WebMD Medical News
Louise Chang, MD
Sept. 21, 2011 -- Far fewer children were hospitalized for a common stomach bug known as rotavirus since routine vaccination was recommended in 2006, a study shows.
The new findings appear in the New England Journal of Medicine.
The CDC recommends that infants get vaccinated for rotavirus. There are two available rotavirus vaccines. The RotaTeq vaccine is given in three doses at ages 2 months, 4 months, and 6 months. The Rotarix vaccine is given as two doses at 2 months and 4 months.
Rotavirus is a common cause of diarrheal illness, especially in children. Symptoms include fever, abdominal pain, vomiting, and diarrhea. It ranges from the mild to the severe. Rotavirus is spread easily from child to child via hand-to-mouth contact. Rotavirus is most likely seen during winter and spring in the U.S.
Before the CDC recommended routine rotavirus vaccination, rotavirus caused in the U.S. each year:
"This is a staggering figure," says study researcher Umesh Parashar, MBBS, MPH. He is a medical epidemiologist and team leader for the viral gastroenteritis team of the CDC's division of viral diseases. "It means that one in 70 children born in the United States during the pre-vaccine era was hospitalized for rotavirus by age 5."
After the CDC got behind vaccination in 2006, there was a substantial drop in the number of severe rotavirus illnesses and associated health care costs. This drop was seen during the rotavirus seasons of 2007-2008 and 2008-2009.
Fewer kids were hospitalized due to rotavirus as well; many of them may have benefited from other children getting the vaccine even if they didn't. There were 60% to 75% fewer hospital admissions among kids due to rotavirus after the vaccine became available, the study showed. This drop was even more pronounced among children who got the vaccine.
As a result, there was also a sharp a reduction in the costs of treating the illness.
The main concern with the rotavirus vaccine is a risk of intussusception, a potentially life-threatening bowel blockage. An earlier rotavirus vaccine was removed from the market because it increased risk for intussusception.
As far as the newer rotavirus vaccines, "there have been data from international settings including Mexico, Brazil, and Latin America that suggest a low level risk of intussusception," Parashar says. In general, "this risk is five- to 10-fold lower than what was seen with the earlier rotavirus vaccine."
This level of risk has not been seen in the U.S., he says.
But "we still don't have enough to confidently exclude a low risk," Parashar says. According to the CDC, the estimated risk of intussusception is one case per 100,000 infants.
"The benefit-risk ratio is clearly on the side of benefit even if such a risk were to be found. These vaccines prevent what is the single most common [cause] of severe diarrhea in U.S. children. Parents should get their children vaccinated against rotavirus."
Greg Yapalater, MD, a New York City pediatrician in private practice, is not ready to endorse the rotavirus vaccine, yet. "With any new vaccine, I need to see a good safety profile and there are still some cases of intussusception," he says. "I am concerned."
He is taking a watch-and-wait approach before recommending that infants receive the rotavirus vaccine. "I don't vaccinate against something that could cause dehydration if there is a chance the vaccine could cause a condition that is life-threatening," he says. "I love the concept of the vaccine, but need to see a better safety profile."
Tamara R. Kuittinen, MD, is the director of medical education at the department of emergency medicine at Lenox Hill Hospital in New York City. She is also a mom.
"This study confirms that it is a useful vaccine," she says. "You don't want your infant or children to end up in the hospital with this virus."
"Kids with rotavirus won't eat or drink and get dehydrated and then come to hospital and may get admitted, and then they are exposed to other infections," Kuittinen tells WebMD.
Avoiding dehydration is the key, she says. Try to get your child to drink liquids, she says. "Ice pops may also help kids with rotavirus stay hydrated."
Learning the warning signs of severe dehydration also can help parents know when to get help. These include:
SOURCES:Cortes, J.E. New England Journal of Medicine, 2011; vol 363: pp 1108-1117.Tamara R. Kuittinen, MD, director, medical education, emergency medicine, Lenox Hill Hospital, New York City.Umesh Parashar, MBBS, MPH, medical epidemiologist; team leader, viral gastroenteritis team, division of viral diseases, CDC.Greg Yapalater, MD, pediatrician, New York City.CDC web site: "Rotavirus Vaccine."
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