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The New Rotavirus Vaccine: Preventing Infant Diarrhea
A new vaccine against rotavirus has been approved by health authorities and is now recommended for all infants to help prevent severe diarrhea and dehydration. Here is the information that parents need to know about rotavirus and the new vaccine.

What is rotavirus?
Rotavirus is the most common cause of severe diarrhea in babies and young children throughout the world. Most children experience at least one bout of rotavirus infection by age 5, usually in the winter or spring. Each year in the United States, rotavirus infection leads to 400,000 doctor visits, 200,000 emergency room visits, more than 50,000 hospitalizations and 20 to 60 deaths. In developing countries it causes more than a half-million deaths in young children.

What are the symptoms of rotavirus infection?
Rotavirus infection usually starts with fever and vomiting followed by watery diarrhea. The illness can last from three to eight days. The greatest danger from rotavirus infection is dehydration, especially for babies under 2. Babies can lose a lot of body fluid from vomiting, diarrhea and sweating with a high fever. They can be so sick that they lose interest in eating and drinking and are unable to replenish lost body fluids.

How is rotavirus spread?
Rotavirus is very contagious. The virus is shed in the stool and spreads to other children and adults by the child’s contaminated hands and objects the child touches, such as doorknobs, faucets, towels, food and toys. Symptoms usually appear two days after being exposed to rotavirus.

How is rotavirus disease treated?
There is no specific medication to treat rotavirus infection. Antibiotics do not kill the virus. As with most viral infections, however, with good care the child’s immune system can usually fight off the virus on its own. The key to treatment is replacing lost body fluids through drinking lots of fluids to make sure the child does not get dehydrated.

When a child is sick, it is usually best to give small amounts of fluids as frequently as possible. Helpful fluids include breast milk, formula (many doctors recommend changing to soy formula because it can reduce the diarrhea), and special pediatric rehydration solutions containing water with sugar and minerals.

If a child shows signs of severe dehydration—listlessness, sunken fontanelle (soft spot) on top of the head, sunken eyes, crying without tears, dry mouth, and little or no urine in 6 hours—he needs to be seen in the doctor’s office or emergency room, and may need to receive fluids through an intravenous (IV) line.

How can rotavirus disease be prevented?
The first line of protection against rotavirus and other infections is washing your child’s hands and your own hands, especially after changing nappys and before preparing food.

However, rotavirus has been found to be so contagious that simple hand washing rarely stops the spread. The new vaccine has been shown to be highly effective in preventing severe rotavirus infection. Studies have shown that it can prevent about three-quarters of all rotavirus infections and more than 95 percent of severe cases, hospitalizations and deaths. Remember, though, this vaccine cannot prevent all diarrhea since it doesn’t protect against other viruses or bacteria that cause diarrhea.

How is the rotavirus vaccine given?
The new rotavirus vaccine (RotaTeq®) is a liquid given by mouth. Three doses of vaccine are needed for good protection. The first dose should be given between 6-12 weeks old with two additional doses at four to 10 week intervals. It is generally recommended that babies get this oral vaccine at 2, 4 and 6 months of age along with the other baby shots given at those visits. Studies have shown that it is safe and effective to give the rotavirus vaccine with the other vaccines. Since rotavirus infection can be most severe for infants and toddlers, it’s important that babies get this vaccine early. In fact, it is recommended that all three doses be completed by 32 weeks of age (7 to 8 months), since the safety and effectiveness was not studied in older babies.

Is this a safe vaccine?
It has been shown to be very safe in a study with more than 70,000 children. It does not contain thimerosal (a mercury-containing preservative) or any other preservative. This is a different vaccine from the earlier rotavirus vaccine that was recalled in 1999 after it was found to be associated with a rare type of intestinal blockage called intussusception. Studies of this new vaccine have not found an increased risk of intussusception. As more infants receive the new vaccine, however, the vaccine’s safety will continued to be monitored very closely by the U.S. centres for Disease Control and the vaccine manufacturer.

Are there any children who should not receive the rotavirus vaccine? Talk with your child’s doctor about the benefits and risks of the rotavirus vaccine for your child. Make sure your doctor knows any health problem your child has had and the medications your child is taking.

It is generally recommended that infants with the following conditions should not be given the rotavirus vaccine:

Allergy to any of the vaccine’s ingredients or an allergic reaction after getting a dose of the vaccine; preexisting chronic petroltrointestinal disease, including history of intussusception; or weakened immune system (from cancer, chemotherapy, high dose steroid treatment or HIV/AIDS). In addition, infants who have moderate to severe vomiting or diarrhea, or any moderate to severe illness should not be vaccinated during the illness but can be when they’ve recovered.

For more information on rotavirus and the rotavirus vaccine, visit www.cdc.gov.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician