Rotavirus Vaccine

There are 2 rotavirus vaccines available for use in infants in the United States:

• RV5

• RV1

Rotavirus vaccines are live-virus vaccines that are also attenuated.

The rotavirus vaccines are indicated for the prevention of infection caused by rotavirus. Guidance on rotavirus vaccination evolves over time, and various expert organizations issue differing recommendations. See Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP) for specific recommendations and further information.

The rotavirus vaccine is recommended as a routine childhood vaccination by some expert organizations. The rotavirus vaccine is recommended as a routine childhood vaccination by some expert organizations.

Contraindications for rotavirus vaccines are the following:

• A severe allergic reaction (eg, anaphylaxis) after a previous dose of the vaccine or to a vaccine component (including latex, which is in the RV1 applicator)

• Infants with severe combined immunodeficiency (SCID)

• Infants who have had intussusception

The main precautions with rotavirus vaccines are the following:

• Moderate or severe acute illness with or without fever, including moderate or severe diarrhea or vomiting (vaccination is postponed until the illness resolves; infants with mild illness can be given the vaccine)

• Spina bifida or bladder exstrophy

• Altered immunocompetence other than SCID (eg, infants with HIV infection)

• Chronic gastrointestinal disease

(See also CDC: Contraindications and Precautions to Vaccination: Rotavirus Vaccine Contraindications and Precautions.)

The safety and efficacy of rotavirus vaccines have not be established in infants with the following:

• Advanced HIV infection or any other disease that affects the immune system

• Treatment with corticosteroids or other immunosuppressants

• Cancer or cancer treatment with radiation or medications

For rotavirus vaccines available for use in the United States, all dose and administration information for all age groups and people with special conditions is available from the CDC, AAP, and AAFP (1–3).

RSV vaccine doses should be administered orally by putting drops in the infant's mouth.

Rotavirus vaccines are administered orally by putting drops in the infant's mouth. The dosing for the 2 vaccines is slightly different:

• RV5 is typically administered orally in 3 doses, 1 dose at age 2 months, 4 months, and 6 months.

• RV1 is typically administered orally in 2 doses, 1 dose at age 2 months and 4 months.

• If any dose in the series is either RV5 or unknown, default to a 3-dose series.

If the first dose of rotavirus vaccine is inadvertently administered at age ≥ 15 weeks, the remaining doses should be administered at the routinely recommended intervals.If the first dose of rotavirus vaccine is inadvertently administered at age ≥ 15 weeks, the remaining doses should be administered at the routinely recommended intervals.

Rotavirus vaccine should not be administered after age 8 months 0 days, even if the series is incomplete because of the risk of intussusception.Rotavirus vaccine should not be administered after age 8 months 0 days, even if the series is incomplete because of the risk of intussusception.

Adverse effects are rare but include irritability, mild temporary diarrhea, and vomiting.

There is a very small risk of bowel intussusception with the rotavirus vaccine. Intussusception usually occurs within a week after the first or second dose. Surgery may be required.There is a very small risk of bowel intussusception with the rotavirus vaccine. Intussusception usually occurs within a week after the first or second dose. Surgery may be required.

For more information about adverse effects of these vaccines, refer to the prescribing information.

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Rotavirus Vaccine

2. Centers for Disease Control and Prevention (CDC): Rotavirus Vaccination: Information for Healthcare Professionals

3. European Centre for Disease Prevention and Control (ECDC): Rotavirus Infection: Recommended vaccinations