Rotavirus

What is it?

Rotavirus gastroenteritis is caused by non-enveloped RNA viruses. It is a common cause of viral gastroenteritis in children. Globally, it is the most common cause of viral gastroenteritis related deaths in those less than 5 years of age.

What to look for

Rotavirus gastroenteritis classically occurs following a 1-3 day incubation period. Symptoms of disease include vomiting, diarrhoea, fever, dehydration and drowsiness. Symptoms can be particularly severe in children who are malnourished or immunocompromised.

How is it transmitted?

Rotaviruses can be transmitted via the faecal-oral route.

Prevention

Previous infection with rotavirus does not provide lifelong immunity. Hand hygiene and disinfecting contaminated surfaces are important measures for preventing transmission.

Prior to the introduction of rotavirus vaccination onto the National Immunisation Program (NIP) in 2007, approximately 10,000 children (< 5 years of age) were hospitalised each year with rotavirus gastroenteritis, with an average of one death per year. These rates have dropped dramatically since its introduction.

Vaccines

There are two live-attenuated rotavirus vaccines available for children in Australia:

• Rotarix- 2 dose course, available on the NIP at 6 weeks of age and 4 months of age
• RotaTeq- 3 dose course, previously given on the NIP, now available through private script.

There is limited data on the safety and efficacy of rotavirus vaccination when given outside of specific age groups. For this reason, it is recommended that rotavirus vaccines are administered within a set timeframe, with particular attention paid to the upper age limits. If adherence to the recommended timeframes for administration is not possible, vaccination should be withheld indefinitely. Pre-term infants are recommended to receive vaccines based on chronological age, not corrected age.

*whilst vaccines should be administered orally where possible, infants who have a feeding tube (eg nasogastric/PEG) can receive rotavirus vaccines via their tube. Rotavirus vaccines should never be injected.

Rotavirus vaccination is not required in order for a child to be considered up to date with their routine vaccines. It is not mandatory for the purposes of the no jab no pay or no jab no play legislations.

Please note, if an infant spits out a small amount of the dose of vaccine it is still considered a valid dose and doesn’t need repeating. If they spit out most of the dose of vaccine within minutes of receiving it, a repeat dose should be administered at the same visit.

Side effects and management

Side effects from rotavirus vaccination more commonly occur within the first 7 days following vaccination and can include vomiting, diarrhoea and irritability.

Supportive therapies such as paracetamol and additional fluids (breastmilk/formula) can help manage symptoms. Good hand hygiene practices are particularly important when handling soiled nappies during this period to minimise the risk of transmission as the virus can shed in stools for 7-10 post immunisation.

Very rare side effects can include anaphylaxis. It is recommended that infants are observed for 15 minutes following vaccination to monitor for symptoms.

There is some suggestion from Australian and international research that there is a small increase in intussusception cases in infants who receive the oral rotavirus vaccine. Intussusception is a rare condition where the bowel slides or telescopes inside itself causing a blockage. Infants may cry, pull up their legs and later have vomiting and sometimes blood in the stools. In most cases the cause of intussusception is not known. It has been estimated that the increased risk with rotavirus vaccines means an additional six cases per 100,000 infants vaccinated.

Precautions

Both rotavirus vaccines are live-attenuated oral vaccines. There is a theoretical risk of vaccine-associated gastroenteritis if vaccines are administered to infants with immunocompromise. However, for some infants with less severe immunocompromise the benefits of vaccine-induced protection may outweigh this risk. Further clarification on the degree of immunocompromise may be sought from specialist immunisation services.

Infants living in households with persons who have an immunodeficiency disorder or impaired immune status can still be vaccinated. Counselling on hand hygiene and disposing of soiled nappies to minimise the risk of vaccine-virus transmission is recommended.

For infants who are immunocompromised (other than severe combined immunodeficiency disorder) or living with HIV, the benefits of vaccination are thought to outweigh any potential risks of vaccine-associated gastroenteritis.

Contraindications

Rotavirus vaccine should not be given to any infant with a previous history of intussusception or a congenital bowel abnormality which pre-disposes them to intussusception.

Infants with severe combined immunodeficiency disorder (SCID) should not receive rotavirus vaccines due to the risks of vaccine-associated gastroenteritis, and lack of immune-system ability to generate a protective immune response.

The vaccine should not be administered to infants with anaphylaxis to a previous dose of rotavirus vaccine.

Infants whose mothers have received biological disease-modifying anti-rheumatic drugs (bDMARDS) during the third trimester of pregnancy should not receive vaccination without seeking specialist advice.

Resources

• MVEC: Preterm infant immunisation
• Australian Immunisation Handbook: Rotavirus
• RCH Kids Health Info: Gastroenteritis
• GSK Rotarix Dosing and Administration Wheel (Rotarix Wheel) ERRORS