Recommendations for the use of rotavirus vaccines in infants

Question 1

When do maternal antibodies ameliorate disease severity?

Answer 1

In the first three months of life

Question 2

What percentage of hospitalizations for any indication in children <5yo was due to rotavirus in the pre-vaccine era?

Answer 2

4-5%

Question 3

What is the decrease in rotavirus gastroenteritis hospitalizations post vaccination?

Answer 3

79% in infants <1yo

73% in infants 12-23mo

Question 4

What are the contraindications to administering rotavirus vaccine?

Answer 4

1. History or greater susceptibility to intussusception
2. Hypersensitivity to any of the ingredients in vaccine
3. Known or suspected SCID or significant immunocompromising condition

Question 5

What are the two vaccines approved in Canada?

Answer 5

1. RotaTeq (RV5) live oral pentavalent bovine human vaccine (G1, G2, G3, G4, P7) 2mL PO x 3 doses
2. Rotarix (RV1) live attenuated mnovalent G1P1 vaccine, 1.5mL PO x 2 dose

Question 6

Why can rotavirus vaccines not be given later than eight months old?

Answer 6

Increased risk of intussusception

Question 7

What are the recommendations re: rotavirus?

Answer 7

1. Rotavirus vaccine prevents severe disease and significantly decreases the risk of dehydration and hospitalization associated with rotavirus. Rotavirus vaccination is recommended for all infants except those who are immunocompromised or have a history of or a known condition that predisposes them to intussusception.
2. Both licensed rotavirus vaccines are efficacious, and there are no interchangeability data. Whenever practical, the rotavirus vaccination series should be completed using the same product. However, if any dose in the series was the RV5 vaccine, a total of three doses of vaccine should be administered.
3. Rotavirus vaccines are given orally and can be started at six weeks of age. Doses are usually administered as part of the routine infant vaccine schedule at two and four months of age if using RV1, with a third dose at six months if using RV5. On the rare occasion that a first dose of RV1 (Rotarix) has been delayed beyond 15 weeks, NACI has indicated that a catch-up first dose of RV1 can be given up to 20 weeks chronological age. This extension regarding the timing of doses does not apply to RV5 at the present time.
4. Parents and caregivers of infants should be informed of the slightly higher temporal risk for intussusception, especially in the week after receiving rotavirus vaccine. All cases of intussusception should be reported to local public health authorities: www.phac-aspc.gc.ca/im/aefi-essi-form-eng.php
5. Physicians should continue to advocate for the universal funding and integration of rotavirus vaccines into provincial/territorial programs in Canada – and into global immunization schedules – to ensure equitable access for all children. The impact of decreasing morbidity and mortality due to rotavirus diarrheal illness through universal rotavirus vaccination will be especially critical in resource-poor settings worldwide.