Two rotavirus vaccines, RotaTeq and Rotarix, are licensed for global use; 
however, the protection they confer to unvaccinated individuals through indirect 
effects remains unknown. We systematically reviewed the literature and 
quantified indirect rotavirus vaccine effectiveness (VE) for preventing 
rotavirus hospitalization in children aged less than 5 years. From 148 
identified abstracts, 14 studies met our eligibility criteria. In our main 
analysis using a random-effects model, indirect rotavirus VE was 48% (95% 
confidence interval [CI]: 39-55%). In a subgroup analysis by country income 
level, indirect VE was greater in high-income countries (52%; 95% CI: 43-60%) 
than in low- and middle-income countries (LMICs) (25%; 95% CI: 5-41%). In a 
sensitivity analysis using a quality-effects model, the indirect VE in LMICs was 
not statistically significant (25%; 95% CI: 0-44%). Our findings highlight the 
importance of increasing rotavirus vaccine coverage, particularly in LMICs where 
evidence for indirect VE is limited and rotavirus burden is high.