Rotavirus Vaccine Prevents Most
Cases in Infants and Children
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Rotavirus is
responsible for more than 400,000 doctor
visits, more than 200,000 emergency room
visits, 55,000-70,000 hospitalizations, and
between 20 and 60 deaths in US children
younger than 5 years of age |
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Rotavirus is a very common cause
of gastroenteritis (sometimes called "stomach flu") in infants
and young children. Rotavirus disease usually starts with fever,
an upset stomach, and vomiting, and is followed by diarrhea.
Rotavirus occurs most often in the winter and spring, usually in
the months between November and May. Rotavirus is very
contagious, spreading easily from children who are already
infected to other children.
Once children have been exposed
to rotavirus, it takes about two days for symptoms to appear.
Children who are infected with rotavirus develop vomiting and
watery diarrhea that lasts from three to eight days. They might
lose interest in eating and drinking and become dehydrated from
loss of fluids.
Nearly every child in the US has
been infected with rotavirus by age 5. A child may develop
rotavirus disease more than once because there are many
different rotavirus types, but second infections tend to be less
severe than the original infections. Likewise, adults can also
be infected, though the illness tends to be mild.
Svapna Sabnis, MD, Assistant
Professor of Pediatrics at the Medical College of Wisconsin,
says, "The US Centers for Disease Control and Prevention (CDC)
reports that each year, rotavirus is responsible for more than
400,000 doctor visits, more than 200,000 emergency room visits,
55,000-70,000 hospitalizations, and between 20 and 60 deaths in
US children younger than 5 years of age."
Although death from rotavirus is
not common in the US, says Dr. Sabnis, "in developing countries,
rotavirus has been estimated to cause up to several hundred
thousand deaths annually in infants and young children.
Vaccine Approved for
Children
In February 2006, the US Food and Drug Administration (FDA)
approved a live, oral vaccine against rotavirus called RotaTeq.
"The vaccine is recommended for infants at 2, 4 and 6 months,"
says Dr. Sabnis. Dr. Sabnis, who sits on the Wisconsin Council
for Immunization Practices, says that in her practice at the
Downtown Health Center, "We offer rotavirus vaccine routinely to
all eligible children, because this is such a common childhood
virus."
The RotaTeq vaccine is quite
effective, says Dr. Sabnis. "The vaccine helps prevent
approximately 3/4 of cases of rotavirus disease, and almost all
of the most severe cases, including those needing
hospitalization." Side effects are minimal, she notes. "After
receiving the vaccine, less than 3% of children may develop mild
vomiting or diarrhea."
"The RotaTeq vaccine has great
potential to save lives, particularly in developing nations with
high mortality rates from rotavirus," says Dr. Sabnis.
"Unfortunately at this time the vaccine is quite expensive."
Dr. Sabnis says that the vaccine
should not be given to children who have had a severe reaction
to the vaccine or its components. In addition, she says,
"children who have problems with their immune system or
gastrointestinal system, a history of intussusception (bowel
obstruction), or moderate to severe illness (including
gastroenteritis) at the time of the visit should not receive
this vaccine."
Different from Previous
Vaccine
The RotaTeq vaccine is different from the previous rotavirus
vaccine. "The RotaShield vaccine was withdrawn in 1999 because
it was found to be associated with intussusception," says Dr.
Sabnis.
Intussusception is a rare
blockage or twisting of the intestine, which can be life
threatening. One portion of the intestine telescopes into
another portion, causing an obstruction. The most common site of
intussusception is where the small intestine joins the large
intestine.
Because the two walls of the
intestines press against each other, this causes inflammation,
swelling, and eventually decreased blood flow. If
intussusception is not detected early, internal bleeding, a hole
in the intestines, or infection in the abdomen can occur because
the intestinal tissue has died from the decreased blood flow.
Intussusception occurs spontaneously in approximately 1 in 2,000
healthy young infants and children per year, but occurred at an
increased rate during the first week or two following
vaccination with the previous rotavirus vaccine.
The RotaTeq vaccine has been very
carefully tested for any problems with intussusception. Dr.
Sabnis says, "In a study of the new vaccine involving over
70,000 children, there was no association found between
intussusception and RotaTeq." Additionally, the vaccine was not
associated with an increased risk of any other serious side
effects.
Dr. Sabnis says the CDC plans a
large study to continue to monitor and collect data on the
safety of the vaccine.
Diagnosis and Treatment
Unfortunately, there are patients who have not yet received the
rotavirus vaccine. In these cases, diagnosis of rotavirus
infection centers mainly on testing. Physicians test the stool
of patients with gastroenteritis, to determine what is causing
their illness; rotavirus and Norwalk virus are the most commonly
diagnosed causes of gastroenteritis. In most cases, rotavirus
gastroenteritis resolves on its own, although about one in 40
children with rotavirus gastroenteritis will require
hospitalization for intravenous fluids. Antibiotics are not used
for treatment, as rotavirus is not a bacterium, but a virus.
The goal of the treatment of any
gastroenteritis, including rotavirus, is to prevent dehydration.
Fluids and electrolytes (salt and minerals) lost from vomiting
or diarrhea must be replaced as soon as possible. Juice, soda,
and water do not replace electrolytes, but electrolyte and fluid
replacement solutions for children are available in most food
and drug stores.
Since the risk of dehydration is
greater in infants and young children, parents should closely
monitor the number of wet diapers changed per day when the child
is sick.
While children have diarrhea,
parents should avoid giving them caffeine, greasy and/or sweet
foods, and foods that are high in fiber. Soft, bland foods are
recommended, starting with bananas, rice, crackers, and toast,
and moving on to boiled potatoes, cooked carrots, or baked
skinless chicken.
Prevention of rotavirus is
two-fold, involving both good hygiene and vaccination. "A clean
water supply, uncontaminated food, and frequent hand washing are
good preventive measures for all stomach viruses," says Dr.
Sabnis. In addition, the RotaTeq vaccine brings added assurance
to parents who want to prevent their children from becoming ill.
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