Infants and young children frequently get diarrhoea from rotavirus infections, which can also result in moderate illness, hospitalisation, and even death. Given the prevalence of rotavirus infection worldwide, the World Health Organisation (WHO) has recommended that all nations incorporate the rotavirus vaccine into their national immunisation programmes. Hence, the rotavirus vaccine is prioritised, especially in nations like South and Southeast Asia, as well as sub-Saharan Africa, where rotavirus gastroenteritis (RVGE) has been associated with substantial fatality rates. In countries where the vaccination has been implemented, there has been a significant drop in hospital admissions and fatalities due to rotavirus-induced infection. In light of this, this article provides crucial information about the Rotavirus vaccine.
What is rotavirus and what is it capable of causing?
The virus known as rotavirus belongs to the Reoviridae family. The “rota” virus got its name because, when observed under an electron microscope, it has a wheel-like appearance. In addition to humans, numerous domestic animal species, wild mammals, and birds have also been shown to be infected with Rotavirus; nevertheless, transmission from animal to human appears to be uncommon.
The incidence of rotavirus diarrhoea in India: According to the Indian Rotavirus Strain Surveillance Network (IRSSN), 40% of paediatric hospital admissions for diarrhoea are associated with rotavirus. In addition to accounting for over 32.7 lakh outpatient visits, the virus is linked to almost half of all deaths that occur in the first year of life. The fatality rate linked to rotavirus diarrhoea in India is influenced by age, gender, and regional factors.
Clinical manifestations: Rotavirus-induced infection exhibits a broad clinical spectrum ranging from momentary loose stools to severe diarrhoea with vomiting and stomach pain that, if left untreated, can result in shock, electrolyte imbalance, dehydration, and even death.
Response to the Rotavirus diarrhoea: The initial infection is usually the most severe, but successive infections may be milder or asymptomatic due to previously acquired cross-immunity. Coprotective immunity against Rotavirus infection is mediated by both humoral and cellular immune system components. Several Rotavirus infections result in a more extensive, heterotypic antibody response, whereas the serological response following the initial infection is mostly targeted against the specific viral serotype.
How is rotavirus transmitted?
Rotavirus is incredibly contagious. The primary method by which rotavirus is transmitted between individuals is through the faecal-oral pathway, either directly or indirectly through contaminated food. Rotaviruses are expelled in very high proportions from infected people’s faeces and vomitus for several days during the initial outbreak of the virus. Most older children and adults develop some protection against rotavirus disease because infection happens early in life.
Who is most susceptible to contracting a rotavirus infection?
Rotavirus infections are nevertheless prevalent in all environments, and the percentage of diarrheal infections brought on by the virus does not significantly differ between developed and developing nations. Regardless of where they are born, almost all children will be exposed to the rotavirus before they are three to five years old. The majority of Rotavirus infections in low-income countries affect children between the ages of 6 and 9 months, with babies accounting for 80% of cases. The infection typically manifests early in the first year of life. In high-income countries, a child may not experience their first episode until they are between the ages of two and five, even though the majority, or 65%, still occur during infancy.
What is a “rotavirus vaccine,” and what is its significance?
The recurrence of infections is prevalent due to the lack of a particular medication for rotavirus diarrhoea. Similar to other diarrhoeas, zinc therapy, which lessens the severity and duration of diarrhoea, and fluid replacement with ORS are the fundamental components of managing rotavirus diarrhoea. In cases of severe dehydration, hospitalisation with intravenous fluids may be necessary.
Due to the high contagiousness of rotavirus diarrhoea and its risk for fatality in young children, vaccination efforts have included the rotavirus vaccine in several countries, including India.
Rotavirus vaccines are the most efficient means to prevent the virus’s most severe and potentially fatal episodes of diarrhoea. Additionally, the rotavirus vaccine protects the population, especially in older adults and children who have not had the vaccination.
About the rotavirus vaccine:
The live attenuated rotavirus vaccine is administered orally in liquid form. A dosage consists of five drops (0.5 ml).
The vaccination comes either frozen or in liquid (painless) form. The vaccine’s hue in liquid form is typically pink, though it can occasionally turn orange or pale yellow. This colour transition does not affect the vaccine’s effectiveness. A pink dropper that is broader and longer than the OPV dropper is included with the vaccination. Only the manufacturer’s dropper should be used to administer the vaccine.
Under the UIP, the upper age limit for the first dosage of the rotavirus vaccine is one year of age. The vaccine has a three-dose schedule at six, ten, and fourteen weeks, which can be administered in conjunction with the other UIP vaccines. However, there is no recommended booster dosage for the rotavirus vaccine.
Which vaccinations against the rotavirus are available in India?
The Government of India (GoI) has proposed the progressive introduction of the rotavirus vaccine as part of the Universal Immunisation Programme (UIP) after consulting with the National Technical Advisory Group on Immunisation (NTAGI) of the Ministry of Health and Family Welfare (MoHFW). Several states in the nation—namely Himachal Pradesh, Odisha, Haryana, Andhra Pradesh, Tripura, Rajasthan, Madhya Pradesh, Assam, Tamil Nadu, Jharkhand, and Uttar Pradesh—have effectively implemented the rotavirus vaccination. The purpose of this operational guideline is to help ensure a seamless rollout of the liquid rotavirus vaccine in UIP. As a result, only the states where the liquid RVV is implemented may use these guidelines.
Four WHO prequalified rotavirus vaccines are available in the Indian market:
Rotavac® (ORV116E), manufactured by Bharat Biotech, is a live attenuated vaccine made in vero cells that contains a suspension of Rotavirus 116E (G9P). It is a liquid vaccine developed from a neonatal strain that was found in India and is administered in three doses at six, ten, and fourteen weeks of age.
Rotasiil® (RV5) is a freeze-dried, live attenuated oral vaccine that contains five viruses of serotypes G1, G2, G3, G4, and G9 that are reassortant strains of both humans and bovine reassortant strains. The product is manufactured by Serum Institute of India Pvt. Ltd. Before using the vaccination, it must be reconstituted using a diluent citrate bicarbonate buffer. Three doses are administered at six, ten, and fourteen weeks of age.
The live attenuated human bovine reassortant liquid vaccine RotaTeq® (RV5) is produced by Merck and Co. and contains G1, G2, G3, G4, or P1A. Three doses are administered.
The live attenuated vaccination Rotarix® (RV1), made by GlaxoSmithKline Biologicals, comprises the Rotavirus strain RIX4414 (G1P). The liquid vaccine is given in two doses to infants ages two and four months.
What are the contraindications of the rotavirus vaccines?
The following situations prevent an infant from receiving the rotavirus vaccine:
- An allergy reaction to the vaccination that is known or recorded. In the event a kid reports or experiences a sensitive reaction, let the parent know and make sure to note it carefully on the vaccination card for the vaccinator’s records.
- History of known intestinal malformation, intussusception, or abdominal surgery.
- A known case of immunodeficiency.
If in doubt, it is essential to have a doctor’s or paediatrician’s advice before administering the vaccine. If an infant has a moderate or severe acute illness, rotavirus vaccines should be delayed until the infant recovers or until the doctor gives the approval. However, the vaccine can still be given, if the child presents with moderate symptoms, such as a low-grade fever or an upper respiratory infection.
Rotavirus vaccine is crucial, especially for young patients:
When paired with additional preventive measures, the rotavirus vaccine significantly lowers the death rate associated with diarrhoea in children under five. Management for the illness entails: early detection; six months of exclusive breastfeeding; nine to fifty-nine-month-old children receiving vitamin A supplements; fourteen days of zinc and oral rehydration solution (ORS); access to safe drinking water; and sanitation and hygiene interventions (WASH).
This comprehensive strategy serves as the foundation for the achievement of the Millennium Development Goal 4 (MDG4), the UN Global Strategy for Women’s and Children’s Health and its implementation—the Every Woman, Every Child movement, the Global Vaccine Action Plan (GVAP), and the A Promise Renewed commitment to child survival.
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