Rotavirus Vaccine

Aka: Rotavirus Vaccine, RotaShield, Rotarix, RotaTeq

1. See Also
   1. Rotavirus
2. Indications
   1. Primary Series in the first year of life in the United States
3. Pharmacokinetics
   1. Oral Tetravalent live virus Vaccine
4. Preparations
   1. Rotarix (RV1)
      1. Monovalent two dose series
   2. RotaTeq (RV5)
      1. Pentavalent three dose series
5. Dosing
   1. Schedule (4 week minimum interval between doses)
      1. Dose 1: Age 2 months
         1. First dose must be between ages 6-15 weeks - previously 12 weeks
         2. Avoid starting series after 15 weeks of age
      2. Dose 2: Age 4 months
      3. Dose 3: Age 6 months
         1. Third dose must be given by 8 months of age
         2. Third dose is required if RotaTeq was used for any dose, or unknown
         3. Third dose is not needed if Rotarix (RV1) was given for first two doses
   2. Dose
      1. Give full vial for each dose (no need to repeat if infant spits up part of dose)
6. Contraindications
   1. Immunocompromised infants
   2. Severe concurrent illness including Gastroenteritis
   3. History of Intussusception
   4. Allergy to Vaccine components
7. Adverse Effects
   1. Fever after first dose within 3 days
   2. Adverse effects increase after age 12 months
   3. Possible association with Kawasaki's Disease
      1. Geier (2008) Med Sci Monit 14(3):PH9-16 [PubMed]
   4. Increased Incidence of Intussusception
      1. Most significant with RotaShield Vaccine (Removed from the U.S. market)
      2. Rotarix and RotaTeq are safer
         1. Intussusception risk is now minimal (0.79 in 100,000 cases)
      3. Intussusception typically occurs days 3 to 6 after first Rotavirus Vaccine dose
         1. Haber (2013) Pediatrics 131(6): 1042-9 [PubMed]
      4. References
         1. Dennehy (2001) Infect Dis Clin North Am 15(1):189-207 [PubMed]
         2. Geier (2008) Med Sci Monit 14(3):PH9-16 [PubMed]
         3. Nakagomi (2001) N Engl J Med 344(24):1866 [PubMed]
         4. Zanardi (2001) Pediatrics 107(6):E97 [PubMed]
8. Efficacy
   1. Prevents 50-70% of all Rotavirus cases
   2. Prevents 70-90% of severe Rotavirus cases
   3. Seropositive response: 92%
   4. For every 4 million children immunized against Rotavirus
      1. Physician visits decrease by 255,000
      2. Emergency Department visits decrease by 137,000
      3. Hospitalizations decreased by 44,000
      4. Deaths decrease by 13
      5. Cortese (2009) MMWR Recomm Rep 58(RR-2):1-25 [PubMed]
9. Resources
   1. CDC Immunization Schedules (last accessed 10/28/2020)
      1. https://www.cdc.gov/vaccines/schedules/
10. References
    1. Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]
    2. Rennels (1996) Pediatrics 97:7-13 [PubMed]
    3. Santosham (1997) J Pediatr 131:632 [PubMed]
    4. Joensuu (1997) Lancet 350:1205 [PubMed]
    5. (1999) Med Lett Drugs Ther 41:50 [PubMed]