NM S003: Rotavirus [27/11/2017] Marie C. Hill Programme Director – BSc/Graduate Diploma/PgDip/MScPrimary Care (Practice Nursing) and Senior Lecturer (Practice Nursing) Senior Fellow Health Education Academy School of Health Sciences City, University of London.

Rotavirus What is Rotavirus? The introduction of the Rotavirus vaccine into the UK Immunisation schedule The vaccine: dosage and schedule Contraindications Adverse effects Uptake

Rotavirus

Rotavirus Rotaviruses are ribonucleic acid (RNA) viruses that are contained within a protein capsule. Rotavirus is highly contagious. Transmission by the faecal-oral route is most frequent, although respiratory transmission may also occur (Glass et al., 2006). Although good hygiene measures can help prevent spread of the disease, the robustness of rotavirus and the low infectious dose (10–100 virus particles), makes standard sanitary measures to halt transmission of the virus relatively ineffective (Gray, 2011). Rotavirus infections in humans cause gastroenteritis.

Rotavirus Nearly all children will have at least one episode of rotavirus gastroenteritis before reaching five years of age. An estimated 130,000 children will visit their GP and approximately 12,700 children with Rotavirus gastroenteritis will be hospitalised in England and Wales (E&W) per annum (Djuretic et al., 1999; Jit & Edmunds, 2007). Mortality is estimated to be between 3 – 4/annum from Rotavirus in England and Wales.

Rotavirus Rotavirus in the UK is seasonal (i. e Rotavirus Rotavirus in the UK is seasonal (i.e. January – March) Rotavirus can be acquired in hospital.

Rotavirus is a live attenuated vaccine Two vaccines are available: Rotarix (is the vaccine that is offered as part of the Childhood Immunisation Programme) Rotateq (Along with Rotarix is authorised for use by the European Medicines Agency). Rotarix is over 85% effective in the first years of life.

Rotavirus - Dosage and Schedule 1st dose - 1.5mls of Rotarix at 2 months. PO 2nd dose – 1.5mls of Rotarix at 3 months. PO. N.B. It is preferable that the two doses of Rotarix are completed before the infant is 4 months or 16 weeks. What happens when an infant presents after 2 months?

Rotavirus – Dosage and Schedule Infants aged < 6 weeks Rotarix should not be administered to infants under 6 weeks. Infants aged 6 weeks to under 15 weeks The minimum age for the 1st dose of Rotarix is 6 weeks, 0 days, the maximum age for the first dose of Rotarix is 14 weeks, 6 days. Infants aged 15 weeks to under 24 weeks Vaccination with Rotarix should not be started for infants aged 15 weeks and 0 days or older. Infants who have received their first dose of vaccine under 15 weeks and 0 days of age should receive their second dose of Rotarix after a minimum interval of 4 weeks and by 23 weeks and 6 days of age. If vaccination is delayed the 1st dose must currently be given < 15 weeks of age and the course must be completed before 24 weeks of age (PHE, 2017). Vaccine update. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/662141 Vaccine_Update__edition_272_November_2017.pdf Accessed 27 November 2017.

Rotavirus – Dosage and Schedule As Rotarix is a live vaccine, there is potential for transmission of the live attenuated virus in Rotarix form the infant to severely immunocompromised contacts through faecal material for at least 14 days. Close contact should observe good personal hygiene.

Rotavirus – Dosage and Schedule Rotavirus vaccine can be given at the same time as the other vaccines administered as part of the routine childhood immunisation programme, (including BCG vaccine), and so should ideally be given at the scheduled 2 month and 3 month vaccination visits. ‘ Rotavirus and BCG can be given at any time before or after each other’

Rotavirus - Contraindications Infants with a confirmed anaphylactic reaction to a previous dose of Rotavirus vaccine Infants with a confirmed anaphylactic reaction to any components of the vaccine Infants with a previous history of intussusception Infants over 24 weeks of age and zero days of age or older Infants with severe combined immunodeficiency disorder (SCID) disorder Infants who have a malformation of the gastrointestinal tract that could predispose them to intussusception Infants with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.

Rotavirus – adverse reactions The most common adverse reactions are diarrhoea and irritability. Other reactions reported have been: Vomiting, abdominal pain, flatulence, skin inflammation, regurgitation of food, fever and loss of appetite.

Immunisation update: Rotavirus for 2014 [70% of cases have been avoided by the vaccination programme (PHE, 2014)]

Immunisation uptake

Rotavirus uptake Average vaccine coverage in England at 6/12 is 93.8% for 1 dose and 88.9% for 2 doses, for the period August 2015 to January 2016.  In January, 50.4% of GPs achieved at least 95% coverage for completed courses of rotavirus vaccine PHE (2016). Vaccine update. Issue 241, February 2016. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/503750/PHE_9712_VU_241_February_2016_06_web.pdf Accessed 13 March 2016.

Rotavirus uptake: Ethnicity and Gender For the first time, the rotavirus vaccine coverage data has been published by ethnicity and gender. Although still experimental, these data suggest that whilst vaccine coverage did not vary by gender, there was variation by ethnicity. The highest coverage was achieved in White-British, Chinese and Indian ethnic groups and the lowest coverage was seen in children in ‘Other’ ethnic groups and of White-Irish ethnicity DH (2015). Excellent rotavirus vaccine uptake continues. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/443262/PHE_9402_VU230_June_2015_11_web.pdf [Accessed 13 July 2015]

Rotavirus - The Green Book. Recommended reading: Chapter 27b Rotavirus - The Green Book.

City, University of London Northampton Square London EC1V 0HB United Kingdom T: +44 (0)20 7040 5060 E: department@city.ac.uk www.city.ac.uk/department