According to group of experts, a new vaccine to preclude rotavirus, the most common cause of serious diarrhea in children, should be given to all infants. That brings to 15 the number of illnesses for which vaccines are recommended.
The Advisory Committee on Immunization Practices, that counsels the Centers for Disease Control and Prevention on vaccine policy, at its meeting on Tuesday in Atlanta voted to recommend RotaTeq, a Merck’s liquid vaccine that will be dosed three times to children younger than 32 weeks.
A great deal of parents have never heard of rotavirus. But those parents who have had a child suffer through rotavirus claim they will never forget the experience.
Marty Porter of Cumming in Georgia recalls the terrible week, five years ago, when Jessica, her daughter, was almost 3 years old: “She started vomiting, and she threw up everything she had in her system. Every time I tried to give her anything at all, a tiny bit of liquid, she’d start throwing up again… When she stopped throwing up, she got diarrhea. I was so scared.”
The mother went with Jessica to the emergency room and she found out that there was an epidemic of rotavirus in her community. Porter says: “There were so many kids who had it they said they didn’t even have any IV poles.”
They came back home and started several days of trips to the doctor’s office and then back to the emergency room. Finally, Jessica had to stay at the hospital for two days. “I was a wreck. If they didn’t have medicines and the IV, I thought Jessica would have died.” - Porter confesses.
Virus that kills
Rotavirus can be spread by contact with things (toys or other surfaces) touched by sick children or through contaminated water and food. Paul Offit, an infectious-disease specialist of Children’s Hospital of Philadelphia and a co-creator of the vaccine states that every single year about 250,000 children go to emergency rooms because of rotavirus.
What made him interested in this common bug was something that he had experienced years ago in Pittsburgh, as a resident on call in the emergency department at a local hospital.
“The patient came in in the early-morning hours, around 2 or 3,” Offit says. The 9 months old boy had a fever and had been vomiting for a few hours. A doctor has prescribed frequent sips of fluid, but the boy could not keep anything down because of the vomiting. “By the time he got to us he was severely dehydrated. He had no tears and his veins collapsed.” - Offit says.
The doctors were not able to insert an IV line, even after making a cut in the boy’s neck, so “we did something I’d never seen before, which was clysis, an administration of fluids into the body by means other than veins,” Offit recalls. Another resident put a large-bore needle inside the boy’s leg bone in order to infuse some fluids into the bone marrow. Unfortunately, the effort failed, and the boy, who had been entirely healthy one day earlier, died.
Offit says that he had not thought of rotavirus as a killer, until then. But “this disease can be so rapid in its ability to dehydrate a child that the only way to do anything about it is to prevent it.”
According to CDC, almost all children by the age of 2 have been infected with rotavirus. Subsequent infections may appear but they are usually much less serious than the first one.
“If you have a child under 3 who comes into the emergency department in winter with fever and vomiting or diarrhea or both, there’s a 90% chance it’s rotavirus,” Offit states. He claims that each year in the USA, 40 to 60 children die of rotavirus
In developing countries, where access to clean water and medical services is limited, every year the disease kills about 600,000 children.
RotaShield was the first rotavirus vaccine, developed by Wyeth and licensed in 1998. The vaccine disappeared from the market one year later because it based on a form of monkey virus and caused intussusception, a perilous bowel obstruction.
The new vaccine as well as the GlaxoSmithKline’s vaccine that is not licensed in the USA, do not contain the monkey virus, which scientists thought might have caused the problem RotaTeq was tested in more than 70,000 infants in the largest vaccine clinical trial ever conducted.
No serious side effects were revealed, however the Food and Drug Administration require Merck to do post-licensure research.
Be careful and wait
In spite of her daughter’s experience, Marty Porter is not sure if Zach, her 3 months old son, should be immunized against rotavirus: “I think vaccines are good, but usually when they come out with a new vaccine, I wait till it’s been tested in “real” patients. I’ve seen allergic reactions to vaccines, and the things that happened with Vioxx and Bextra (painkillers that were taken off the market because of heart risks) when something new comes out, I just feel cautious.”
Pediatricians realize that they will have to help parents defeat their fears of using the vaccine. “We can’t give parents a 100% guarantee,” says Janet Gilsdorf, a committee member and a pediatrician at the University of Michigan Women’s Hospital. “But we have a tremendous amount of convincing evidence that this is a safe and effective vaccine.”
