How we Beat Rotavirus

As a pediatric resident in 2000, winter meant Rotavirus. Every winter, miserable babies with fever, severe vomiting and watery diarrhea would fill our hospital wards. Anxious parents would watch and wait as we treated their weakened babies with intravenous fluids to prevent severe dehydration.

The babies I treated were not alone.  Before the vaccine, almost one in sixty-five babies were hospitalized for Rotavirus in the United States.  That meant 50,000 hospitalized babies, 500,000 seen in physicians’ offices and 160,000 treated in emergency rooms for the illness every year.  In countries with limited medical resources, Rotavirus is deadly.  In fact, it is more fatal than any other single infection, killing about 1,400 children every day.

Rotavirus is hard to control because it is extremely contagious. The virus gets taken in by mouth and is then excreted in the stool.  It lives a long time on surfaces like toys and changing tables, so young children who are constantly touching objects and putting them in their mouths are easily infected. The illness lasts days or weeks and can spread like wildfire through childcare centers. That’s why affected babies cannot return to childcare until all diarrhea is resolved.

This places a great deal of stress on parents.  The first stress of caring for a sick baby, and the second stress of prolonged absence from work.

In August 1998, a vaccine against Rotavirus, called RotaShield, was introduced to protect against this serious viral infection.   What happened over the ensuing decade is a remarkable story.

The RotaShield Story

Every vaccine undergoes extensive testing prior to introduction to the market to ensure that it is safe.   Sometimes, however, very rare side effects can only be detected once a vaccine or drug is given to hundreds of thousands of people.

Rotashield administration began in fall 1998, and by July 1999 about 800,000 children had received the vaccine.  It was only then that a concern emerged that more children may be getting a rare blockage of the intestine, called intussusception. Because the condition is so rare, it was hard to know if there was truly an increased number of cases.

It turns out that the vaccine was associated with about 1 extra case of intussusception per 10,000 vaccinated infants. This information led to the vaccine being taken off the market less than one year after it was introduced.

Scientists went back to the lab to try and develop a safer vaccine.  It took seven years!  Finally, in 2006, a new vaccine called RotaTeq was introduced, and a second vaccine, Rotarix, came out in 2008.

These vaccines have been a remarkable success story. While mild disease can still occur, severe Rotavirus infection in children has been virtually eliminated. Between 2007-2011, the vaccines prevented more than 176,000 hospitalizations, 242,000 emergency room visits, and 1.1 million outpatient visits.  I have only seen a couple of cases since 2006, versus dozens I saw every year in the early 2000’s.

A great deal of research has been done to determine if the new vaccines cause any increase in intussusception.  It is believed that the vaccine causes a very small number of extra cases, about 1 in 100,000 infants, primarily in the first week after vaccination. In summary, the risk of severe infection, about one in sixty five, far outweighs the risk of the vaccine.

The Rotavirus vaccine is a great success story of protecting babies from one of childhood’s most dangerous infections.  I don’t miss Rotavirus!

Pediatrics

July 2001, VOLUME 108 / ISSUE 1

Intussusception, Rotavirus Diarrhea, and Rotavirus Vaccine Use Among Children in New York State

Hwa-Gan H. Chang, Perry F. Smith, Joel Ackelsberg, Dale L. Morse, Roger I. Glass

Pediatrics

September 2016, VOLUME 138 / ISSUE 3

Intussusception Rates Before and After the Introduction of Rotavirus Vaccine

Jacqueline E. Tate, Catherine Yen, Claudia A. Steiner, Margaret M. Cortese, Umesh D. Parashar

http://media.chop.edu/data/files/pdfs/vaccine-education-center-rotavirus.pdf Accessed 11/15/2017