnutrition among a cohort of children enrolled in a vaccine trial. A PRV study entitled Efficacy, Safety, and Immunogenicity of RotaTeq™ Among Infants in Asia and Africa was conducted at the Matlab field site of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in collaboration with PATH and Merck Research Laboratories, and has been previously described [21].