Rotavirus Vaccination

Rotavirus (ICD-10 A08.3: enteritis caused by other viruses) is a pathogen that is the most common cause of diarrheal disease in children. Rotavirus belongs to the Reoviridae group. Seven serogroups can be distinguished, with serogroup A being the most common worldwide. Rotaviruses are very environmentally resistant. The main reservoir is humans. Children between the ages of six months and two years are particularly frequently affected due to their still limited immune system. In adults, the virus usually occurs as traveler’s diarrhea (traveler’s diarrhea) and the disease is milder. In older persons > 60 years, the frequency of the disease increases again. Symptoms can range from mild to severe and include diarrhea, vomiting, and possibly fever and abdominal pain. Peak incidence is in the winter months (seasonal peak usually in March). Transmission occurs by smear or droplet infection, but also through contaminated water and food. The incubation period (time that elapses between infection with a pathogen and the appearance of the first symptoms) is only a few days. The pathogens are excreted in the acute stage of the disease until about eight days later. The highest incidence (frequency of new cases) is in infants and one-year-old children; boys are more frequently affected than girls. Rotavirus infection is notifiable under the Infection Protection Act. Rotavirus vaccination (synonym: RV vaccination) is given using a pentavalent rotavirus vaccine that includes the five predominant rotavirus serotypes (pentavalent; RV5). Rotavirus vaccination is a regular vaccination (standard vaccination), meaning that all infants six weeks of age and older should be vaccinated. In addition to the RV5 vaccine, there is also the RV1 vaccine (monovalent). The following are the recommendations of the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute for rotavirus vaccination:

Indications (areas of application)

  • Protection against rotavirus-related gastroenteritis (gastrointestinal inflammation).
  • After weighing the benefits and risks of rotavirus vaccination, timely RV vaccination may also be recommended for hospitalized preterm infants and other mature but hospitalized infants according to their chronologic age.

Contraindications

  • Severe immunodeficiency such as severe combined immunodeficiency.
  • History of intussusception or malformations of the gastrointestinal tract

Implementation

  • Rotavirus oral vaccine for active immunization of infants should be given as early as 6 weeks of age (up to 4 months of age; depending on the active ingredient). There are currently two vaccines available, which are vaccinated with 2 or 3 doses at intervals of 4 weeks each.
  • Depending on the vaccine, vaccination is as follows:
    • RV1: 2 doses – vaccination series should be administered before the age of 16 weeks (according to the technical information: in any case be completed by the age of 24 weeks).
    • RV5: 3 doses – vaccination series should be started no later than the 11th week of life and preferably completed by the completion of the 20th or 22nd week of life, but no later than the completion of the 32nd week of life.
  • Vaccination can be done together with other standard vaccinations of infancy.
  • Follow-up vaccination: the rotavirus vaccination series can only be followed up in a short time window, as the 1st vaccine dose should be administered by 12 weeks of age and the last dose should preferably be completed by 16 weeks of age (Rotarix ) or 20-22 weeks of age (RotaTeq ), depending on the vaccine used (see technical information). The vaccination series must be completed by the age of 24 or 32 weeks.

Efficacy

  • The effectiveness of vaccination is between 96-98%.
  • The vaccine protection lasts 2-3 seasons

Possible side effects/vaccine reactions

  • Diarrhea (diarrhea), vomiting.
  • Invagination (intussusception of intestinal loops), i.e., invagination of a proximal (upper) portion of the intestine into the distal (lower) portion, which can lead to ileus (intestinal obstruction); ileocolic invagination is most common (ileum/rum or hip (part of the small intestine) into the colon/large intestine) Incidence (frequency): 1 case per 12. 000 vaccinations; incidence (without vaccination): about 60-100 cases per 100,000 infants within the first year. Therefore, in France, the Haut Conseil de la Santé Publique withdrew the recommendation for rotavirus vaccination from the infant vaccination calendar (Paul Ehrlich Institute communication, March 7, 2015).The relative risk (RR) for intussusception was 1-7 days
    • After the 1st dose was 5.71 (95% confidence interval: [4.50; 7.25]).
    • 1.69 [1.33; 2.14] after the 2nd dose and 1.14 [0.75; 1.74] after the 3rd dose.

    The AR to this at the recommended vaccination age 1.7 [1.1; 2.7] and 0.25 [0.16; 0.40] additional intussusceptions per 100,000 vaccinated children after the 1st and 2nd dose, respectively. If infants >3 months of age are vaccinated, the AR increases to 5.6 [4.3; 7.2]/100,000 after the 1st dose and to 0.81 [0.63; 1.06]/100,000 after the 2nd dose, respectively.Therapy: Rapid reduction (“putting back” or “bringing back”) by the physician. This leads to healing in the majority of cases. In more complicated courses, surgery (partial bowel resection/surgical removal of part of the bowel) may be necessary.

  • Unspecified upper respiratory tract infections.
  • Fever
  • Irritability