What is Rotavirus illness and what are the complications of this disease?
Rotavirus is a common cause of gastrointestinal illness (diarrhea and vomiting) in children. Rotavirus is caused by a virus that is present in the bowel and it is spread by hand to mouth when contact is made with the fecal material from an infected person. It is easily transmitted among family and household members. It is known that rotavirus illness affects infants and young children regardless of the state of hygiene and sanitation.
Rotavirus causes the majority of childhood gastrointestinal illness, which requires hospitalization. As well as requiring hospitalization, rotavirus illness contributes to a significant number of physician and Emergency Department visits, and to parents having to miss work due to a child’s or their own illness. Rotavirus affects 95 per cent of children and the highest incidence of infection is in children between the ages of six – 24 months.
The rotavirus vaccine helps a child’s immune system to make antibodies against the most common types of rotavirus infection. Rotavirus vaccine is given by mouth and an infant requires two doses given at least one month apart. Rotavirus vaccine is offered at the two and four month Public Health Immunization clinic visits. The first dose should be given between six weeks and 15 weeks of age. There should be an interval of at least four weeks between the first dose and the second dose. All doses should be completed by 24 weeks of age.
What are the contents of Rotavirus vaccine?
Rotavirus vaccine contains live, weakened rotavirus and traces of non-medicinal ingredients including sterile water, sucrose, a medium to help grow the cells, and an antacid to prevent the vaccine from being inactivated by the stomach acids. This vaccine has been approved for use by the Biologics and Genetics Therapies Division of Health Canada. The applicator that is used to administer the vaccine does not contain latex.
What are the possible reactions from Rotavirus vaccine, and what precautions should be observed?
Rotavirus vaccine is generally very well tolerated. The most common side effects are mild loss of appetite and fussiness/irritability. Less often, an infant may experience fever, fatigue, diarrhea, vomiting, gaseousness, spitting up, and abdominal discomfort.
Breastfeeding may be continued during the vaccination schedule. There are no restrictions on the infants liquid or food intake before or after receiving the vaccine. If a child spits out most of the dose at the time of administration, a replacement dose may be given at the same visit.
The Rotavirus vaccine may be excreted in the stools up to 10 days after vaccine administration, particularly with the first dose. The peak excretion is around day seven. Those who change the infant’s diapers are reminded to use good handwashing at all times and especially after changing diapers.
It is not known if administration of Rotavirus vaccine to infants poses a risk to household members who have a condition lowers their ability to resist infection or have decreased immunity. However, because most children are infected with naturally occurring rotavirus by age 5 years, vaccination may decrease the overall risk of exposure of immune compromised household contacts. The risks and benefits of vaccine administration must be assessed and if a decision is made to administer the vaccine, persons with decreased immunity should avoid contact with the stools of the immunized child and practice good personal hygiene.
Intussusception (infolding of one portion of the bowel over another) is a very unusual event that theoretically may occur after the administration of Rotavirus vaccine and this continues to be monitored. Symptoms of intussusception include severe abdominal pain, persistent vomiting, bloody stools, abdominal bloating, and/or high fever. Parents are advised to seek medical care if such symptoms occur with their infant, regardless of whether the vaccine was received or not.
What are the situations in which rotavirus vaccine should not be given?
The Rotavirus vaccine should not be given if the infant has had a previous allergic reaction to rotavirus vaccine or any component of the vaccine. An infant born with a malformation of the gastrointestinal system, which has not been repaired, who is prone to intussusception, or who has a history of intussusception should not receive the vaccine.
An infant who has a severe infection with a high temperature, or diarrhea and vomiting at the time of clinic should return to receive the vaccine as soon as the infant has recovered. A minor infection such as a cold is not a problem.
What are the risks if the vaccine is not received?
Infants and children who are not protected with rotavirus vaccine immunization are more at risk of becoming ill with severe vomiting, diarrhea, and life threatening loss of fluids that require hospitalization. Rotavirus vaccine efficacy has been shown to be between 85 per cent to 98 per cent against severe diarrhea in the developed world.