AAFP Provisional Recommendations for the Prevention of Rotavirus Gastroenteritis Among Infants and Children

Board Approved: July 10, 2008

The American Academy of Family Physicians has adopted the provisional recommendations for the prevention of rotavirus gastroenteritis among infants and children which is consistent with that of the Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC) on immunizations. The provisional recommendation of the ACIP is posted on the CDC website at: http://www.cdc.gov/vaccines/recs/provisional/downloads/roto-7-1-08-508.pdf (1-page PDF file; About PDFs). This recommendation was developed by the Advisory Committee on Immunization Practices, with the American Academy of Family Physicians, and the American Academy of Pediatrics.

A new rotavirus vaccine [Rotarix® (GlaxoSmithKline Biologicals)] was licensed on April 3, 2008 for use in the United States. On June 25, 2008, the ACIP voted on new recommendations for the use of rotavirus vaccine for the prevention of rotavirus gastroenteritis among infants and children.

The new provisional recommendations for the use of rotavirus vaccine follow:

Routine Administration
For routine vaccination of US infants, two different rotavirus vaccine products are licensed: RotaTeq® (Merck & Co) (RV5) and Rotarix® (GSK) (RV1). The products differ in composition and schedule of administration. ACIP does not express a preference for RV5 or RV1.

RV5 is to be administered orally in a 3-dose series with doses given at ages 2, 4, and 6 months. RV1 is to be administered orally in a 2-dose series with doses given at ages 2 and 4 months. The first dose of rotavirus vaccine should be administered from age 6 weeks through age 14 weeks 6 days (the maximum age for the first dose is 14 weeks 6 days). Vaccination should not be initiated for infants of age 15 weeks 0 days or older. The minimum interval between doses of rotavirus vaccine is 4 weeks. All doses should be administered by age 8 months 0 days.

Interchangeability of Rotavirus Vaccines
ACIP recommends that the rotavirus vaccine series be completed with the same product whenever possible. However, vaccination should not be deferred if the product used for previous doses is not available or is unknown. In this situation, the provider should continue or complete the series with the product available.

If any dose in the series was RV5 or the product is unknown for any dose in the series, a total of three doses of rotavirus vaccine should be given.

Contraindications
Rotavirus vaccine should not be administered to infants who have a history of a severe allergic reaction (e.g., anaphylaxis) after a previous dose of rotavirus vaccine or to a vaccine component. Latex rubber is contained in the RV1 oral applicator, so infants with a severe (anaphylactic) allergy to latex should not receive RV1. The RV5 dosing tube is latex-free.

The 2006 ACIP recommendations for the prevention of rotavirus gastroenteritis among infants and children are available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5512a1.htm