Dr. Ong Yoon Nee, Consultant Paediatrician, Growell Baby and Child Specialist Clinic Old Klang Road
Rotavirus was the leading cause of severe, dehydrating diarrhoea in children aged <5 years worldwide, resulting in an estimated >500 000 childhood deaths and >2 million hospitalizations worldwide in 2000.
The first rotavirus vaccine, that was approved by The Centers for Disease Control and Prevention(CDC) in 2006 is RotaTeq. This vaccine is given as a series of 3 doses by mouth starting at age of 6 weeks, with interval of 4-8 weeks between doses. A second vaccine, called Rotarix, was approved for use in June 2008 and is given as a series of two doses by mouth at 2 months and 4 months of age.
Rotaviruses belong to the Reoviridae family. Rotaviruses damage the enterocyte lining of the small intestinal villi, leading to reduced absorption and therefore, diarrhoea. The wide clinical spectrum of rotavirus disease ranges from loose stools to severe diarrhoea and vomiting causing dehydration, electrolyte disturbances, shock and, in severe cases, death. The mainstay of treatment of severe RVGE are fluid replacement and zinc supplementation.
In patients with severe gastroenteritis, the destruction of small intestinal villi can lead to transient post gastroenteritis lactose intolerance. Lactose intolerance occurs due to reduced production of enzyme lactase in the small intestine. As a result, lactose cannot be broken down, stays in the gut where it is fermented, producing gas and loose stool.
WHO position on rotavirus vaccines
Rotavirus vaccines should be included in all national immunization programmes and considered a priority, particularly in countries with high rotavirus gastroenteritis (RVGE). The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrheal diseases with the scaling up of both prevention (promotion of early and exclusive breastfeeding, handwashing, improved water supply, and sanitation) and treatment (oral rehydration solution recommended by WHO).
In the first two years of life, rotavirus vaccines are able to prevent more than 90% of severe cases of rotavirus diarrhoea in countries with low child mortality rates, more than 75% in countries with medium child mortality rates, and 35% to 58% in countries with high child mortality rates (Cochrane Review 2021)
How the rotavirus vaccine is given
The rotavirus vaccine is given as a liquid that’s squirted into your baby’s mouth. If your baby spits out or vomit the liquid straight away, they’ll be given another dose.
After the vaccination
Your baby can feed normally and do their usual activities after having the vaccine. For a few weeks after being vaccinated, your baby’s poo may contain a weakened version of rotavirus. Although the risk of getting ill from this is very small, it’s a good idea to keep washing your hands regularly (especially after changing your baby’s nappy).
Side effects of rotavirus vaccines
Like all medications, the rotavirus vaccines have side effects as well, but not all babies get them.
1. Common side effects
- Diarrhea
- Vomiting
- Irritability
2. Other side effects
- A rash
- Fever
- Loss of appetite
3. Rare side effects
- More serious side effects, such as a severe allergic reaction, are very rare. The person who vaccinates your child will be trained to deal with allergic reactions and treat them immediately.
- There is also a very small risk of a serious problem when the bowel becomes blocked (intussusception) in the week after being vaccinated. A meta-analysis done by Lu et al. in 2019 showed that rotavirus vaccination is not associated with an increased risk of intussusception for up to 2 years after vaccination among neonates or infants.
Types of rotavirus vaccine available in Malaysia
1. Rotarix
Rotarix is a vaccine indicated for the prevention of rotavirus gastroenteritis caused by G1 and non-G1 types (G3, G4, and G9) when administered as a 2-dose series. Rotarix is approved for use in infants 6 weeks and up to 24 weeks of age.
2. Rotateq
RotaTeq is indicated for the prevention of rotavirus gastroenteritis in infants and children caused by Types G1, G2, G3, G4, and G9 when administered as a 3-dose series to infants between the ages of 6 to 32 weeks. The first dose of RotaTeq should be administered between 6 and 12 weeks of age
Contraindications for rotavirus vaccination
- Infants with a demonstrated history of hypersensitivity to the vaccine or any component of the vaccine.
- Infants with Severe Combined Immunodeficiency Disease (SCID)
- Infants with a history of intussusception
- Infants with history of gastrointestinal disorders
Summary
Severe rotavirus gastroenteritis which leads to severe dehydration and electrolytes is preventable with this easy to administer oral vaccine. First dose can be given from 6 weeks onwards. The protective duration of this vaccine is up to 2 years.
