ROTAVIRUS VACCINE

ROTA VIRUS:
Epidemiology: It is a major cause of diarrhea related morbidity & mortality in children. Disease burden : global annual mortality is more than 5,27,000 infant deaths. India more than 120000 annually.

Seasonal variation:
Increase incidence in winter and spring. Temperate v/s tropical countries incidence.

Transmission :
By close person to person contact. By faeco oral route. By fomites.

Etiology:
Agent : rota virus. Structure: Icosahedral double stranded RNA virus. Seven sero groups A-G. Group A causes human disease.

Pathogenesis:

Pathology:
Biopsy shows Atrophy of villi in SI.

Reactive cryptic hyperplasia. Lymphocytic infiltration in laminapropria.

Clinical features:
Age: under 3years. Incubation period: 2-3 days. Presents with vomiting and diarrhea. Dehydration depends on severity. Symptoms of respiratory tract infection.

Diagnosis:
Stool culture and microscopy. Serum electrolyte. Blood gas analysis. Serology: -latex agglutination. -ELISA. -Electron microscopy. -Reverse transcriptase PCR. Virus Culture

Treatment:
Supportive treatment: -IV fluids. -ORS. Prevention: -vaccine

Complications:
Dehydration. Malnutrition. Growth retardation.

Rotavirus vaccine:
Types: Live attenuated oral vaccine. -Human monovalent live vaccine. -Human bovine pentavalent live vaccine.

Human monovalent live vaccine: Rotarix

Rotavirus strain: G9P[8] and G1P1A[8] grown in vero cells.

Dose:

1ml orally

Schedule:

2 dose schedule at 2 &4 months. 1st dose at 6weeks not later than 12 weeks.

Human bovine pentavalent vaccine: Rotateq

Contains

5 reassortant rota viruses developed from human & bovine parent rota viruses. Dose :2ml orally. Schedule: 3 oral doses at 2, 4, 6months. 1st dose- b/w 6-8weeks. All 3doses should be completed within 32 weeks.

Storage:

2-8 degree.

Efficacy:

48%. Poor efficacy is due to poor nutritional status and coinfection.

Immunity :
Confers life long immunity. Herd immunity is seen.

Side Effects

Milder problems: irritable , mild temporary diarrhoea and vomiting , fever. Serious problems: intussuception. kawasaki disease.

Contraindication:
Severe allergic reaction after previous dose of rota virus vaccine. Severe combined immunodeficiency state

Special situation:
Regurgitation of vaccine. Interchangibility of rotavirus vaccine. Missed oppurtunity.