DOCTOR'S VIEW ARCHIVE
Rotavirus Vaccination ... Postponed as a Precaution
There have been many erroneous rumors about the rotavirus vaccine. MedicineNet strongly recommends that all children (and adults) be fully immunized according to the current government health recommendations. We wish, therefore, to share with you the words as they came from the U.S. Centers for Disease Control and Prevention (CDC) regarding the rotavirus vaccine.
On July 15-16, 1999 the CDC issued a statement about rotavirus vaccination. The following is the CDC statement verbatim (word-for- word).
The CDC Statement about Rotavirus Vaccine
Based on early surveillance reports of bowel obstructions among some infants, the Centers for Disease Control and Prevention (CDC) recommends that health care practitioners and parents postpone use of the rotavirus vaccine until November 1999.
As of June 1, 1999, an estimated 1.5 million doses of RRV-TV (rotavirus vaccine) have been administered to children in the United States. As of July 7, 1999, fifteen (15) cases of intussusception (a type of bowel obstruction) among children who had recently received rotavirus vaccine have been reported to the Vaccine Adverse Event Reporting System (VAERS). An additional eight cases have been identified in the initial phase of an on going multi-state investigation.
Although vaccine adverse event reports and preliminary surveillance data do not provide sufficient evidence to determine if there is a relationship between the vaccine and intussusception, the CDC recommendation is made with the consideration that rotavirus season is still 4 to 6 months away in most parts of the U.S. In the interim, the CDC in collaboration with local and state health departments throughout the United States will be undertaking additional data collection and analysis to determine if there is a relationship between the vaccine and intussusception.
Key Points - Rotavirus Illness and Infections
1. Rotavirus illness is very easy to catch. Children can spread rotavirus both before and after they become symptomatic. The virus is often transmitted from one infected child to another by contaminated hands or objects. Washing with soaps or cleansers will not kill the virus, but will help reduce the spread of rotavirus.
2. Rotavirus is the most common cause of severe gastroenteritis in infants and young children in the U.S. Virtually all children contract a rotavirus infection in the first 3-5 years of life. In the U.S., rotavirus illness tends to be seasonal, with the greatest number of cases occurring from November to May.
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3. Rotaviral gastroenteritis usually starts with fever, an upset stomach, and vomiting, followed by diarrhea. The diarrhea can be mild to severe and generally will last 3 to 9 days. Severe diarrhea and dehydration occur primarily among children 3 months to 35 months of age.
4. In the first five years of life, four out of five children in the U.S. will develop rotavirus diarrhea. One in seven will require a clinic or emergency room visit. One in 78 will require hospitalization and one in 200,000 will die from rotavirus illness. As a result, rotavirus accounts for more than 500,000 physician visits and approximately 50,000 hospitalizations each year among children less than 5 years of age.
Key Points - Rotavirus Vaccine
1. Rotavirus vaccine is an oral, live-virus preparation that is administered to infants between the age of 6 weeks and 1 year. The recommended schedule is a three-dose series, with doses usually administered at 2, 4, and 6 months of age.
2. Four vaccine efficacy trials suggested the vaccine is 49% to 68% effective against any rotavirus diarrhea; 69% to 91% effective against severe diarrhea; and 50% to 100% effective in preventing physician visits for evaluation and treatment of rotavirus diarrhea."
Please note in the foregoing CDC statement the key recommendation to "...postpone use of the rotavirus vaccine until November 1999."
The American Academy of Pediatrics (AAP) Position
The American Academy of Pediatrics (AAP) issued a statement at the same time as the CDC. In keeping with the CDC's statement, the AAP recommended that (and again this is verbatim):
"1. Clinicians temporarily should suspend administration of rotavirus vaccine to unimmunized and partially immunized children, pending collection and evaluation of additional information.
2. Parents or guardians of children who have received rotavirus vaccine within a period of approximately three weeks should be advised to promptly contact their physician if signs or symptoms compatible with intussusception develop."
The Nature of Intussusception
The AAP emphasizes that intussusception is a rare cause of abdominal pain in young infants. It usually occurs in the first year of life. It is due to one part of the intestine telescoping on itself. This creates a blockage that causes severe pain. The child will intermittently and abruptly cry and pull the legs toward the stomach. This is often followed by periods without pain and without any apparent distress. And then the pain recurs with the abrupt resumption of crying, etc.
Anyone caring for a child needs to recognize that the baby is in severe pain and talk to the baby's doctor immediately. The doctor will surely want to see the child immediately and perhaps order an X- ray called an air or barium enema. This test not only makes the diagnosis but also sometimes unblocks the intestine. If the enema does not unblock the intestine, an emergency operation may well be needed to correct the condition.
In July, 1999 the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) jointly recommended that rotavirus vaccination be postponed until November, 1999. This recommendation was made as a precaution because of some reports of intussception in infants who had had rotavirus vaccination.
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