Another success of the UK immunisation schedule.

Winter epidemics used to fill paediatric wards. Globally in 2015, rotavirus was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths).

Vaccine is live attenuated virus, taken orally. 2 doses, at 8 and 12 weeks.

As with other live viruses, theoretical risk of disease, but you need to balance against risk from wild type disease.

Rotavirus almost always OK in immunosuppressed children – recommended in HIV, for example – you probably wouldn’t give to a SCID or severe DiGeorge, though, especially since prevalence virtually zero.

Chapter 6 of the Green book says that if a Mum is on a biologic you should skip rotavirus (and defer BCG to 6/12+). If breast feeding, infliximab product information says only give live vaccines if baby serum infliximab levels undetectable!!!

Rotarix – monovalent vaccine, but protection is cross strains! 96% efficacy vs admission, 90% vs severe disease (Europe). Some evidence of herd immunity.

First Rotavirus vaccine (RotaShield) was pulled from the market in 1999 due to increased risk of intussusception. Risk appeared to be in first 14 days.

Intussusception relative risk (first 7-14 days) 5.5x for first dose, 1.8x second dose (post-licensure data from US).

Not to be started if over 15/52, and must be completed before 24/52 (median age of intussusception presentation is 5 months).