Tag: rotavirus

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