On the 1st July 2017, Victoria is changing it’s brand of oral rotavirus vaccine.
Rotarix® (given in a 2-dose schedule) will replace RotaTeq® (given in a 3-dose schedule).
After 1st July 2017, Rotarix® will be the only rotavirus vaccine used under the NIP in Australia for children commencing their childhood schedule.
The ATAGI clinical advice (see Resources) includes information on how to use rotavirus vaccines during the brand switch period.
The key difference to note with Rotarix is that the 1st dose is administered prior to turning 15 weeks of age and the 2nd (final dose) by 25 weeks
  • Rotarix is not to be administered outside of these time windows

Previous doses

of Rotateq®

given

Rotateq® available and

Rotarix® available

 

Rotateq® NOT available

and Rotarix® available

(must see Table 2 for more details)

0 Do not commence Rotateq® ⇒ Follow 2-dose Rotarix® schedule
1 Give 2nd dose of Rotateq® Give 1 Rotarix®  – No further doses required
2 Give 3rd dose of Rotateq® No further doses required*

* In this scenario, administration of a 3rd dose of vaccine (as Rotarix®) is not routinely recommended but      would be acceptable if given prior to turning 25 weeks of age.

What is it?

Rotavirus is a common cause of acute severe gastroenteritis in children less than 5 years of age. It is found in all countries and without immunisation almost every child in the world would suffer at least one infection by the time they are 3-years old.

What to look for?

Rotavirus has a large spectrum of illness. Symptoms can range from mild, watery diarrhoea to severe dehydrating diarrhoea with vomiting and fever. In extreme cases, this can result in death.

The clinical features of rotavirus gastroenteritis are non-specific so diagnosis can only be confirmed with laboratory testing. In Australia the peak incidence of severe disease is between 6 and 24 months of age.

How is it transmitted?

Rotavirus is transmitted via the faecal-oral route. Because large amounts of the virus are shed in faecal matter and the virus is stable in the environment, contamination of hands and objects is relatively easy. Common areas for transmission include day care centers, family homes and aged care facilities. Individuals who do not have symptoms can still excrete the virus.

Am I already protected?

Unlike other childhood diseases, such as measles and chickenpox, natural rotavirus infection does not offer lifetime protection. It can offer protection from severe disease when subsequently exposed to the virus.

Vaccination to prevent infection?

In Australia, prior to vaccine introduction in 2007, about 4% of children were hospitalised with rotavirus gastroenteritis by the age of 5 years, with on average one death per year. These rates have dropped dramatically since introduction of vaccines onto the National Immunisation Program.

Oral rotavirus vaccines are only recommended for use in young infants. Protection against rotavirus is available under the National Immunisation Program Schedule. In Victoria, immunisation against rotavirus is free of charge, with doses at:

  • approximately 2 months (from 6 weeks)*
  • 4 months of age

Unlike other routine immunisations, the Rotavirus vaccine needs to be administered in infancy, with strict age cut offs for the 1st and 2nd doses.

During transition period, some babies will receive a 3rd dose of Rotavirus vaccine at age 6 months (refer to transition schedule from 1 July 2017, noting age cut offs)

*The upper age limit for receipt of the 1st dose of Rotarix® is immediately prior to turning 15 weeks old, and the upper age limit for receipt of the 2nd dose is immediately prior to turning 25 weeks old – these are detailed on our Immunisation Schedule App

http://www.rch.org.au/rch/apps/vicvax/Victorian_immunisation_schedule_app/

Use of rotavirus vaccines in older children and adults is not recommended.

Special risk groups

Infants with pre-existing chronic gastrointestinal are at risk of severe rotavirus infection and stand to benefit from vaccination.

Hospitalised infants, including premature infants, who are otherwise clinically stable and of the correct chronological age can be given the vaccine. This includes those in special care nurseries. Strict hand-hygiene should be employed to minimise risk of virus transmission

Infants living in household with persons who have an immunodeficiency disorder or impaired immune status can be vaccinated.

Intussusception

There is evidence from Australian and international research that there is a small increase in intussusception cases in infants who receive the oral rotavirus vaccine. Intussusception is a rare condition where the bowel slides or telescopes inside itself causing a blockage. Infants may cry, pull up their legs and later have vomiting and sometimes blood in the stools. In most cases this cause of intussusception is not known. It has been estimated that the increased risk with rotavirus vaccines means an additional six cases of intussusception in Australian infants per year.

Contraindications

Rotavirus vaccine should not be given to any infant with a previous history of intussusception or a congenital abnormality, which pre-disposes them to intussusception.

Infants with severe combined immunodeficiency disorder (SCID) are also excluded from vaccination, as they may have prolonged excretion of the rotavirus vaccine strain due to their impaired immunity

The vaccine should also not be administered to an infant with anaphylaxis to a previous dose of Rotavirus vaccine

Resources

Please refer to the ATAGI Clinical advice to support the introduction of Rotarix® to replace RotaTeq® in specified Australian states (Western Australia, South Australia, Victoria and Queensland) from 1 July 2017

ATAGI Clinical advice Rotavirus

More information about Rotavirus and the available vaccine(s) is available from the National Centre for Immunisation Research and Surveillance (NCIRS) fact sheet

http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/rotavirus-fact-sheet.pdf

and the Better Health Channel

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Rotavirus

Reviewed by: Nigel Crawford (Paediatrician, The Royal Children’s Hospital, Melbourne) and Georgina Lewis (Clinical manager – SAEFVIC)
Date: June 2017
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


RCH
Monash
Melbourne University
SAEFVIC

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