| Rotavirus |
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| Disease Issues |  | Contraindications and Precautions | | | | | Vaccine Recommendations | | Vaccine Safety | | | | | Scheduling and Administering Vaccine | | Storage and Handling | |
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| Illness Problems |
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| Why is it important to vaccinate confronting rotavirus? Isn't the affliction beneficial? |
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| Before rotavirus vaccines were bachelor, rotavirus was the most common cause of severe gastroenteritis in infants and young children in the United States and worldwide. Almost all children were infected by age v years. Before vaccine was introduced in the United states, rotavirus was responsible each year for about 3 1000000 episodes of gastroenteritis, 410,000 physician visits, 205,000–272,000 emergency department visits, 55,000–70,000 hospitalizations, and between 20 and lx deaths among children younger than age 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 bacteria or viruses found in the stool of one person are swallowed past some other person. This can occur when small amounts of fecal matter may be found on surfaces such as toys, books, clothing, etc. and on the hands of parents or child-care providers; but are commonly invisible. Rotavirus may also 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 amongst children in adult and less developed countries are like. |
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| Is it possible for adults to contract rotavirus? What are the symptoms in adults? |
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| Yeah. Rotavirus infection of adults is usually asymptomatic but may cause diarrheal illness. Outbreaks of diarrheal disease acquired past rotavirus have been reported, especially among elderly persons living in retirement communities. For more information on this issue encounter www.cdc.gov/mmwr/pdf/wk/mm6042.pdf, page 1456. |
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| Vaccine Recommendations | Dorsum to top | |
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| Where tin I get the most recent recommendations for the utilize of rotavirus vaccine? |
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| Advisory Committee on Immunization Practices (ACIP) recommendations for apply of rotavirus vaccines are bachelor at www.cdc.gov/mmwr/PDF/rr/rr5802.pdf. |
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| What are the recommendations for use of rotavirus vaccines? |
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| Two rotavirus vaccines are available in the U.s.a.. RotaTeq (RV5; Merck) is recommended for routine oral administration for all infants as a 3-dose series. The usual schedule is at ages 2, 4, and 6 months. Rotarix (RV1; GlaxoSmithKline) is recommended as a 2-dose series at ages 2 and iv months. |
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| The minimum interval between doses of rotavirus vaccine is 4 weeks. The minimum age for the first dose is 6 weeks and the maximum age for dose #1 is xiv weeks 6 days. Vaccination should not be initiated for infants age xv weeks 0 days or older considering there are insufficient data on the safe of dose #i in older infants. The maximum historic period for the concluding dose of rotavirus vaccine is 8 months and 0 days. |
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| How exercise the two rotavirus vaccines differ? |
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| The ii rotavirus vaccine products differ in composition and schedule of administration. RotaTeq was approved past the Food and Drug Administration (FDA) in 2006. It contains five reassortant rotaviruses developed from human and bovine parent rotavirus strains; iii doses are given in the series. Rotarix was canonical by the FDA in 2008 and contains an adulterate human rotavirus strain; 2 doses are given in the serial. |
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| Co-ordinate to the bundle inserts the maximum age for a dose of RotaTeq is 32 weeks and the maximum historic period for Rotarix is 24 weeks. According to ACIP recommendations the maximum age for a dose of rotavirus vaccine is viii months 0 days. Eight months 0 days is older than age 24 weeks and may be older than age 32 weeks. Should I follow the parcel labels or the ACIP recommendation? |
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| ACIP recommendations and packet inserts practise not always match. Occasionally, ACIP may use different data to formulate its recommendations, or try to add flexibility to its recommendations (equally was the case in this state of affairs), which results in a recommendation unlike than the packet insert. Published recommendations of national informational groups (such as ACIP or AAP'southward Committee on Infectious Diseases) should exist considered equally as administrative as those on the package insert. You lot 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 then, what schedule should nosotros follow? |
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| ACIP recommends that the rotavirus vaccine series be completed with the same production whenever possible. However, vaccination should not exist deferred because the production used for a previous dose is not bachelor or is unknown. In these situations, the provider should continue or complete the serial with the product available. If any dose in the series was RotaTeq, or the vaccine product is unknown for whatsoever dose in the serial, a full of three doses of rotavirus vaccine should be administered. The minimum interval betwixt doses of rotavirus vaccine is 4 weeks. All doses should exist administered by age eight months and 0 days. |
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| A kid received the beginning rotavirus vaccine and later got laboratory-confirmed rotavirus diarrhea. Should we continue the vaccine? |
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| ACIP recommends that infants who take had rotavirus gastroenteritis before receiving the full series of rotavirus vaccination should all the same outset or complete the schedule co-ordinate to the age and interval recommendations because the initial rotavirus infection might provide only fractional protection against subsequent rotavirus disease. |
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| Can preterm infants receive rotavirus vaccine? |
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| ACIP supports vaccination of preterm infants according to the same schedule and precautions as full-term infants and under the post-obit conditions: if the infant'due south chronological age meets the age requirements for rotavirus vaccine (for example, age half dozen weeks to fourteen weeks 6 days for dose #1), the babe is clinically stable, and the vaccine is administered at the time of belch from the hospital or subsequently discharge from the hospital. |
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| We have a 20-calendar week-old infant who was born prematurely. The infant has never received rotavirus vaccine and is technically past the maximum historic period for first dose. Should we give rotavirus vaccine to this baby? |
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| ACIP recommends vaccination of preterm infants co-ordinate to the same schedule and precautions every bit total-term infants. In preterm infants (equally in full-term infants), the maximum chronological age for the first dose is xiv weeks 6 days. Vaccination should non be initiated for infants aged 15 weeks 0 days or older because of bereft data on safety of dose i of rotavirus vaccine in older infants. For more information, see page nineteen of ACIP'south recommendations on rotavirus vaccination, bachelor at www.cdc.gov/mmwr/PDF/rr/rr5802.pdf. |
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| Scheduling and Administering Vaccine | Back to top | |
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| If we don't know which rotavirus vaccine an infant previously received, how should we 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 nevertheless be given, give a full of iii doses of rotavirus vaccine. All doses should be administered past age eight months and 0 days. |
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| If the first dose of rotavirus vaccine is inadvertently given to a child age 15 weeks 0 days or older, should the series be continued? |
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| Infants for whom the first 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 not affect the prophylactic and efficacy of the remaining doses. Rotavirus vaccine should non be given after age viii months 0 days even if the series 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 not to requite them more. But how can we be sure that the niggling they ingest is enough? |
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| Try to follow general guidelines for oral administration of liquid vaccines. Outset, give this vaccine at the beginning of the office visit, while the baby is still happy, and before you administer injections or perform other procedures. Second, make every effort to aim the dropper containing the vaccine downwards one side and toward the back of the child's rima oris. Don't put the dropper so far dorsum that you lot gag the child. You may observe the following information from the RotaTeq manufacturer helpful: world wide web.merckvaccines.com/Products/RotaTeq/Pages/dosageandadministration. You can also find a pictorial clarification of both reconstitution and administration of Rotarix at www.gsksource.com/pharma/content/gsk/source/u.s./en/brands/rotarix/pi/dosing.html. |
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| Tin rotavirus vaccine be given via G-Tube? If and then, is it okay to flush with normal saline or sterile water? |
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| The manufacturer has not addressed this issue but CDC considers assistants of rotavirus vaccine via gastrostomy tube to be acceptable exercise. In that location should be no problem flushing the tube after vaccine has been administered. |
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| Is information technology okay to administer rotavirus vaccine and immune globulin at the same time? |
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| Aye. The effectiveness concerns with antibody-containing blood products (ACBP) do not utilize to rotavirus vaccine, since it is administered orally and replication of the vaccine virus occurs in the GI tract, "dissever" from the site of the ACBP. Notation that the child should exist carefully screened for other potential contraindications or precautions to vaccination since administration of immune globulin could point immunosuppression. |
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| We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If non, when should it be repeated? |
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| The rotavirus vaccine dose given by the intramuscular road is not valid and should be repeated past the oral route every bit soon equally possible. In a review of such rotavirus vaccine administration errors, there usually were non adverse reactions, and those documented were limited to local reactions and general, brief irritability. See www.cdc.gov/mmwr/pdf/wk/mm6304.pdf, page 81, for more information. |
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| Please accept steps to ensure that such vaccine administration errors are avoided in the future. This issue should exist reported to the Vaccine Agin Outcome Reporting System at vaers.hhs.gov even if an agin reaction does non 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, subsequently the baby has received rotavirus vaccine? |
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| Yeah. Rotavirus vaccine virus is shed during the beginning weeks later administration of rotavirus vaccine. Handwashing subsequently diaper changing is ever recommended. |
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| Contraindications and Precautions | Back to top | |
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| Which infants should non receive rotavirus vaccine? |
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| Exercise not give rotavirus vaccine to an baby who has a history of a severe allergic reaction (for example, anaphylaxis) afterward 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-costless. Rotavirus vaccine is contraindicated in infants with the rare disorder astringent 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 contradistinct immunocompetence, including those whose mothers received immunosuppressive biologics (such every bit 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 experience astringent or prolonged rotavirus gastroenteritis. Still, few safe or efficacy data are bachelor for the assistants of rotavirus vaccine to infants who are immunocompromised or potentially immunocompromised, including 1) infants with main and caused immunodeficiency, cellular immunodeficiency, and hypogammaglobulinemia and dysgammaglobulinemia; 2) infants with blood dyscrasias, leukemia, lymphomas, or other malignant neoplasms affecting the os marrow or lymphatic arrangement; 3) infants on immunosuppressive therapy (including high-dose systemic corticosteroids); and 4) infants who are HIV-exposed or infected. |
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| A woman in our exercise received infliximab (Remicade, Janssen Pharmaceuticals) for treatment of Crohn's Illness while she was pregnant. Should nosotros change her infant's vaccination schedule considering of this handling? |
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| Infliximab is an IgG monoclonal antibody that neutralizes the biological action of tumor necrosis gene-alpha. Like other IgG antibodies infliximab crosses the placenta. Infliximab has been detected in the claret of infants up to 6 months following nativity. Consequently, these infants may be at increased run a risk of serious infection. |
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| Neither ACIP nor CDC provides specific guidance on this issue because there are few data on safety 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) be deferred for at least 6 months after birth for infants whose mothers received infliximab during pregnancy. Hence, if a practitioner follows the manufacturer�due south recommendation the child would non exist eligible to receive rotavirus vaccine because according to ACIP guidelines the rotavirus vaccine series should not to be started after historic period 15 weeks 0 days. |
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| Inactivated vaccines should be given on schedule. |
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| Can rotavirus vaccine be given to an infant who has an immunosuppressed household contact? |
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| Having an immunocompromised household contact is non usually 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 hands afterward changing the diaper of an infant. This minimizes rotavirus manual from an infant who received rotavirus vaccine. Additional information on this topic can be found in the ACIP General Best Practice Guidelines for Immunization, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/immunocompetence.html. |
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| Vaccine Safety | Back to top | |
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| What adverse reactions have been reported following rotavirus vaccines? |
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| In the RotaTeq clinical trials in the starting time calendar week after whatever dose vaccine recipients had a small but statistically pregnant increased rate of diarrhea (18.1% in the RotaTeq group, 15.iii% in the placebo group) and vomiting (11.vi% in the RotaTeq group, nine.9% in the placebo group). During the 42-mean solar day period post-obit whatsoever 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 showtime week after vaccination, Grade 3 (i.due east., those that prevented normal everyday activities) cough or runny nose occurred at a slightly simply statistically college rate in the Rotarix group (3.6 %) compared with placebo group (3.two%). During the 31 day flow after vaccination, these unsolicited agin events occurred at a statistically college incidence amid vaccine recipients: irritability (xi.4% in Rotarix group, 8.seven% in placebo group) and flatulence (2.two% in Rotarix group, 1.three% in placebo group). |
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| In clinical trials of both vaccines the occurrence of intussusception was studied very carefully (meet adjacent Q&A). |
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| Have the electric current rotavirus vaccines been associated with intussusception? |
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| Large pre-licensure clinical trials of both RotaTeq and Rotarix did not notice an increased risk for intussusception among vaccine recipients. A large mail service-licensure report of more 1.2 million rotavirus vaccine recipients establish a very small increased adventure of intussusception (1 to 1.v additional cases of intussusception per 100,000 vaccinated infants) in the vii to 21 days post-obit the starting time dose. No increased risk of intussusception was establish after the second or third doses. CDC and the Nutrient and Drug Assistants (FDA) go on to believe that the benefits of rotavirus vaccination outweigh the risks associated with vaccination and that routine vaccination of infants should go on. |
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| A study conducted by the CDC Vaccine Safety Datalink (VSD) between May 2006 to February 2010 found no increased risk of intussusception following vaccination with RotaTeq. Notwithstanding, the study indicated an increased take a chance of intussusception following dose 1 and dose 2 of Rotarix. Over 200,000 doses of Rotarix accept been given to children monitored in VSD. Based on these findings, one case 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 fridge temperature and protected from calorie-free. Do not administrate the vaccine if information technology has been frozen or exposed to freezing temperatures. |
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