Introduction Rotavirus-attributed diarrhoea is a major cause of death in young children. The WHO-Eastern Mediterranean Region, with a population over 590 millions, is a diverse area in terms of socioeconomic status and health indicators. This study aimed to evaluate the burden of rotavirus-associated mortality in order to encourage implementation of rotavirus vaccine.

Methods Based on rotavirus-associated mortality in the pre-vaccination period, the effect of rotavirus vaccine to avert children deaths was calculated.

Results In the Eastern Mediterranean Region more than 61 000 children aged <5 years died of rotavirus in 2004. Pakistan and Afghanistan, each with more than 15 000 deaths per year, were the countries with the highest rates of rotavirus-associated mortality; follow by Iraq, Somalia, Sudan, Yemen, Egypt and Morocco. Bahrain, Kuwait and Qatar with less than 10 deaths per year were the countries with the lowest rates of rotavirus-associated mortality. When the coverage of currently used vaccines was applied to a rotavirus vaccine, a minimum of 24 100 and maximum of 43 300 deaths would be averted with vaccine efficacy of 50% to 90%, respectively.

Conclusion Rotavirus-associated mortality and morbidity varies considerably in the region. While in some countries reducing rotavirus-associated mortality is a great concern, in others reducing rotavirus-attributed morbidity is the main benefit of rotavirus immunisation. Implementing comprehensive strategies to facilitate usage of rotavirus vaccine in the region is encouraged.