Rotavirus Vaccine

Approved Indications:

• Prevention of Rotavirus Gastroenteritis:
• Indicated for active immunization of infants to prevent gastroenteritis caused by rotavirus infections.
• Protects against severe diarrhea, vomiting, dehydration, and hospitalization due to rotavirus.
• Covers multiple rotavirus serotypes including G1, G2, G3, G4, G9, and G12.

Important Off-Label or Clinical Use:

• Not used in treatment of active rotavirus infection.
• Occasionally used in catch-up immunization schedules under clinical discretion before the maximum age limit.

Available Brands & Formulations in Bangladesh (per Medex):

• Rotarix® – Oral suspension, 1 mL/dose (monovalent, G1P[8] strain)
• RotaTeq® – Oral solution, 2 mL/dose (pentavalent, G1-G4 and P1[8] reassortant strains)
• ROTAVAC®, ROTASIIL® – Also available in select regions

Standard Dosing Schedule:

a. Rotarix®:

• Infants (6–24 weeks):
• Dose: 2 oral doses of 1 mL each.
• First dose: From 6 weeks of age.
• Second dose: Minimum 4 weeks after the first.
• Must complete by 24 weeks of age.

b. RotaTeq®:

• Infants (6–32 weeks):
• Dose: 3 oral doses of 2 mL each.
• First dose: From 6 weeks of age.
• Doses at intervals of 4–10 weeks.
• Complete all 3 doses by 32 weeks of age.

Administration Route:

• Oral only. Must not be injected.
• Administer the full dose into the infant’s mouth using the provided applicator.

Special Populations:

• Preterm infants: Safe if clinically stable and aged ≥6 weeks.
• HIV-exposed or HIV-positive infants: May be vaccinated per WHO guidelines.
• Immunocompromised infants: Use with caution based on risk-benefit evaluation.

Rotavirus vaccines contain live attenuated rotavirus strains that replicate in the intestinal mucosa. This replication stimulates both mucosal (secretory IgA) and systemic immune responses. The immune system recognizes viral antigens and forms protective antibodies, especially targeting VP4 and VP7 surface proteins, which are essential for viral entry and pathogenesis. This immune response prevents reinfection by promoting viral neutralization and inhibiting intestinal epithelial damage caused by rotavirus, thus providing protection against diarrhea and dehydration.

As an oral live-attenuated vaccine, traditional pharmacokinetic properties (ADME) are not directly applicable.

• Absorption: Local replication in intestinal epithelium.
• Distribution: Primarily local mucosal immunity; negligible systemic circulation.
• Metabolism: No hepatic metabolism; inactivated naturally by host immunity.
• Excretion: Vaccine virus may be shed in feces for up to 10 days after dosing.
• Onset of Protection: Effective immune response develops after the full vaccine series, generally within 2 weeks of final dose.

• Pregnancy Category: Not assigned (Not applicable – not intended for adult or pregnant populations).
• Lactation: Safe.
• Breastfeeding during the vaccination schedule is permitted.
• Maternal antibodies in breast milk do not significantly affect vaccine efficacy.
• No harmful effects reported in infants due to lactating mothers being in contact with the vaccine virus.

• Primary Class: Live Attenuated Viral Vaccine
• Subclass: Pediatric Oral Vaccine against Rotavirus Infection

• Known hypersensitivity to any component of the vaccine or previous rotavirus dose.
• History of intussusception.
• Severe combined immunodeficiency (SCID).
• Uncorrected congenital gastrointestinal malformations (e.g., Meckel’s diverticulum).
• Acute moderate or severe illness (vaccination should be postponed).
• History of anaphylaxis following a prior rotavirus vaccine dose.

• Intussusception Risk: Rarely reported, especially after the first dose; caregivers should be informed about signs such as vomiting, blood in stool, or severe abdominal pain.
• Shedding of Virus: Live virus may be excreted in stools; hygienic precautions are advised, especially around immunocompromised persons.
• Premature Infants: May be vaccinated if clinically stable and at least 6 weeks old.
• Immunocompromised Exposure: Close contacts of recently vaccinated infants (e.g., transplant recipients) should maintain hygiene.
• Postpone vaccination in infants with acute diarrhea or vomiting until recovery.

Common Adverse Effects:

• Gastrointestinal:
• Diarrhea
• Vomiting
• Flatulence
• Abdominal discomfort
• General:
• Irritability
• Low-grade fever
• Restlessness

Serious but Rare Adverse Effects:

• Intussusception (usually within 7–21 days after dose)
• Severe allergic reaction (anaphylaxis)
• Seizures (very rare)

Onset & Severity:

• Most symptoms are mild and appear within 1–3 days of administration.
• Serious side effects are extremely rare and typically require prompt medical attention.

• Drug–Drug:
• No significant interactions reported with other routine pediatric vaccines.
• Can be co-administered with DTP, polio (IPV/OPV), hepatitis B, Hib, and pneumococcal vaccines.
• Drug–Food:
• No restrictions. Breastfeeding is allowed before and after administration.
• Drug–Alcohol: Not applicable for infant population.
• Enzyme Interactions: Not metabolized via liver enzymes (e.g., CYP450), so enzyme induction/inhibition not relevant.

• WHO (2023–2024):
• Reaffirmed universal inclusion of rotavirus vaccine in infant immunization programs.
• Endorsed new thermostable versions (e.g., ROTASIIL) for low-resource settings.
• CDC/ACIP Guidelines (USA):
• Emphasized strict adherence to age cutoffs:
• First dose by 14 weeks and 6 days.
• Final dose must be completed by 8 months.
• Bangladesh EPI Program:
• Included rotavirus vaccine in routine immunization schedule.
• Administered starting at 6 weeks alongside pentavalent and OPV doses.

• Temperature: Store between 2°C and 8°C (refrigerated).
• Protection: Protect from light and do not freeze.
• Handling:
• Discard if frozen or discolored.
• Shake well before use (especially for suspensions).
• Reconstitution:
• Not required for ready-to-use liquid forms.
• Shelf Life: Typically 2–3 years if stored as directed.