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Rotavirus vaccines for infants

David O Matson, MD, PhD
Section Editors
Morven S Edwards, MD
Teresa K Duryea, MD
Deputy Editor
Mary M Torchia, MD


Rotavirus is the most common cause of severe, acute gastroenteritis in infants and children worldwide [1-3]. In the prevaccine era, rotavirus was estimated to cause approximately 440,000 deaths, 2 million hospitalizations, and 25 million outpatient visits per year worldwide among children <5 years of age [2]. (See "Epidemiology and causes of acute diarrhea in resource-rich countries".)

More than 40 percent of World Health Organization member countries have introduced a rotavirus vaccine into their infant vaccination schedules [4]. Other countries are documenting their rotavirus disease burden in preparation for introduction of a rotavirus vaccine.

Rotavirus vaccination of infants will be discussed below. The pathogenesis, clinical presentation, and diagnosis of rotavirus gastroenteritis are discussed separately, as are general measures to prevent viral gastroenteritis in children. (See "Clinical manifestations and diagnosis of rotavirus infection" and "Acute viral gastroenteritis in children in resource-rich countries: Management and prevention".)


Rotavirus is a double-stranded RNA virus in the Reoviridae family [3]. The outer capsid contains two proteins that define rotavirus serotypes: a G protein (VP7) and a P protein (VP4) (figure 1). Five G-P combinations account for approximately 90 percent of human rotaviruses circulating worldwide: G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8], but serotype prevalence varies from time to time and from place to place for reasons that are not understood. It is plausible that the differences in composition of the two licensed vaccines will impose different pressures on serotype prevalence.


Vaccine development — Rotavirus vaccines have been developed from animal rotavirus strains, human-animal rotavirus reassortants (genes from human and animal strains), attenuated human rotaviruses, and subunits of rotavirus virions [5-10]. Reassortants are necessary because most human rotaviruses grow too poorly in cell culture for production of standard vaccine lots for large-scale immunization programs. Monovalent vaccines prepared from animal rotaviruses have not been promising in humans. Assessment of rotavirus subunit vaccine candidates have reached animal studies [11].

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Literature review current through: Oct 2017. | This topic last updated: Oct 18, 2017.
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