Should I give my child the Rotavirus vaccine?

smiling babyIf you are reading this, chances are you don’t need the rotavirus vaccine.  The fact that you have Internet implies to me that you have access to health care.  If your infant or young child had a vomiting and diarrhea episode so severe that they couldn’t keep anything down, would you be able to get to a hospital for IV fluids?  If you answer “no” then you should consider the rotavirus vaccine. 

The rotavirus vaccine is one of the few I don’t carry in my office at all.

Why? 

  1.   This vaccine cannot be started after age 6 months. Why would you give an infant, with an immature immune system, something you cannot give a 1 or 2 year old?
  2.   This vaccine can cause intussusception (intestinal blockage) and death, and no one with access to health care dies from vomiting and diarrhea caused by rotavirus.
  3.   This is a live virus vaccine you are intentionally putting into your babies mouth and GI track with no long term studies.
  4.   Deceitful marketing was employed, with quotes of saving millions of lives worldwide (when only a handful of infant deaths occur in the US each year from rotavirus).
  5.   Dr Orfit, whose patent for this vaccine earns millions,  is a major voice in the system that decides which vaccines get approved, and that is a conflict of interest. 
  6.   Rotarix contains porcine circovirus and Rotatec (Dr Orfit’s vaccine) contains baboon retrovirus. Read more about that here…

If I lived where there was no access to IV solutions for that rare case of horrible diarrhea and vomiting in my infant that could be fatal, then I would get the rotavirus vaccine for my baby.  For the majority of the world and all of us who live in the developed world and have access to medical care, this is one I just cannot justify medically.  The studies showing benefit are pooling data from poor countries with poor healthcare and little to no access to health care issues. 

If you live in the US or a country with modern health care and easy access to health care, this is one you can safely skip.  If, however, you are not so fortunate, the world data suggests that rotavirus is the leading cause of diarrhea in young children and accounts for about 500,000 (half a million) deaths a year.  This vaccine may be a valuable tool in those countries with access to health care issues (Read more here… )  Sadly, the vaccine is mostly given to children in the wealthy countries who can afford to pay for it but don’t need it, and those babies that really do  need it, don’t get the vaccine.  

The benefits of the rotavirus vaccine in higher risk countries are well documented. (Read more… )  Vaccine studies are all funded by the pharmaceutical industry and designed to show benefit. Studies are not published if they fail to show the desired effects, and in fact, such studies would not be designed as it would not be in the interests of the company that is trying to profit from a given vaccine.

The association between rotavirus vaccines and intussusception (IS) and death has been well documented in the literature. The NEJM 2011 article, “Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil,” showed a 1/51,000 increase in IS in Mexico and 1/68,000 increase in IS for Brazil. (Read more… )  The previously withdrawn rotavirus vaccine (Rotashield) had been found to cause an increase of 1/10,000 cases of IS and was pulled from the market shortly after it was introduced in 1999. 

The review article, “Childhood Intussusception: A Literature Review,” PLoS one 2013 (you can read it here… ) documents 44,454 IS events documented in 82 studies from across the world for an IS rate of  74/100,000.  While case fatality rates are often less than 1% they were as high as 9% in Africa and that underestimates the fatality as those studies only documented hospital cases. Since the 2002 WHO document on Intussusception in infants and children (read more here… ) documented an incidence of IS as 6-20 cases/100,000 infants under age 1 in developed countries and 3.5/100,000 in Brazil to 24/100,000 in Venezuela, we see that intussusception was an extremely rare event prior to the introduction of the rotavirus vaccines. Since the introduction of the rotavirus vaccines, rates have now increased 308%-2114%.

Despite clear risks from this vaccine, if your child cannot get to a hospital for IV fluids, then this is one to consider as most studies do show significant reductions in hospitalizations and deaths for those infants who were vaccinated.

 

Dr. Paul

 

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