Tag: rotavirus

Can I Get Rotavirus from My Recently Vaccinated Baby?

Your two month old recently got her vaccines, including the rotavirus vaccine.

Shedding Season is not a real thing.
Shedding Season is not a real thing.

Now you have diarrhea.

Was it from shedding from your child’s rotavirus vaccine?

Does the Rotavirus Vaccine Shed?

Like some other live virus vaccines, it is well known that the rotavirus vaccine can shed.

And like with most other vaccines, this shedding isn’t usually a cause for concern and definitely isn’t a reason to think about skipping or delaying your child’s vaccines.

Why not?

“All members of the household should wash their hands after changing the diaper of an infant. This minimizes rotavirus transmission, for an undetermined number of weeks after vaccination, from an infant who received rotavirus vaccine.”

General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you wash your hands when you change your child’s diapers after they have been vaccinated, just like you hopefully do anyway, you can avoid any possible contact with any rotavirus vaccine virus that might be shed in your child’s stool.

Can I Get Rotavirus from My Recently Vaccinated Baby?

But what would be the risk of your getting sick if you did come into contact with shedding rotavirus vaccine virus in your child’s diaper?

Would you be at risk to get sick?

Did your baby get sick after getting the actual vaccine?

That’s the thing about shedding that many people don’t understand. These live vaccines are made with attenuated or weakened strains of viruses, so they don’t typically get you sick when you are vaccinated. And they don’t typically get you sick when you are exposed through shedding. In fact, this shedding can sometimes help build herd immunity, as more people get exposed to the weakened strain of vaccine virus.

But can they get you sick?

Yes, if you have a problem with your immune system, which is why there are warnings about giving live vaccines to folks who are immunocompromised. And there used to be warnings about giving the oral polio vaccine to kids if they were around anyone with an immune system problem.

Vaccine viruses could also get you sick if they mutated from their attenuated state and became more virulent. Fortunately, that rarely happens with most vaccines.

“The theoretical risk of HRV and PRV shedding, transmission to, and infection of immunocompromised contacts is much lower than the real risk of wildtype rotavirus infection transmitted from unvaccinated children.”

Anderson on Rotavirus vaccines: viral shedding and risk of transmission

And most importantly, since kids are much more likely to shed virus after natural infections, it is much safer for everyone to get vaccinated and protected with these vaccines.

Surprisingly, even children with asymptomatic natural rotavirus infections can shed virus for several weeks, which is likely why these infections used to spread so easily or without known contacts.

Something that will likely surprise some folks even more is the news that just because someone gets diarrhea after being exposed to the rotavirus vaccine, either because they were vaccinated or through shedding, it doesn’t mean that the vaccine was the cause of the diarrhea!

“Of note, among all six AGE cases which possessed Rotarix-derived strains, four (sample No.1, 5, 6 and 7) were suspected to be caused by other pathogens. Most likely, the infants were infected with other pathogens during the shedding period of Rotarix strain.”

Kaneko et al on Identification of vaccine-derived rotavirus strains in children with acute gastroenteritis in Japan, 2012-2015

When vaccine strain rotavirus have been detected in kids with gastroenteritis, they often have other reasons to have diarrhea.

What does this all mean?

Don’t believe all of the hype anti-vaccine folks push about shedding from vaccines.

More on Shedding and Rotavirus Vaccines

Do You Know What Vaccine-Preventable Diseases Look Like?

Odds are that you have never seen anyone with smallpox, but what about measles or mumps?

No?

Have you ever even seen someone with chicken pox?

Photos of Vaccine-Preventable Disease

Maybe if more folks knew what typical vaccine-preventable diseases looked like, then they wouldn’t be so quick to think about skipping or delaying their kids vaccines.

And they certainly wouldn’t think that these are mild diseases that they wanted their kids to get, thinking natural immunity would be better than the immunity that they could more easily and safely get from a vaccine.

Severe dehydration in a child with a rotavirus infection.
Severe dehydration in a child with a rotavirus infection.

Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat.
Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat. Photo by the Japanese Society of Tropical Medicine

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Newborns and infants have the highest rates of death from pertussis.
Newborns and infants have the highest rates of death from pertussis or whooping cough.

An infant with measles during the 2014 outbreaks in the Philippines.
An infant with measles during the 2014 outbreaks in the Philippines. Photo by Jim Goodson, M.P.H.

Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.
Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.

A baby with a congenital cataract and blueberry muffin rash - classic signs of congenital rubella syndrome.
A baby with a congenital cataract and blueberry muffin rash – classic signs of congenital rubella syndrome. (CC BY-NC-SA)

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.
This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.

Chronic hepatitis B is a silent killer.
Chronic hepatitis B is a silent killer.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.
Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcal disease.

In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath.
In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath. Seen here are the ‘thumb sign’ on X-ray and the cherry red epiglottis.

Before wide use of the Hib and Prevnar vaccines, infants with fever would routinely get spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a bacterial infection).
Before wide use of the pneumococcal vaccines, infants with fever would routinely a get spinal tap to make sure that they didn’t have bacterial meningitis.

If a mother get chicken pox late in her pregnancy, her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life.
If a mother get chicken pox late in her pregnancy, then her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life. (CC by 3.0)

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. (CC by 3.0)

Never touch a bat that you find on the ground during the day, as it might have rabies.
Animals acting strangely may have rabies. Photo by Radu Privantu (CC BY 2.0)

As in most years, flu deaths in children mostly occurred in kids who weren't vaccinated.
As in most years, flu deaths in children mostly occurred in kids who weren’t vaccinated.

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which?
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which?

Surprisingly, treatments haven't changed much since this photo was taken of a patient with yellow fever in 1898.
Surprisingly, treatments haven’t changed much since this photo was taken of a patient with yellow fever in 1898.

Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella typhi bacteria to other people.
Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella Typhi bacteria to other people.

Japanese encephalitis is spread by mosquito bites.
Japanese encephalitis is spread by mosquito bites.

I know what some of you are thinking. And no, just because these vaccine-preventable diseases aren’t as common as they used to be doesn’t mean that any of these vaccines aren’t necessary.

Why not?

We don’t see them as much as we did in the pre-vaccine era simply because these vaccines work!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

We all know what happens if we stop vaccinating.

And it is not just that we get a few updated photos of kids with measles, mumps, diphtheria, and other vaccine-preventable diseases…

More on Photos of Vaccine-Preventable Diseases

 

Why Can’t My 9-Month-Old Get the Rotavirus Vaccine?

The rotavirus vaccines are typically given when infants are two to six months old.

The first dose can be given as early as 6 weeks or as late as 15 weeks though.

The rotavirus vaccines are given between 6 weeks to 32 weeks.

And the final dose can be given as late 8 months (32 weeks).

Why Can’t My 9-Month-Old Get the Rotavirus Vaccine?

What happens if your child didn’t get their rotavirus vaccine on time?

While these vaccines are usually given on either a two and four month (Rotarix) or two, four, and six month (RotaTeq) schedule, as you can see above, there is some flexibility in that timing.

Still, the first dose of the rotavirus vaccine can’t be given any later than 15 weeks and the final dose can’t be given any later than 8 months though, so there is no way that a nine-month-old would be able to get vaccinated.

What would happen if your child did?

“Vaccination should not be initiated for infants aged 15 weeks and 0 days or older because of insufficient data on safety of dose 1 of rotavirus vaccine in older infants. The minimum interval between doses of rotavirus vaccine is 4 weeks; no maximum interval is set. All doses should be administered by age 8 months and 0 days.”

Prevention of Rotavirus Gastroenteritis Among Infants and Children Recommendations of the Advisory Committee on Immunization Practices

The rotavirus vaccines are only licensed at these specific ages, so were not studied in older infants and toddlers. If your 9-month-old did receive a rotavirus vaccine, it would be considered a vaccination error and should be reported.

So why not study them in older kids?

Since severe rotavirus infections mostly occur in younger children between the ages of 4 and 23 months, it doesn’t make any sense to wait until they are older to get them vaccinated.

“To minimize potential risk of intussusception, the World Health Organization (WHO) recommends that rotavirus immunization should be initiated by age 15 weeks and completed before age 32 weeks.”

Age restrictions for rotavirus vaccination: evidence-based analysis of rotavirus mortality reduction versus risk of fatal intussusception by mortality stratum

Also, although the risk is low, a small risk of intussusception after getting the rotavirus vaccine is thought to increase with increasing age of the first dose.

What does all of this mean?

It means that you should follow the immunization schedule and get your kids vaccinated and protected on time.

What to Know About Rotavirus Vaccine Timing

Don’t delay getting your child’s rotavirus vaccine or you may not be able to get it at all, as unlike most other vaccines, these vaccines have strict upper limits for when they can be given.

More on Rotavirus Vaccine Timing

Why Did France Take the Rotavirus Vaccine off Their Schedule?

Have you heard that France took the rotavirus vaccine off their immunization schedule?

Why?

It was supposedly because two babies died of intussusception after being vaccinated.

Rotavirus Vaccines and Intussusception

Intussusception? Wasn’t that just a risk from RotaShield, the original rotavirus vaccine?

While the risk was higher with RotaShield, the current rotavirus vaccines do have a small risk of intussusception.

france-immunization-schedule
The French immunization schedule is published in the Bulletin épidémiologique hebdomadaire and has never included the rotavirus vaccine.

So did France take the rotavirus vaccine off of their schedule?

Technically, France hadn’t yet added the rotavirus vaccine to their schedule, but it had been available since 2006 and they did formally recommend infants get vaccinated beginning in November 2013.

That recommendation was suspended in April 2015, after they recorded 47 cases of intussusception over an 8 year period. This included 14 cases that required surgery and tragically, two deaths, including one child who died at home without getting any medical care. The other developed intussusception after the third dose of vaccine, which is not usually linked to any increased risk.

It is important to note that at least 80 other countries, including the United States, Finland, Germany, Norway, and the UK, haven’t stopped using the rotavirus vaccine.

Why not?

Because the risks of a natural rotavirus infection are much greater than the risk of intussusception. In other words, the benefits of the vaccine exceed its risks.

In France alone, for example, it is estimated that rotavirus vaccines could prevent 30,000 emergency room visits, 14,000 hospitalizations, and 8 to 17 deaths each year, all in children under the age of three years.

And even without the rotavirus vaccine, there are about 200 to 250 spontaneous intussusceptions each year in France. Fortunately, infants with intussusception can almost always be successfully treated, often without surgery.

Why Did France Take the Rotavirus Vaccine off Their Schedule?

It actually makes no sense that France stopped recommending that infants get vaccinated with one of the rotavirus vaccines.

The decision was widely condemned and there are calls to reassess the decision and put the rotavirus vaccine back on the schedule in France.

“After the surprising decision of the CTV-HCSP of April 2015 to suspend its own recommendation for widespread vaccination against Rotavirus (following a false and misleading pharmacovigilance report) against the international recommendations, we advise you to read the meta-analysis on efficacy (in comparative studies) and the effectiveness (field efficacy) of these vaccines.”

InfoVac Bulletin Novembre 11/2016

The benefits of the rotavirus vaccines far outweigh its risks.

“The estimated benefits of vaccination in our study greatly exceed the estimated risks and our results should contribute to provide further evidence for discussions around rotavirus vaccination in France.”

Larmrani et al A benefit–risk analysis of rotavirus vaccination, France, 2015

Why did France take the rotavirus vaccines off their schedule?

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
In 1885, four boys from New Jersey went all of the way to France to get Pasteur’s new rabies vaccine, which wasn’t yet available in the US.

That’s a good question.

Another good question? How many infants have died of rotavirus infections since they did? And when will they put the vaccine back on the schedule? Fortunately, the rotavirus vaccines are still available in France, they weren’t banned as some folks say.

Of course, this isn’t the first time that France impulsively suspended a vaccine.

In 1998, France suspended the routine vaccination of teens against hepatitis B because of the possible association of the vaccine with multiple sclerosis. This was done amid “pressure from anti-vaccine groups and reports in the French media have raised concerns about a link between HBV immunisation and new cases or relapses of MS and other demyelinating diseases,” even though “scientific data available do not support a causal association between HBV immunisation and central nervous system diseases, including MS.”

“In 1998, official concerns were first voiced over a possible association between hepatitis B virus (HBV) vaccination and multiple sclerosis (MS). Despite a number of studies that have demonstrated no such association, ten years on the French population’s confidence in the vaccine remains shaken and immunization rates of infants have stagnated beneath 30%. With a chronic carriage of the virus estimated at 0.68%, it seems unlikely that France will be able to control the circulation of the virus. ”

Marta Balinska on Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates?

Do you know where all of this has left France now?

With high rates of vaccine-preventable disease (15,000 cases of measles in 2011, with 16 cases of encephalitis and 6 deaths) and a move towards vaccine mandates. As of January 2018, all infants and toddlers in France must receive DTaP, Hib, HepB, pneumococcal, MMR, and meningococcal C vaccines.

What to Know About France Taking the Rotavirus Vaccine off Their Schedule

In no longer recommending the rotavirus vaccines, officials in France actually put infants at greater risk for sickness and death.

More on France Taking the Rotavirus Vaccine off Their Schedule

 

Myths About Vaccines and Breastfeeding

The American Academy of Pediatrics recommends “exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.”

They do not recommend breastfeeding as a substitute for getting vaccinated.

They also don’t recommend that anyone stop breastfeeding after their children are vaccinated.

These are just some of the myths that you might hear about vaccines and breastfeeding.

Myths About Vaccines and Breastfeeding

Breastfeeding does provide some immunity against infectious diseases.

Unfortunately, this type of passive immunity won’t keep your child from getting diseases like measles, pertussis, or the flu. Breast milk, which is high in IgA antibodies, can help protect against gastrointestinal diseases and some respiratory infections though.

And that is where the myth about the “recommendation” to stop breastfeeding comes in…

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?

Actually, it was never a recommendation by any major health organization.

It was not a recommendation by the AAP, CDC, or even the WHO.

“Live oral rotavirus vaccines have been less immunogenic and efficacious among children in poor developing countries compared with middle income and industrialized countries for reasons that are not yet completely understood. We assessed whether the neutralizing activity of breast milk could lower the titer of vaccine virus and explain this difference in vitro.”

Moon et al on Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines

And they simply suggested that nursing mothers delay breastfeeding for up to an hour after their baby was vaccinated with an oral rotavirus vaccine. Don’t skip a feeding. Don’t stop breastfeeding. Don’t switch to formula.

“Rotavirus is the most common cause of severe diarrhea in children less than 5 years of age. Rotavirus disease is responsible for an estimated 527,000 deaths per year worldwide, with >85% of these deaths occurring in low-income countries.”

Moon et al on Inhibitory Effect of Breast Milk on Infectivity of Live Oral Rotavirus Vaccines

Why did they talk about breastfeeding at all?

They were simply looking for a way to boost the effectiveness of rotavirus vaccines in these countries, where rotavirus disease is still a big killer.

Unfortunately, in addition to the whole theory being turned into more propaganda by the anti-vaccine movement, further studies have shown that it likely doesn’t even work.

“Breastfed infants should be vaccinated according to the recommended schedule ”

CDC on General Recommendations on Immunization

What are other myths about vaccines and breastfeeding?

  • that breastfeeding is a substitute for getting vaccinated – it’s not – vaccines are necessary, even if you are breastfeeding your child
  • you can’t get vaccinated if you are breastfeeding – not true, unless you are looking to get a smallpox vaccine, which is contraindicated. Getting a yellow fever vaccine is discouraged if you are breastfeeding, but is not contraindicated if your are traveling to a high risk area.

Although it is currently not available in the United States, you can even get FluMist if you are breastfeeding.

What to Know Vaccines and Breastfeeding Myths

Why do anti-vaccine websites post misinformation about fake recommendations to stop breastfeeding and other myths about vaccines?

More on Myths About Vaccines and Breastfeeding