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Rotavirus vaccines for infants

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

INTRODUCTION

Rotavirus was the most common cause of severe gastroenteritis in infants and children before mass immunization [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".)

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".)

MICROBIOLOGY

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.

ROTAVIRUS VACCINES

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 [4-9]. 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 [10].

Licensed vaccines — Two live, attenuated oral rotavirus vaccines are licensed for use in the United States and other countries (table 1). The vaccines have similar efficacy and safety and no preference for one over the other vaccine exists, with a few exceptions (eg, latex allergy) [1,3,11,12]. (See 'Contraindications' below and 'Efficacy/effectiveness' below and 'Adverse events and safety' below.)

                               

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Literature review current through: Nov 2016. | This topic last updated: Wed Oct 05 00:00:00 GMT+00:00 2016.
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