Rotavirus Vaccine, Live (oral route)

Rotavirus vaccines are used to treat rotavirus infections, which is the leading cause of diarrhea in children. In most severe cases, rotavirus can be fatal.

Overview

Rotavirus is a common viral infection, affecting almost every child before the age of five. It can cause stomach cramps, fever and vomiting, and especially diarrhea. Symptoms range from mild to severe, and it is difficult to predict which babies will be affected more than others. It can be present in faeces and is transmitted when food, hands or objects are contaminated. Children usually catch it when they touch something contaminated and then place their hands in their mouths. There is also a possibility that rotavirus is transmitted through the air, although there is insufficient research at the moment.

Across the world, rotavirus is responsible for over 600,000 deaths a year, usually affecting children younger than 5 years of age. The majority of the deaths tend to happen in countries with poor resources for health, such as countries in South Asia, or in sub-Saharan Africa. In the United States, prior to the use of rotavirus vaccines, hospitals saw up to 200,000 emergency room treatments a year, with up to 60 to 65 deaths annually. Since then the number has dropped drastically.

As it damages the lining of the small intestine, it causes gastroenteritis, also called stomach flu, although it is a different virus from the influenza virus. In extreme cases, it can lead to dangerous levels of dehydration due to severe diarrhea and vomiting, and possibly to death. Severe cases tend to happen to children who are aged 6 to 24 months, although they can also happen to children who are outside of that age bracket.

Rotavirus vaccines help to protect children by aiding the body with immunity against infection. They are usually made of a few active but disabled strains of the virus, along with other inactive ingredients. It is not a full guarantee against the virus however, and will not help if a child already has rotavirus. In countries that use rotavirus vaccines, the rate and severity of infections drop in significant numbers, and therefore is highly encouraged. Rotavirus vaccines can prevent up to 74% of all rotavirus infections, and most importantly, up to 98% of severe infections as well as 96% of hospitalisations.

It is an oral vaccine which comes in the form of a suspension or a powder to be made into a suspension and is usually given in two to three doses by a qualified healthcare professional.

The use of rotavirus vaccines unfortunately may lead an increase in the risk of getting intussusception. Intussusception is when a part of the intestine (usually the small intestine) becomes folded into another part of itself, creating a blockage that may become fatal.

Previously, a rotavirus vaccine was available that caused an increase in the amount of intussusception cases. However, the vaccine has been removed from the market, and the current vaccinations available are safe as they do not increase the risk of intussusception.

Conditions Treated

  • Rotavirus infection

Type of Medicine

  • Oral vaccine

Side Effects

As with most medications, side effects may occur while the child takes the vaccine. While not every patient will encounter these side effects, it is still important to take note of them so that the doctor or other primary healthcare giver can be informed. As this is an incomplete list of side effects that may occur, the parent or caretaker should observe the child carefully for any unusual symptoms and contact their doctor if necessary.

The most common side effects are as follows:

  • Diarrhea
  • Mild fever or headache
  • Vomiting
  • Irritability and/or crying
  • Sore throat

Less common to rare side effects include the following:

  • Black stools
  • Persisent or serious diarrhea
  • Cough, with yellow or green mucus
  • Difficulty with breathing
  • Sharp chest pains
  • Dizziness
  • Loss of appetite
  • Increase in heart rate
  • Seizures
  • Pain or swelling in the ear, possible discharge
  • Persistent or high fever, above 102 degrees F
  • Chills
  • Peeling skin, rashes, or cracked and dry lips

If any of the above side effects are experienced, immediate medical help is required.

There is also a risk of allergic reaction to the vaccine, as there is to almost any kind of other vaccine or medication. If the child exhibits signs of allergic reaction such as swelling, hives or difficulty in breathing, they or their primary caretaker should seek medical help immediately.

Some milder side effects such as excessive gas, fussiness or a runny nose may occur. These do not usually need medical attention, unless they persist for a period of time, in which case the doctor should be notified and medical help should be sought.

In extremely rare cases, intussusception may occur. This is a blockage of the bowel, caused by a part of the intestine folding into another part of itself, and is a serious condition that requires hospitalisation and possible surgery. If this happens, contact your doctor or primary healthcare provider immediately. As the symptoms of intussusception may happen even weeks after receiving the vaccine, parents or caretakers should be alert for any of the signs.

Symptoms of intussusception in children and infants include:

  • Abdominal pain
  • Bloody stools
  • Diarrhea
  • Crying when stomach is touched
  • Pulling up of knees to stomach

Dosage

There are currently two brands of rotavirus vaccines and depending on the brand, the vaccine is given in either two or three oral doses. The doctor will administer the doses in intervals of four to ten weeks, and they may be given in conjunction with other vaccines. In order to obtain the best protection from the vaccine, the parent or caretaker of the child should make sure that they keep to the schedule set by the doctor and receive all required doses on time.

When the child is scheduled to receive a booster or follow-up vaccine, the doctor should be notified of any side effects caused by the previous dose, if there were any. There is a possibility that the child should not continue to receive the vaccine.

If a dose is missed, the child may not be protected against rotavirus.

Prior to starting the vaccine, the parent or caretaker should read and understand the information on it provided by their healthcare provider. If they have any questions, they should resolve it with the doctor prior to starting the vaccination.

The vaccine doses should be given by the same clinic or doctor. Different brands of the rotavirus vaccine will also affect the schedule of the doses or booster vaccines.

As the dosage is adminstered by a healthcare professional, overdosing is unlikely. The rotavirus vaccine is most effective when the first dose is given before 15 weeks of age, and should be completed when the child is 32 weeks, or 8 months old. However there is currently insufficient information on the effectiveness and safety of the vaccine with children younger than 6 weeks of age. The parent or caretaker should consult with the doctor on the best time to start the rotavirus vaccine.

In some cases, the child may spit out the vaccine after it has been administered, but it is not always necessary to give another dose in the same period. The doctor will be able to advise on further action.

Interactions

The rotavirus vaccine may interact with other drugs or supplements. These interactions may change the way the vaccine works or increase the likelihood of side effects. In order to lessen the risk of or prevent them, the doctor or primary healthcare giver should be notified about any existing medication or supplements, such as multi-vitamins or herbal products, that the child may be taking.

Likely interactions with the vaccine include corticosteroids, recent blood transfusions and drugs that weaken the immune system, such as chemotherapy or azathioprine. Certain other vaccines, especially live ones, may also cause severe interactions with the rotavirus vaccine, so it is imperative to check with the doctor what other vaccines can be safely given together with the one for rotavirus.

The following is an incomplete list of drugs that will interact with the rotavirus vaccine:

  • Azathioprine
  • Abatacept
  • Belinostat
  • Bexarotene
  • Busulfan
  • Cortisone
  • Cyclosporine
  • Dexamethasone
  • Epirubicin
  • Fludrocortisone
  • Hydrocortisone
  • Lymphocyte immune globulin
  • Melphalan
  • Mitomycin
  • Omacetaxin
  • Oxaliplatin
  • Paclitaxel
  • Pentostatin
  • Prednisone
  • Ribociclib
  • Streptozocin

Warnings

If the child shows any allergic reaction to the initial dose, they should not receive any follow up or booster vaccine. The parent or caretaker should give the doctor details of the child’s reaction to the vaccine. Other allergic reactions may also occur due to the packaging or inactive ingredients in the vaccine, such as porcine-derived products or dry latex on the applicator, so the doctor should also be informed about any allergies the child has.

Before the child receives any dosage of the vaccine, the doctor should be given information on the child’s medical history. These include:

  • Any ongoing illnesses with fever
  • Growth and developmental problems
  • Blood disorders
  • Cancer
  • HIV/AIDs or a weakened immune system
  • Current medication that may cause a weakened immune system, such as dosages with steroids
  • Previous or ongoing blood transfusion or blood products
  • Blood disorders such as hemophilia
  • Existing gastro-intestinal problems and diseases
  • Any history of intussusception

The parent or caretaker should also let the doctor know if the child comes into constant contact with anyone who has a weakened immune system, such as a family member with cancer or AIDs, as they may catch the rotavirus themselves. This is because the rotavirus vaccines comprise of disabled but live virus.

If the child is receiving or has received the rotavirus vaccine within the last fifteen days, the parent or caretaker should be careful that the child does not come into contact with people with vulnerable immune systems.

Summary

Rotavirus is a common childhood infection and will affect almost every child before the age of 5. It can be fatal and is the cause of 600,000 child deaths globally every year, with the majority of them happening in countries in South Asia and in sub-Saharan Africa. Before rotavirus vaccines were introduced, 60 to 65 children died per year in the United States due to severe infections. Rotavirus infections cause diarrhea, vomiting, fever and abdominal cramps, with extreme cases leading to dehydration through diarrhea and vomiting.

A previous rotavirus vaccine had been shown to increase incidences of intussusception in children, which is a blockage in the bowel created when the intestines fold back upon themselves, and which can be dangerous. However, the vaccine is no longer available and the current vaccines used are considered to be safe. Rotavirus vaccines are generally given to children before they are eight months of age. They prevent a large percentage of rotavirus infections.

Children with existing bowel diseases like intussusception or weakened immune systems should not receive the vaccine. If they have any pre-existing medical conditions, the doctor should be made aware of them so that any vaccination can proceed accordingly and safely. Rotavirus vaccines can be given at the same time as some other vaccines.

While there is a chance of side effects, the CDC considers the positive effects of the vaccine to far outweigh the negative. Therefore rotavirus vaccines are encouraged and considered necessary to protect the child.

Resources
Last Reviewed:
January 29, 2018
Last Updated:
February 10, 2018
Content Source: