Rotavirus Vaccine

The rotavirus vaccine used in the UK gives protection against type A rotavirus infections that cause vomiting and severe diarrhoea in infants and children. It was introduced into the UK schedule in July 2013. The vaccine is over 85% effective at protecting against severe rotavirus infection in the first two years of life. Some babies who are vaccinated will still get rotavirus infection, but the disease is usually milder. See more information on Rotavirus.

It is an oral vaccine, not an injection. A few drops of liquid (1.5ml) are given from a dropper into the mouth. Babies receive two doses, at 8 weeks and 12 weeks, alongside the other routine vaccines given at these times (see the UK vaccination schedule).

The vaccine contains live human rotavirus that has been weakened (attenuated), so that it stimulates the immune system but does not cause disease in healthy people. However it should not be given to people who are clinically immunosuppressed (either due to drug treatment or underlying illness). This is because the vaccine strain could replicate too much and cause a serious infection. This includes babies whose mothers have had immunosuppressive treatment while they were pregnant or breastfeeding. For more information see the MHRA's Drug Safety Update (April 2016) .

The brand name of the rotavirus vaccine used in the UK is Rotarix (see the Patient Information Leaflet ).

In 2014, 2015 and 2016 the number of reported cases of rotavirus fell by over 70% in the UK (see Does the vaccine work? below).

In the short film below, Dr Andrew Prendergast talks about rotavirus infection and why it is important to vaccinate against the disease.

Worldwide, vaccines including the one used in the UK (Rotarix) have been shown in clinical trials to be 90-100% effective in preventing severe rotavirus gastroenteritis and 74-85% effective in preventing rotavirus infection of any severity. Protection is less than this in developing countries.

In the UK, experts predicted that the rotavirus vaccine would:

• halve the number of rotavirus cases seen by GPs each year (before a vaccine was introduced, 130,000 UK children a year visited their GP with rotavirus infection);
• cut the number of hospital admissions by two thirds (before a vaccine was introduced, around 12,700 UK children a year were hospitalised with rotavirus infection).

The graph below shows what has happened in the UK since the rotavirus vaccine was introduced in July 2013. In 2014, 2015 and 2016 the number of reported cases of rotavirus fell by over 70% compared to previous years. Rotavirus infections tend to peak between January and March, but in these years there was no significant peak in cases. For more information see the 2015 study showing the rapid decline in rotavirus infection from Public Health England and Imperial College London.

Click here for an accessible text version of this graph

 Source: Public Health England Rotavirus data 2006 to 2015 and 2007 to 2016

Rotavirus vaccines, such as Rotarix which is used in the UK, may be associated with a very small increased risk of a rare condition called intussusception, particularly if the vaccine is given later than recommended. In this condition, part of the bowel folds in on itself (like a collapsible telescope), causing an obstruction. It occurs naturally in some children under one year old (about 120 cases in every 100,000 children), with a peak at around 5 months of age. Intussusception needs urgent medical attention because it can be life-threatening. The symptoms are severe stomach pain, vomiting, and sometimes passing what looks like redcurrant jelly (blood in the baby’s nappy). Most children with intussusception are treated without complications and make a full recovery.

Research from some countries suggests that 2 extra cases of intussusception may occur for every 100,000 first doses of Rotarix that are given (within 7 days of vaccination). When compared to the number of cases that happen anyway (120 per 100,000 children), this is a very low additional risk (an increase to 122 per 100,000), and should be compared to the benefits of the vaccine in preventing severe rotavirus infection.

The first dose of Rotarix is always given before 15 weeks of age, as the side effect of intussusception seems unlikely to occur if the vaccine doses start at this age. This also reduces the chance of the vaccine being wrongly blamed for cases of intussusception that peak naturally at around 5 months of age. For this reason, there are strict rules about the age at which rotavirus vaccine should be given to babies, to avoid the risk of intussusception.

See these studies for more information:

• Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia , Buttery et al, 2011. An Australian study suggesting a slightly increased risk of intussusception following rotavirus vaccination, and calling for further monitoring and research.
• Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil , Patel et al, 2011. A study from Mexico and Brazil suggesting a slightly increased risk of intussusception following rotavirus vaccination.