| Rotavirus |
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| Illness Problems |  | Contraindications and Precautions | | | | | Vaccine Recommendations | | Vaccine Safe | | | | | Scheduling and Administering Vaccine | | Storage and Treatment | |
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| Illness Issues |
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| Why is it important to vaccinate confronting rotavirus? Isn't the disease benign? |
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| Before rotavirus vaccines were available, rotavirus was the near mutual cause of severe gastroenteritis in infants and young children in the United States and worldwide. Nigh all children were infected past age five years. Before vaccine was introduced in the U.s., rotavirus was responsible each year for well-nigh 3 million episodes of gastroenteritis, 410,000 physician visits, 205,000–272,000 emergency section visits, 55,000–70,000 hospitalizations, and between xx and threescore deaths amongst children younger than historic period 5 years. |
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| How is rotavirus spread? |
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| Rotavirus is contagious and the infection is usually spread from person to person, through the fecal-oral route. Fecal-oral transmission occurs when leaner or viruses found in the stool of i person are swallowed by another person. This can occur when pocket-sized amounts of fecal matter may be found on surfaces such every bit toys, books, article of clothing, etc. and on the easily of parents or kid-care providers; just are normally invisible. Rotavirus may besides be transmitted through intake of fecally-contaminated water or food or past respiratory droplets that people sneeze, cough, drip, or exhale. Rates of the illness amid children in adult and less adult countries are similar. |
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| Is it possible for adults to contract rotavirus? What are the symptoms in adults? |
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| Aye. Rotavirus infection of adults is usually asymptomatic but may crusade diarrheal disease. Outbreaks of diarrheal disease acquired by rotavirus have been reported, specially amid elderly persons living in retirement communities. For more information on this effect see world wide web.cdc.gov/mmwr/pdf/wk/mm6042.pdf, page 1456. |
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| Vaccine Recommendations | Back to tiptop | |
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| Where can I become the virtually recent recommendations for the use of rotavirus vaccine? |
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| Advisory Committee on Immunization Practices (ACIP) recommendations for use of rotavirus vaccines are available at www.cdc.gov/mmwr/PDF/rr/rr5802.pdf. |
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| What are the recommendations for employ of rotavirus vaccines? |
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| Two rotavirus vaccines are bachelor in the The states. RotaTeq (RV5; Merck) is recommended for routine oral administration for all infants as a 3-dose series. The usual schedule is at ages 2, iv, and half-dozen months. Rotarix (RV1; GlaxoSmithKline) is recommended as a two-dose series at ages ii and 4 months. |
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| The minimum interval between doses of rotavirus vaccine is 4 weeks. The minimum historic period for the get-go dose is 6 weeks and the maximum age for dose #1 is 14 weeks half dozen days. Vaccination should not be initiated for infants age 15 weeks 0 days or older considering there are insufficient information on the safety of dose #1 in older infants. The maximum age for the last dose of rotavirus vaccine is 8 months and 0 days. |
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| How do the two rotavirus vaccines differ? |
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| The two rotavirus vaccine products differ in composition and schedule of administration. RotaTeq was canonical past the Food and Drug Administration (FDA) in 2006. It contains five reassortant rotaviruses developed from man and bovine parent rotavirus strains; 3 doses are given in the serial. Rotarix was canonical by the FDA in 2008 and contains an adulterate human rotavirus strain; 2 doses are given in the series. |
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| According to the packet inserts the maximum age for a dose of RotaTeq is 32 weeks and the maximum age for Rotarix is 24 weeks. According to ACIP recommendations the maximum age for a dose of rotavirus vaccine is 8 months 0 days. Eight months 0 days is older than age 24 weeks and may exist older than age 32 weeks. Should I follow the package labels or the ACIP recommendation? |
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| ACIP recommendations and package inserts do not always match. Occasionally, ACIP may use dissimilar data to formulate its recommendations, or try to add flexibility to its recommendations (as was the case in this situation), which results in a recommendation different than the parcel insert. Published recommendations of national informational groups (such as ACIP or AAP'southward Committee on Infectious Diseases) should be considered equally equally authoritative as those on the package insert. Y'all should consider 8 months 0 days as the maximum age for a dose of rotavirus vaccine. |
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| Can RotaTeq and Rotarix vaccines be used interchangeably? If so, what schedule should we follow? |
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| ACIP recommends that the rotavirus vaccine series be completed with the same production whenever possible. Nonetheless, vaccination should not be deferred considering the production used for a previous dose is not available or is unknown. In these situations, the provider should continue or complete the series with the production available. If any dose in the serial was RotaTeq, or the vaccine product is unknown for any dose in the series, a full of 3 doses of rotavirus vaccine should exist administered. The minimum interval between doses of rotavirus vaccine is 4 weeks. All doses should be administered by age 8 months and 0 days. |
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| A child received the first rotavirus vaccine and afterward got laboratory-confirmed rotavirus diarrhea. Should nosotros continue the vaccine? |
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| ACIP recommends that infants who have had rotavirus gastroenteritis before receiving the total series of rotavirus vaccination should all the same offset or complete the schedule according to the historic period and interval recommendations because the initial rotavirus infection might provide only partial protection confronting subsequent rotavirus illness. |
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| Can preterm infants receive rotavirus vaccine? |
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| ACIP supports vaccination of preterm infants according to the aforementioned schedule and precautions as full-term infants and under the following conditions: if the infant's chronological age meets the age requirements for rotavirus vaccine (for example, age 6 weeks to 14 weeks 6 days for dose #one), the infant is clinically stable, and the vaccine is administered at the time of discharge from the infirmary or after discharge from the hospital. |
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| Nosotros have a twenty-calendar week-old baby who was born prematurely. The infant has never received rotavirus vaccine and is technically past the maximum age for starting time dose. Should nosotros give rotavirus vaccine to this infant? |
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| ACIP recommends vaccination of preterm infants co-ordinate to the same schedule and precautions equally total-term infants. In preterm infants (equally in full-term infants), the maximum chronological age for the get-go dose is 14 weeks 6 days. Vaccination should not be initiated for infants aged xv weeks 0 days or older because of bereft data on safety of dose 1 of rotavirus vaccine in older infants. For more information, see folio nineteen of ACIP's recommendations on rotavirus vaccination, bachelor at world wide web.cdc.gov/mmwr/PDF/rr/rr5802.pdf. |
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| Scheduling and Administering Vaccine | Back to top | |
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| If nosotros don't know which rotavirus vaccine an baby previously received, how should nosotros complete the schedule? |
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| If the product used for a previous dose is unknown, and the infant is at an age when the vaccine can still be given, give a total of 3 doses of rotavirus vaccine. All doses should be administered by age 8 months and 0 days. |
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| If the first dose of rotavirus vaccine is inadvertently given to a child age xv weeks 0 days or older, should the serial be connected? |
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| Infants for whom the showtime dose of rotavirus vaccine was inadvertently administered at age 15 weeks or older should receive the remaining doses of the serial at the routinely recommended intervals. Timing of the first dose should non bear on the safety and efficacy of the remaining doses. Rotavirus vaccine should not be given after age 8 months 0 days fifty-fifty if the serial is incomplete. |
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| Our experience has been that many babies who receive the oral rotavirus vaccine spit a lot of it out. We know non to requite them more. But how can we be certain that the little they ingest is plenty? |
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| Try to follow general guidelines for oral assistants of liquid vaccines. Kickoff, give this vaccine at the beginning of the office visit, while the baby is withal happy, and before you lot administer injections or perform other procedures. 2nd, brand every try to aim the dropper containing the vaccine down i side and toward the dorsum of the child's rima oris. Don't put the dropper so far dorsum that you gag the child. You may find the following information from the RotaTeq manufacturer helpful: www.merckvaccines.com/Products/RotaTeq/Pages/dosageandadministration. Yous tin can too find a pictorial description of both reconstitution and administration of Rotarix at world wide web.gsksource.com/pharma/content/gsk/source/united states of america/en/brands/rotarix/pi/dosing.html. |
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| Can rotavirus vaccine exist given via Yard-Tube? If so, is it okay to flush with normal saline or sterile water? |
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| The manufacturer has non addressed this effect but CDC considers administration of rotavirus vaccine via gastrostomy tube to be adequate practice. At that place should exist no problem flushing the tube afterward vaccine has been administered. |
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| Is it okay to administer rotavirus vaccine and immune globulin at the same fourth dimension? |
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| Yep. The effectiveness concerns with antibiotic-containing blood products (ACBP) do non apply to rotavirus vaccine, since information technology is administered orally and replication of the vaccine virus occurs in the GI tract, "separate" from the site of the ACBP. Note that the kid should be carefully screened for other potential contraindications or precautions to vaccination since administration of immune globulin could indicate immunosuppression. |
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| Nosotros received a study of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated? |
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| The rotavirus vaccine dose given by the intramuscular route is not valid and should be repeated past the oral route equally soon as possible. In a review of such rotavirus vaccine administration errors, there usually were not adverse reactions, and those documented were express to local reactions and general, brief irritability. Come across www.cdc.gov/mmwr/pdf/wk/mm6304.pdf, page 81, for more data. |
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| Please take steps to ensure that such vaccine assistants errors are avoided in the futurity. This event should exist reported to the Vaccine Adverse Event Reporting Organisation at vaers.hhs.gov even if an adverse reaction does not result from it. |
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| Should nosotros warn parents/guardians to wash their hands after diaper changes, which they should be doing anyway, after the baby has received rotavirus vaccine? |
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| Yes. Rotavirus vaccine virus is shed during the first weeks later administration of rotavirus vaccine. Handwashing afterwards diaper changing is always recommended. |
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| Contraindications and Precautions | Back to superlative | |
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| Which infants should not receive rotavirus vaccine? |
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| Do not requite rotavirus vaccine to an infant who has a history of a severe allergic reaction (for example, anaphylaxis) after a previous dose of rotavirus vaccine or to a vaccine component. The oral applicator for Rotarix contains natural latex rubber so infants with a severe (anaphylactic) allergy to latex should not be given Rotarix; the RotaTeq (Merck) dosing tube is latex-free. Rotavirus vaccine is contraindicated in infants with the rare disorder severe combined immunodeficiency (SCID) and in infants with a history of intussusception. |
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| Practitioners should consider the potential risks and benefits of administering rotavirus vaccine to infants with known or suspected altered immunocompetence, including those whose mothers received immunosuppressive biologics (such as infliximab) during pregnancy. Consultation with an immunologist or infectious diseases specialist is advised. |
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| Children and adults who are immunocompromised because of congenital immunodeficiency, hematopoietic transplantation, or solid organ transplantation sometimes feel severe or prolonged rotavirus gastroenteritis. However, few prophylactic or efficacy information are bachelor for the administration of rotavirus vaccine to infants who are immunocompromised or potentially immunocompromised, including 1) infants with chief and acquired immunodeficiency, cellular immunodeficiency, and hypogammaglobulinemia and dysgammaglobulinemia; 2) infants with blood dyscrasias, leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic arrangement; three) infants on immunosuppressive therapy (including high-dose systemic corticosteroids); and iv) infants who are HIV-exposed or infected. |
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| A woman in our practice received infliximab (Remicade, Janssen Pharmaceuticals) for treatment of Crohn'due south Disease while she was pregnant. Should we modify her baby's vaccination schedule because of this handling? |
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| Infliximab is an IgG monoclonal antibody that neutralizes the biological activity of tumor necrosis factor-alpha. Like other IgG antibodies infliximab crosses the placenta. Infliximab has been detected in the claret of infants upwardly to 6 months following nativity. Consequently, these infants may exist at increased run a risk of serious infection. |
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| Neither ACIP nor CDC provides specific guidance on this event considering there are few data on rubber or efficacy in children exposed to potentially immunosuppressive biologics during pregnancy. As noted above, practitioners should consider the potential risks and benefits of administering rotavirus vaccine to infants with known or suspected altered immunocompetence. Consultation with an immunologist or infectious diseases specialist is advised. |
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| The manufacturer recommends that live vaccines (rotavirus and BCG) exist deferred for at least six months later nativity for infants whose mothers received infliximab during pregnancy. Hence, if a practitioner follows the manufacturer�due south recommendation the kid would not exist eligible to receive rotavirus vaccine because according to ACIP guidelines the rotavirus vaccine serial should non to be started after age 15 weeks 0 days. |
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| Inactivated vaccines should be given on schedule. |
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| Tin rotavirus vaccine be given to an infant who has an immunosuppressed household contact? |
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| Having an immunocompromised household contact is not commonly a reason for delaying routine vaccination for others in the household. Rotavirus vaccine should be administered to susceptible household contacts and other close contacts of immunocompromised patients when indicated. All members of the household should wash their easily after changing the diaper of an infant. This minimizes rotavirus transmission from an infant who received rotavirus vaccine. Additional data on this topic can be found in the ACIP General All-time Practice Guidelines for Immunization, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html. |
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| Vaccine Safety | Back to meridian | |
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| What adverse reactions have been reported following rotavirus vaccines? |
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| In the RotaTeq clinical trials in the first week after whatsoever dose vaccine recipients had a small only statistically significant increased rate of diarrhea (18.1% in the RotaTeq group, 15.3% in the placebo grouping) and vomiting (xi.six% in the RotaTeq group, ix.9% in the placebo grouping). During the 42-twenty-four hours period following any dose, statistically significantly greater rates of diarrhea, vomiting, otitis media, nasopharyngitis and bronchospasm occurred in RotaTeq recipients compared with placebo recipients. |
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| In the Rotarix clinical trials, in the first calendar week after vaccination, Grade three (i.e., those that prevented normal everyday activities) cough or runny nose occurred at a slightly but statistically higher charge per unit in the Rotarix group (iii.6 %) compared with placebo group (iii.2%). During the 31 day period after vaccination, these unsolicited adverse events occurred at a statistically college incidence among vaccine recipients: irritability (11.4% in Rotarix group, 8.seven% in placebo grouping) and flatulence (2.two% in Rotarix group, 1.iii% in placebo group). |
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| In clinical trials of both vaccines the occurrence of intussusception was studied very carefully (run across next Q&A). |
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| Take the current rotavirus vaccines been associated with intussusception? |
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| Large pre-licensure clinical trials of both RotaTeq and Rotarix did not find an increased hazard for intussusception amidst vaccine recipients. A large post-licensure study of more than 1.two meg rotavirus vaccine recipients found a very pocket-sized increased risk of intussusception (one to 1.5 additional cases of intussusception per 100,000 vaccinated infants) in the seven to 21 days following the first dose. No increased take chances of intussusception was establish subsequently the 2nd or third doses. CDC and the Nutrient and Drug Administration (FDA) continue to believe that the benefits of rotavirus vaccination outweigh the risks associated with vaccination and that routine vaccination of infants should go along. |
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| A study conducted by the CDC Vaccine Rubber Datalink (VSD) between May 2006 to February 2010 found no increased chance of intussusception following vaccination with RotaTeq. However, the study indicated an increased adventure of intussusception following dose ane and dose two of Rotarix. Over 200,000 doses of Rotarix have been given to children monitored in VSD. Based on these findings, one example of intussusception would be expected for approximately each 20,000 children who are fully vaccinated. |
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| What are the storage and handling guidelines for rotavirus vaccine (RotaTeq and Rotarix)? |
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| Both vaccines should be stored at refrigerator temperature and protected from light. Do not administer the vaccine if it has been frozen or exposed to freezing temperatures. |
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