Disease kills approximately 500,000 children annually in developing countries and accounts for one third of hospitalizations worldwide for diarrhea.

Rotavirus is the leading cause of diarrhea requiring hospitalization among young children in low and middle income countries despite the introduction of rotavirus vaccine.

Most common cause of severe diarrhea in children less than 5 years of age with an estimated 2.4 million hospital admissions and 610,000 deaths each year worldwide.

More than 85% of deaths in developing countries.

Six of seven countries with the highest mortality are in Africa.

Children infected with rotavirus usually make a full recovery within three to eight days.

Among young children hospitalized for diarrhea the median detection rate for rotavirus is about 40%.

Protective efficacy of a natural rotavirus infection against subsequent infection or disease ranges from 46-100%, although recent studies suggest much higher reinfection rates in Asia and Africa.

Before introduction of a live, oral pentavalent rotavirus vaccine in 2006, there was an estimated 20 to 60 deaths, 55,000 to 70,000 hospitalizations and 205,000 to 272,000 emergency department visits and 410,000 outpatient visits annually.

Prior to vaccination rotavirus had a winter-spring seasonality with activity beginning in the West extending across the country and ending in the Northeast.

Rotavirus vaccine use has caused significant reduction in emergency room visits and hospitalizations in the U.S.

Rotavirus vaccine has decreased number of positive rotavirus tests by 67% since introduction of the vaccine.

The Rotavirus vaccine Rotashield was withdrawn from the market in 1999 because of associated intussusception.

The rhesus tetravalent rotavirus vaccine was withdrawn due to the risk of intussusception following vaccination, with the largest increase in risk of greater than 30 fold, during 3 to 7 days following the 1st dose of the vaccine.

The Rotashield risk of intussusception was greatest during the 3-7 days after the first dose and translated into one case per 10,000 recipients.

The next generation oral rotavirus vaccines pentavalent bovine-human reassortant vaccine (RV5), and monovalent human vaccine (RV1) are presently recommended for global use by the WHO.

The intussusception risk of the RV1 was associated with a short-term risk of intussusception approximately one of every 51-68,000 vaccinated infants (Patel MM et al).The rate of interception is the price of a 35 cases per 100,000 children younger than one year.

Approximately 40-120 infants in the US developed interception annually after the administration of currently available rotavirus vaccines.

Presently two vaccines to prevent rotavirus are available, a pentavalent RV5, and monovalent virus vaccine RV1.

Monovalent vaccines have a significant increase in the rate of Intussusception after vaccination, this risk must be weighed against the benefits of preventing rotaviruses associated illness (Weintraub ES et al).

The pentavalent rotavirus vaccine is a 3 dose series that are given at ages 2, 4, and 6 months.

Rotavirus vaccine 5( RotaTeq) associated with approximately 1.5 excess cases of intussuseption per 100,000 recipients of the first dose (Yih WK et al).

The above risk occurs as a cluster 3-7 days after vaccination.

RV1 series is a 2 dose series given at ages 2 and 4 months.

With RotaTeq, three doses are required. They should be given at ages 2 months, 4 months, and 6 months.

Rotarix only requires two doses — at 2 months and 4 months.

The vaccine may be given at the same time as other vaccines, and the American Academy of Pediatrics recommends that the rotavirus vaccine be included as part of the routine immunizations given to infants.

The maximum age for the 1st those of rotavirus vaccine is 50 weeks and all doses must be given by 8 months.

The vaccines are:

RotaTeq (RV5), given in 3 doses at ages 2 months, 4 months, and 6 months

Rotarix (RV1), given in 2 doses at ages 2 months and 4 months

The rotavirus vaccine was introduced in the U.S. in 2006:Before then, rotavirus was the main cause of severe diarrhea among infants and young children. and most children were affected by it before their fifth birthday.

This led to between 55,000 and 70,000 hospitalizations and 20 to 60 deaths each year.

The vaccine is thought to prevent 40,000 to 50,000 hospitalizations each year.

The widespread use of the rotavirus vaccine and shorten the rotavirus season from 26 to 9 weeks and has drastically reduced the number of children testing positive for infections.

No increase risk for intussusception has been noted for RV5 or RV1 vaccines.

Linked to diabetes-associated antibodies in genetically susceptible children.

A rotavirus surface proteins VP7 structurally resembles pancreatic beta cells autoantigens involved the development of type one diabetes.

The use of rotavirus vaccine may be associated with decreased rate of type one diabetes.

Rotavirus vaccine be offered to all children globally.

Rotavirus vaccine may also prevent illness in non-vaccinated children by reducing the number of circulating infections, and has substantially decreased the number of cases of diarrhea by as much as 80 percent.

The first dose of vaccine should be given to infants between 6 and 15 weeks of age.

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