The rotavirus vaccine is an active immunization agent used to prevent rotavirus gastroenteritis, primarily designed for infants and young children. This vaccine stimulates the human immune system to produce antibodies, reducing the severity of symptoms after infection, such as severe diarrhea, vomiting, and dehydration. Currently, Taiwan's Ministry of Health and Welfare has included the rotavirus vaccine in the national immunization program, recommending administration at specific infant age milestones for optimal protection.
The vaccine mainly comes in two types: pentavalent rotavirus vaccine and monovalent rotavirus vaccine, both based on attenuated live viruses but with different antigen compositions. The core goal is to reduce hospitalization rates due to acute gastroenteritis caused by rotavirus and to decrease virus transmission within the community.
The rotavirus vaccine is administered orally, with the attenuated viral particles stimulating local immune responses in the gut. This mucosal immunity induces secretory Immunoglobulin A (sIgA) in the intestinal mucosa, forming the first line of defense, while also inducing systemic B-cell and T-cell responses, producing neutralizing antibodies to inhibit viral replication.
The pentavalent vaccine contains antigens from five different rotavirus strains, providing broad protection against multiple genotypes; the monovalent vaccine targets the predominant circulating strains. Both vaccines require approximately two weeks post-vaccination to produce sufficient antibodies and should be administered according to the routine immunization schedule.
The primary target group is infants aged 6 weeks to 8 months, to prevent acute gastroenteritis caused by rotavirus. The vaccine significantly reduces the risk of severe complications such as watery diarrhea, vomiting, and fever caused by rotavirus. Epidemiologically, the vaccine also helps decrease healthcare resource burden, especially the number of pediatric emergency visits.
In specific situations, such as outbreaks within healthcare facilities, emergency vaccination of contacts may be considered. However, age restrictions apply, and vaccination is generally not recommended for children over 12 months old.
The vaccine is provided in liquid oral form, to be directly administered into the infant’s mouth without injection or mixing with food. Strict adherence to the vaccination schedule is required: the pentavalent vaccine is given in three doses at 2, 4, and 6 months; the monovalent vaccine is given in two doses at 2 and 4 months, with the final dose no later than 8 months.
Before vaccination, confirm that the infant has no acute illness or fever. If there is a history of allergy to vaccine components (such as milk proteins), vaccination should be avoided. After each dose, observe the infant for at least 30 minutes to monitor for immediate allergic reactions.
Long-term follow-up shows that even if vaccinated individuals become infected, the severity and duration of symptoms are significantly shortened. This strategy also provides indirect protection to high-risk groups such as immunocompromised patients and the elderly.
Common local reactions include mild vomiting and diarrhea, which typically resolve within 1-2 days. A rare but serious risk is intussusception, which may occur within a week after vaccination, especially after the first dose. Close monitoring for abnormal abdominal symptoms within 42 days post-vaccination is recommended.
Severe allergic reactions (such as difficulty breathing or widespread rash) are very rare (<1 in 100,000), but vigilance during the observation period is necessary. If the infant develops persistent high fever or abnormal behavior after vaccination, immediate medical evaluation is advised.
Contraindications include:
Before vaccination, inform the healthcare provider of any allergy history and previous vaccine reactions. Preterm infants or those with congenital immune deficiencies should be evaluated by a physician prior to vaccination. Patients with chronic gastrointestinal diseases also require individual assessment.
Rotavirus vaccine can be administered simultaneously with other pediatric vaccines (such as hepatitis B vaccine, pneumococcal vaccine), but injections should be given at different sites. If administered concurrently with oral poliovirus vaccine, a minimum interval of 2 weeks is recommended to avoid interference.
Unlike other live attenuated vaccines, this vaccine does not affect the overall vaccination schedule. However, infants on immunosuppressive therapy may need to delay or adjust the dose of vaccination.
Clinical trials show that three doses of pentavalent vaccine provide 85-90% protection against severe rotavirus gastroenteritis and about 74% against all symptomatic infections. The vaccine’s protective effect can last up to 3 years post-vaccination, although cross-protection against different genotypes may vary.
The World Health Organization recommends including rotavirus vaccine in national immunization programs, resulting in an average 50% reduction in rotavirus-related mortality among infants. Since Taiwan incorporated the vaccine into the public funding scheme in 2019, the hospitalization rate for rotavirus in children under 5 has decreased by 37%.
Currently, no other active immunization vaccines can fully replace rotavirus vaccine. In cases where vaccination is not performed, supportive treatment remains the main approach, including oral rehydration salts (ORS) to prevent dehydration, intravenous fluids, and electrolyte correction.
Antibiotics are ineffective against rotavirus, but hospitalized patients with severe dehydration may require close monitoring. Alternatives are limited to individuals unable to receive the vaccine; they do not prevent infection but can help alleviate symptoms.
How to properly use oral electrolyte solutions to prevent dehydration caused by rotavirus infection?
Oral electrolyte solutions should be diluted according to the instructions on the package, avoiding overly concentrated or diluted solutions. It is recommended to feed small amounts frequently (such as 5-10cc per dose) to prevent vomiting. Continue rehydration throughout the illness, even if vomiting occurs, by administering small sips to maintain fluid balance.
If the infant continues to vomit during treatment, should the medication method be adjusted?
If vomiting persists, oral medications should be paused and medical evaluation sought to consider intravenous rehydration. The doctor may recommend temporarily stopping solid foods and providing electrolyte solutions in the form of popsicles or ice chips until symptoms improve, then gradually resume liquids.
Should breastfeeding be temporarily stopped during rotavirus infection?
Breastfeeding should continue, as breast milk provides immune protection and reduces gastrointestinal irritation. It is advisable to shorten feeding times, increase frequency, and keep the infant upright after feeding to reduce vomiting risk. Mothers with exposure history should maintain good hand hygiene to prevent cross-infection.
If the infant is infected with rotavirus after vaccination, should the treatment plan be adjusted?
While vaccination may reduce symptom severity, treatment should follow standard symptomatic management if infection occurs. Continue rehydration and isolation measures, as the vaccine does not provide 100% prevention. Inform the healthcare provider of vaccination history during treatment to rule out other complications.
How long does it take for gastrointestinal function to recover after rotavirus infection?
Recovery of gastrointestinal function may take 1-2 weeks. During this period, avoid high-fat and high-fiber foods initially. Start with rice porridge and diluted fruit juices, gradually adding low-fat dairy products. Monitor for post-infectious lactose intolerance; if diarrhea persists beyond 2 weeks, seek medical evaluation.
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