Quick answers to frequent rotavirus vaccine questions
This factsheet provides quick answers to frequent rotavirus vaccine questions.
Overview
Rotarix (RV1) is a live attenuated ORAL vaccine. It MUST NOT be injected. Please familiarise yourself with the Rotavirus chapter in the current Immunisation Handbook, including the contraindications and precautions for this vaccine.
Recommended immunisation schedule
What is the recommended Rotarix schedule?
Rotarix is a two-dose course. The first dose is given at 6-weeks immunisation visit and the second dose at 3-months immunisation visit.
When is an infant too old to receive their first dose of Rotarix?
When they are 15 weeks and 0 days old. The latest that the first Rotarix dose can be given is 14 weeks and 6 days of age because of an unknown but possible increase in risk of intussusception.
If an infant does not receive their first Rotarix dose before they are 15 weeks old, they cannot receive any Rotarix doses.
What happens if an infant is inadvertently given their first dose of Rotarix when aged 15 weeks or older?
An infant who inadvertently receives their first dose of Rotarix when aged 15 weeks or older should complete their course of vaccines. The second dose must be given before the infant is aged 25 weeks and 0 days.
When is an infant too old to receive their second dose of Rotarix?
When they are aged 25 weeks and 0 days. The latest that the second Rotarix dose can be given is 24 weeks and 6 days of age because of an unknown but possible increase in risk of intussusception.
An infant who does not receive their second rotavirus vaccine dose before they are 25 weeks old, they cannot complete a course of rotavirus vaccines.
Dosage and administration
Is there minimum interval between receiving a BCG, blood transfusion or immunoglobulin product and Rotarix?
No minimum interval is required between receiving a live oral vaccine and a live injected vaccine (BCG), blood transfusion or immunoglobulin product.
Do we repeat a dose of Rotarix if the infant spits the vaccine out or vomits straight after receiving their dose?
No. Do not re-administer the dose if the infant spits it out or vomits immediately after administration.
- If this occurs with the first dose, give the second dose at 3 months of age or a minimum of 4 weeks after the first dose (and before 25 weeks of age), whichever is later.
- If this occurs with the second dose, no more doses are required.
Do infants have to wait 20 minutes if they only receive Rotarix?
Yes. Rotarix is a vaccine and, like all vaccines, has the potential risk of anaphylaxis even though it is administered orally. The Immunisation standards for vaccinators require the vaccinator to provide safe immunisation and vaccinees to remain under observation for a minimum of 20 minutes after immunisation.
Can we give Rotarix through a nasogastric (NG) tube?
Yes. Rotarix is a liquid vaccine for oral administration (see Contraindications and precautions).
Contraindications and precautions
What are the contraindications for Rotarix?
- Severe combined immunodeficiency (SCID).
- Uncorrected congenital gastrointestinal malformation that predisposes to intussusception.
- Previous intussusception.
- Anaphylaxis to a previous dose or component of the vaccine.
What if an infant is suspected or known to have a weakened immune system?
Seek further medical advice before administering Rotarix.
Can an infant whose mother was on immunosuppressive medication during pregnancy have Rotarix?
Seek further medical advice before administering Rotarix.
Can an infant who lives in a house with someone who is pregnant or immunocompromised receive Rotarix?
Yes. After changing nappies caregivers only need to follow standard hygiene measures, i.e. wash their hands using soap and water and dry them well or use liquid hand gel.
Can an infant with colic or severe reflux receive Rotarix?
Yes, unless the infant also has a condition where Rotarix is contraindicated.
Can an infant with a nasogastric (NG) tube receive Rotarix?
It depends on why they need a NG tube:
- Rotarix is contraindicated if the infant has an uncorrected gastrointestinal malformation that predisposes them to intussusception.
- Rotarix can be given if the NG tube is in situ for any other reason.
After immunisation
Should breast feeding be delayed after an infant receives Rotarix?
No. An infant can breast feed immediately after immunisation. No special precautions need to be taken by the mother.
Can a woman with cracked nipples breast feed her baby after they receives Rotarix?
Yes. A mother can safely breast feed her baby any time after they have received Rotarix. No special precautions need to be taken by the mother.
What vaccine responses could occur?
One or two babies in 10 may have mild vomiting or diarrhoea during the 7 days after immunisation. However, studies suggest these symptoms may be unrelated to rotavirus vaccine because around the same number of babies who received a placebo liquid not containing rotavirus also developed these symptoms.
There may be a small increase in the risk of developing intussusception during the week following the first vaccine dose and a smaller risk after the second dose.
How will parents recognise if their baby develops intussusception?
It is recommended that parents seek medical advice if their baby develops intermittent crying/screaming episodes, start pulling their knees towards their chest, vomiting, or has pink or red coloured jelly-like stools.
How long is the vaccine virus excreted in stools?
The weakened rotavirus from the vaccine may be found in stools for up to 28 days after the first immunisation and up to 15 days after the second dose.
What hygiene measures are needed for nappy changing after an infant receives Rotarix?
After changing nappies caregivers only need to follow standard hygiene measures, i.e. wash their hands using soap and water and dry them well or use liquid hand gel.
Do infants have to use disposable nappies after they have Rotarix?
No. Babies can wear cloth or disposable nappies after immunisation. No special precautions need to be taken when washing cloth nappies.
How should vomits or spills be managed after an infant has received Rotarix?
Standard hygiene measures can be used to clean up vomit or spills. No special precautions need to be taken.
Can someone kiss an infant on the mouth after they have received Rotarix?
No studies have investigated transmission of vaccine virus from kissing a baby on the mouth after immunisation. However, it is theoretically possible for a person to be exposed to weakened vaccine virus in this way.
Can an infant attend day care after receiving Rotarix?
Yes. After changing nappies caregivers only need to follow standard hygiene measures, i.e. wash their hands using soap and water and dry them well or use liquid hand gel.
Can an infant go swimming after they receive Rotarix?
Yes.
References
- Buyse H, Vinals C, Karkada N, Han HH. The human rotavirus vaccine Rotarix™ in infants. Hum Vaccin Immunother. 2014;10(1):19-24.
- Carlin JB, Macartney KK, Lee KJ, Quinn HE, Buttery J, Lopert R, et al. Intussusception risk and disease prevention associated with rotavirus vaccines in Australia’s National Immunization Program. 2013;57(10):1427-34.
- Gray J. Rotavirus vaccines: safety, efficacy and public health impact. J Intern Med. 2011;270(3):206–14.
- Hsieh Y-C, Wu F-T, Hsiung CA, Wu H-S, Chang K-Y, Huang Y-C. Comparison of virus shedding after lived attenuated and pentavalent reassortant rotavirus vaccine. Vaccine. 2014;32(10):1199-204.
- Marshall GS. Rotavirus disease and prevention through vaccination. Pediatr Infect Dis J. 2009;28(4):351-64.
- Ministry of Health. Immunisation handbook 2017 2nd Edition [Internet]. Wellington: Ministry of Health; 2018 [cited 2020 July 24]. Available from: https://www.health.govt.nz/ publication/immunisation-handbook-2017
- Rosillon D, Buyse H, Friedland LR, Ng S-P, Velazquez FR, Breuer T. Risk of intussusception after rotavirus vaccination: Meta-analysis of postlicensure studies. Pediatr Infect Dis J. 2015;34(7):763-8.
- Soares-Weiser K, Bergman H, Henschke N, Pitan F, Cunliffe
- N. Vaccines for preventing rotavirus diarrhoea: Vaccines in use (Review). Cochrane Database Syst Rev. 2019(3. Art. No.: CD008521).
- World Health Organization. Rotavirus vaccine and intussusception: Report from an expert consultation. Wkly Epidemiol Rec. 2011;86(30):317-8.
