rotavirus

RotaTeq®

Rotavirus

RotaTeq® is an immunisation given to infants by mouth (orally) to protect them from severe rotavirus infection. RotaTeq® is free on the National Immunisation Schedule at 6 weeks, 3 months and 5 months of age - at the same visits as Infanrix®-hexa and either Synflorix® or Prevenar 13®.

Otago aid new rotavirus vaccine development

Monday, 26 March 2012

The University of Otago is playing a major role in the international development of a new low-cost oral vaccine to protect newborn babies against rotavirus.

Rotvairus “gastro” is a life-threatening diarrheal disease that results in the death of over half a million children under five worldwide and two million hospitalisations each year. In New Zealand, rotavirus is responsible for 1500 hospital admissions of children under five years of age each year.

The research collaboration led by the Murdoch Children’s Research Institute at the Royal Children’s Hospital, Melbourne, is supported by the New Zealand Health Research Council and its Australian counterpart the National Health and Medical Research Council. The Dunedin Clinical Trial Team at the University of Otago began the second phase of the vaccine development in January this year. 

University of Otago researcher, Dr Pam Jackson, from the Department of Women’s and Childrens’ Health, said that one dose of the rotavirus vaccine was well tolerated in the first phase of development in the Melbourne-based trial in babies, which was completed last year.
In the second phase of development of the vaccine, newborn babies and infants in Dunedin will be given three doses of the oral vaccine, called RV3-BB, or a placebo to ascertain the level of immunity to rotavirus generated by the vaccine. The vaccine is derived from a harmless strain of rotavirus found in newborn babies.

Children who have had this strain show no symptoms, and have shown to be protected against future infection by rotavirus strains.
Dr. Jackson said that unlike the current rotavirus vaccines that are available which are given to babies six to eight weeks of age, this vaccine will be given to newborns. 

“This is important because we know that infection can occur very early in developing countries and means that the vaccine has the potential to save many thousands of lives by vaccinating at birth while babies are still in a health care setting,” she says.

“After this time, babies are often lost track of, when their risk of the severe rotavirus disease is very high. By starting vaccination from birth we will be potentially able to offer them protection from rotavirus disease by three months of age.”

At present in New Zealand and many other countries, the currently available rotavirus vaccines are not part of the National Immunisation Programme of funded vaccinations, mainly due to cost.

The research and development of this vaccine is being led and conducted by academic institutions rather than the pharmaceutical industry with the intention to partner with developing country manufacturers so that the vaccine will ultimately become available at lower cost for developing countries, where they are needed most.

Dr. Jackson says that there is significant potential benefit of a lower cost, effective vaccine for babies from birth in developing nations, and also to the healthcare system, children and their parents in developed nations such as New Zealand.

In the next few months, expectant parents will be given information about the trial and asked whether they wish to participate.

“This oral vaccine has been shown to be well tolerated. What we now need to know is how effective the vaccine is at protecting against the disease and how long protection lasts.”

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Rotarix®

Rotavirus

Rotarix® is used for primary vaccination of infants to protect from rotavirus infection. The first dose is given between six and 14 weeks of age.

Rotavirus

Parents & Caregivers
Introduction: 

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting) in infants and young children. Without immunisation almost all children in the world are infected by rotavirus before five years of age. Rotavirus is recognised as the most common cause of diarrhoea and dehydration in infants and young children in all countries. Adults can also become infected.

A brief history: 

Rotavirus was first identified in 1973. It is named rotavirus because of its wheel-like appearance.

The current New Zealand situation: 

Rotavirus occurs in every country in the world, including New Zealand. By the age of three years 90% of New Zealand children will have contracted rotavirus.

Death from rotavirus infection in New Zealand is very rare.

Symptoms: 

The illness begins with the sudden onset of vomiting and watery diarrhoea which can last from three to seven days.

Fever and abdominal pain may also occur.

How do you get it?: 

Rotavirus is spread by the faecal-oral route and generally occurs in winter and early spring. Spread of infection within families and institutions is common as large amounts of rotavirus are present in the faeces/poos/tütae of infected individuals. Contamination of hands, hard surfaces, toys, utensils and other objects is relatively easy.

What are the risks?: 

The major risk is dehydration from vomiting and diarrhoea.

  • Death from rotavirus infection is extremely rare in New Zealand.
  • Adult symptoms are usually mild.
Who is most at risk?: 

Most infections occur in infants and children between 6-24 months of age.

Treating the symptoms: 

There is no specific treatment for a rotavirus infection. Replacing fluid loss from vomiting and diarrhoea is very important to prevent dehydration.

Continue breast feeding if appropriate. Alternatively, offer small frequent drinks of either clear fluids or a rehydration preparation such as Gastrolyte or Pedialyte – offering from a small cup or spoon or syringe sometimes helps.

The disease can cause a rapid and severe deterioration. Signs of dehydration include:

  • Dry mouth and tongue
  • No wet nappies
  • No tears when crying
  • Sunken fontanelle
  • Sunken eyes
  • Reduced skin turgor - Gently pinched skin remains ‘pinched’
  • Lethargic or irritable

Many children will require medical intervention and hospitalisation for dehydration.

Children can start eating solids whenever they feel ready. Bland foods e.g. toast, dry biscuits, are a good to start with.

Preventing Disease Spread: 

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

Purifying water supplies and improving hygiene alone are unlikely to substantially reduce the incidence of this disease.

Health Professionals
Introduction (HP): 

Rotavirus infects the intestinal mucosa, altering the function of the intestinal epithelium resulting in malabsorptive diarrhoea. It has also been found in extra-intestinal sites including blood, lungs, and liver. Immunity after infection is incomplete but first infections are generally more severe than subsequent infections.

The incidence of rotavirus gastroenteritis typically peaks during winter in temperate climates whereas in tropical settings it occurs year round.

Causative organism: 

A segmented, double stranded RNA virus of the Reoviridae family.

The mature virus is a triple shelled capsid consisting of the outer, intermediate, and inner layers. The outer capsid contains two proteins. A binary classification is used to designate their neutralisation specificity, G and P.

Seven groups of rotavirus have been identified (named A-G); most strains affecting humans belong to group A but outbreaks of groups B and C rotaviruses have been identified. In 2007, 5 serotype combinations caused approximately 90% of all human rotavirus infections.

No correlation between rotavirus serotypes and  disease severity has been demonstrated.

Clinical signs, symptoms and complications: 

Incubation is approximately 1-3 days.

Vomiting and watery diarrhoea for 3 - 7 days, frequently with fever and abdominal pain.

For individuals with healthy immune systems, rotavirus gastroenteritis is a self-limited illness, lasting for only a few days.

The most serious complication of rotavirus is dehydration, with an associated weight loss.

Severe dehydration can lead to death.

Method of transmission: 

Transmission is primarily by the faecal–oral route; person to person or via contaminated fomites, as rotaviruses are shed in large numbers for many days in vomit and diarrhoea.

Public health significance: 

Rotavirus is highly infectious, it can survive on hands for at least four hours and on hard surfaces for weeks.

New Zealand epidemiology: 

Ninety percent (90%) of New Zealand children will contract rotavirus by the age of 3 years. In a survey undertaken of children under 3 years of age with acute diarrhea admitted to eight NZ hospitals, rotavirus was detected in 42.6% of stool samples and varied significantly by age (26.8% for 0-5 months; 42.5% for 6-11 months; and 52.1% for 12-35 months; p<0.001) and by season (51.2% in winter/spring vs 24.5% in summer/autumn; p<0.001).

It has been estimated, in NZ, that the annual burden of rotavirus is 1506 hospitalisations (476 per 100,000), 3086 emergency department presentations not requiring hospitalization, plus 10,120 cases of rotavirus managed solely in primary care.

Prevention: 

The spread of rotavirus can be minimised by thorough hand washing after changing nappies or cleaning up vomit, after using the bathroom, before preparing food and before eating.

Children with diarrhoea or vomiting should not attend school or childcare centres until they have not had any loose poos/ tütae or vomiting for 24 hours.

The oral rotavirus vaccine RotaTeq® was added to the National Immunisation Schedule on 1 July 2014.

Treatment: 

There is no specific treatment for rotavirus infection.

Oral rehydration is very important, to hydrate the child and replace fluid lost through vomiting and diarrhoea. Mothers can continue to breastfeed, alternatively clear fluids or a rehydration fluid such as Gastrolyte or Pedialyte can be offered frequently using a small cup or spoon.

Parents need advice on early signs and symptoms of dehydration (dry mouth and tongue, no wet nappies, no tears when crying, sunken fontanelle, sunken eyes, reduced skin turgor, lethargic or irritable), and to be aware that a sudden deterioration may occur after a large, watery bowel motion.

Children can start solids as soon as they feel ready. It is recommended they start with bland foods such as toast or dry biscuits.

Disease Effects vs Vaccine Side Effects (Table)
Disease Description: 

Rotavirus is a highly contagious virus that infects the intestine (gut) causing gastroenteritis (diarrhoea and vomiting).

Effects of disease: 
Vomiting.
Diarrhoea.
Abdominal pain.
Fever.
Dehydration.
Dehydration can lead to death.
Common side effects of vaccine: 
Mild, temporary diarrhoea and/or vomiting within 7 days after the vaccine.
Fever.
Fussiness.
Crying.
Uncommon side effects of vaccine: 
Flatulence.
Abdominal pain.
Rare/very rare side effects of vaccine: 
Anaphylaxis.
Intussusception.
Blood in faeces/poos/tūtae.

Was the rotavirus vaccine associated with a bowel obstruction called 'intussusception'?

Answer: 

In the late 1990s a different rotavirus vaccine was associated with intussusception and removed from the market. The new vaccine has been tested in over 70,000 children and no link with intussusception was found. As part of ongoing vaccine safety monitoring a large study of Rotarix® in Mexico suggested there may be a small increase in the risk of developing intussusception following the first vaccine dose. 

The U.S. Centers for Disease Control and Prevention (CDC) reviewed all the information available. They recommended that as the increased risk of intussusception is extremely small and the benefits of rotavirus vaccination are great, Rotarix® continue to be used to prevent rotavirus disease.

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