ACIP, AAFP in Agreement

Check Out New Rotavirus Vaccine Guidance

By News Staff
7/16/2008

Transmission electron micrograph of rotavirus with single-shelled capsid

The Academy has approved provisional recommendations from the CDC's Advisory Committee on Immunization Practices, or ACIP, on the use of rotavirus vaccine in infants and young children. The provisional recommendations offer guidance on administration of the two vaccine products currently licensed to prevent rotavirus gastroenteritis in these patients.

Both vaccines -- RotaTeq, or RV5, marketed by Merck & Co., and Rotarix, or RV1, marketed by GlaxoSmithKline -- are administered orally, but they differ somewhat in composition and dosing schedules. RV5 is administered in a three-dose series, with doses given at ages 2, 4 and 6 months. RV1 requires a two-dose series, with doses given at ages 2 and 4 months.

The ACIP recommendations express no preference for either the RV5 or the RV1 vaccine.

With each vaccine, the first dose may be given as early as age 6 weeks and as late as age 14 weeks 6 days; vaccination should not be initiated in infants age 15 weeks or older. The minimum interval between doses of rotavirus vaccine is four weeks. All doses should be administered by age 8 months.

CDC Analysis Points to Less Rotavirus Activity in 2007-08

Although rotavirus infection in the United States causes relatively few deaths each year, the disease remains a substantial cause of morbidity among young children. An article in the June 25 Morbidity and Mortality Weekly Report estimated the annual number of hospitalizations from rotavirus infection to be between 55,000 and 70,000. That article also attributed between 205,000 and 272,000 emergency department visits and 410,000 physician office visits each year to the disease.

Now, a CDC analysis of long-term surveillance data indicates that, when compared with the 15 previous rotavirus seasons (spanning 1991-2006), the onset of rotavirus activity during the 2007-08 season appeared to have been delayed by two to four months and was diminished in magnitude by more than half.

"These changes in rotavirus activity coincide with increasing use of rotavirus vaccine among infants," an editorial note to the MMWR article points out, adding that herd immunity may have played a role in the decline.

"Additional surveillance and epidemiologic studies are needed to confirm the impact of rotavirus vaccination on the 2007-08 season and to monitor the impact of the vaccine on the incidence and epidemiology of rotavirus during future seasons," the MMWR editors conclude.

The ACIP recommends that the rotavirus vaccine series be completed with the same product that was used initially whenever possible. However, the recommendations note, vaccinations should not be deferred if the product used for previous doses is not available or is unknown. In such cases, physicians should continue or complete the series using whichever rotavirus vaccine product they have on hand.

If RV5 was used for any dose in the series, or if the product used for any dose in the series is not known, a total of three doses of rotavirus vaccine should be given.

Rotavirus vaccine should not be given to infants with a history of a severe allergic reaction, such as anaphylaxis, to a previous dose of rotavirus vaccine or to any vaccine component. In addition, the RV1 oral applicator contains latex, so infants with a severe latex allergy should not receive RV1. In these infants, RV5, which has a latex-free dosing tube, should be administered.

The 2008 Recommended Childhood Immunization Schedule (1-page PDF; About PDFs) developed by the CDC in conjunction with the AAFP and the American Academy of Pediatrics and released in January, includes information on administration of the RV5 vaccine. As previously reported in AAFP News Now, RV1 was first licensed for use in the United States in April of this year.

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