A childhood vaccine that's more important than you might think

Oct. 9-Atlanta

Which virus causes the greatest number of hospitalizations among children in the United States younger than 5 years? Did you say “influenza”?

Not true, according to Larry Pickering, MD, senior advisor to the director of the National Center on Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. The correct answer is, in fact, rotavirus.

Providing an update on new vaccines today at the AAP’s National Conference and Exhibition, Dr. Pickering spoke first about rotavirus at the audience’s request-even though only about half of attendees at the scientific session indicated by show of hands that they planned to use the newly approved vaccine (sold under the name RotaTeq) in their practice.

“I’ve heard several comments that the vaccination schedule is cumbersome,” said Dr. Pickering. “I think a lot of the willingness to incorporate rotavirus vaccination into a practice depends in the type of practice. Family practices don’t see a lot of rotavirus cases. Hospital-based practitioners do.”

Rotavirus is the most common cause of severe diarrhea in children worldwide, with the highest incidence in children between 3 and 24 months old. In the United States, estimates are that more than 55,000 hospitalizations annually are caused by rotavirus.

An even larger obstacle to acceptance of the vaccine by clinicians, however, may be lingering concern over a risk of intussusception. That’s because an earlier rotavirus vaccine, Rotashield, was withdrawn from the market after a short time in 1999 following several reports of the catastrophic event that appeared to be associated with Rotashield vaccination (especially the first dose).

Dr. Pickering explained that, although it isn’t certain that intussusception would not occur at all with RotaTeq, he did volunteer his opinion that the problem is much less likely: Not only was the study that supported RotaTeq very large and free of cases of intussusception above the rate seen in a placebo group, but the use of the vaccine in the field, post-approval, is being monitored closely.

Pickering cautioned pediatricians to educate parents that vaccination will not prevent all cases of diarrhea caused by rotavirus, but that it does virtually eliminate severe rotaviral diarrhea and provides almost all the protection necessary to prevent hospitalization.

RotaTeq requires three oral doses; the series is to be completed by 32 weeks of age. The first dose is given between 6 and 12 weeks of age; the following two doses, at least four weeks apart. RotaTeq is contraindicated in patients who have a severe hypersensitivity to any component of the vaccine.

The rotavirus vaccine has been recommended for inclusion on the childhood schedule by the Advisory Committee on Immunization Practices. An AAP recommendation statement is in the approval process and, Pickering reported, will be released shortly.