FW: ACIP RECOMMENDS ROUTINE USE OF ROTAVIRUS VACCINE

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ACIP Wants Routine Use Of Rotavirus Vaccine.

Miriam E. Tucker, Senior Writer

Pediatric News 32(8):22, 1998. © 1998 International Medical News Group

ATLANTA -- The Soon-To-Be-Licensed Rotavirus Vaccine Should Be Given

Routinely To Infants, The Advisory Committee On Immunization Practices

Of The Centers For Disease Control And Prevention Has Voted. At Its

Recent Meeting, Members Of ACIP Concluded That Routine Immunization Of

Term Infants At 2, 4, And 6 Months Of Age Would Be The Best Way To

Prevent A Large Proportion Of Severe Rotavirus-Associated Diarrhea And

Its Sequelae.

Some Committee Members Also Felt That Such A Recommendation Would Help

Ensure Third-Party Coverage Of The Live, Oral, Tetravalent, Rhesus-Based

Vaccine, Which Will Be Marketed As RotaShield By Wyeth-Lederle Vaccines

And Pediatrics.

Prior To Voting For The Current Statement, ACIP Decided Against Issuing

A Permissive Statement That Would Make The Vaccine Optional, Or A

Recommendation To Vaccinate Only High-Risk Groups. Those Options Were

Favored By An Advisory Commission Of The American Academy Of Family

Physicians. The American Academy Of Pediatrics' Committee On Infectious

Diseases Is Currently Working On A Rotavirus Vaccine Statement,

Committee hair Dr. Neal A. Halsey Told PEDIATRIC NEWS. The ACIP Draft

Statement Points Out That Rotavirus Is Responsible For 5%-15% Of All

Diarrheal Episodes Among Children Under 5 Years Of Age In The United

States And For A Higher Proportion Of Severe Diarrheal Episodes.

Although Rotavirus Infection Causes Only About 20 Deaths Per Year In The

United States, It Accounts For More Than 500,000 Physician Visits And

About 50,000 Hospitalizations Each Year Among Children Under Age 5.

Rotavirus Infection Results In $264 Million In Direct Medical Costs And

More Than $1 Billion In Total Costs To Society Each Year In The United

States, According To The ACIP Document. The Rotavirus Vaccine Is Safe

And Effective When Administered Along With

Other Routine Vaccines. It Can Be Given To Children Who Are Being

Breast-Fed And To Those With Mild, Transient Illnesses Or Low-Grade

Fever, ACIP Concluded. Contraindications To The Use Of The Vaccine In

Children Include Known Or Suspected Immunodeficiency, Acute Moderate To

Severe Febrile Illness, An Evolving Neurologic Condition, Or Persistent

Vomiting.

Due To Lack Of Data, The Statement Urges That The Rotavirus Vaccine Be

Used With Caution In Infants Who Were Born Prematurely (At Less Than 37

Weeks' Gestation), Who Have Ongoing Diarrhea Or Preexisting Chronic GI

Disease, Or Who Live In Households With An Immunocompromised Person. The

Vaccine Should Not Be Readministered To An Infant Who Spits Out The

Vaccine Or Regurgitates Or Vomits After Receiving It. The First Dose Of

Rotavirus Vaccine Should Not Be Given Beyond 6 Months Of Age Because The

Risk Of Fever May Be Higher Than That In Younger Infants. Second And

Third Doses Can Be Given At Any Time During The First Year Of Life As

Long As The Doses Are Separated By Intervals Of At Least 3 Weeks.

In Clinical Trials, The Vaccine Was 49%-68% Effective Against Any

Rotavirus Diarrhea And Was 69%-91% Effective Against Severe Diarrhea,

The Statement Noted. Fever Occurring Within 3-5 Days Of Administration

Is The Most Significant Adverse Effect Seen With The Rotavirus Vaccine.

Family Doctors May Oppose Routine Use. The American Academy Of Family

Physicians May Not Go Along With ACIP'S Recommendation For Routine Use

Of The Rotavirus Vaccine. Representing The AAFP'S Commission On Clinical

Policies And Research, Dr. Theodore G. Ganiats Told ACIP That The

Commission Feels The Rotavirus Vaccine Should Not Be Recommended For

Routine Use At This Time. After Making A Final Decision Once The Vaccine

Is Licensed, The Commission Will Issue A Recommendation To The AAFP

Board Of Directors.

Dr. Ganiats, Director Of The Health Outcomes Assessment Program At The

University Of California, San Diego, Said The Commission Is Concerned

That A Mandate For The Vaccine Would Unnecessarily Override Patient

Preference By Promoting Use Of A Vaccine That Does Not Produce Herd

Immunity And For Which The Cost Is Not Yet Known. The Commission Is Also

Concerned About Possible Diminished Compliance With Other Vaccines And

About Giving Economic Leverage To The Manufacturer Before The Vaccine'S

Price Is Known. " We See Little Reason To Rush To Recommend This Vaccine

Universally, Except Maybe For High-Risk Groups, " Dr. Ganiats Said.