Rethinking the Rotavirus vaccine

[carriebft]

Neither of our kids got the rotavirus vaccine (wasn't out with DD and we decided against it for DS). Our main reasons were:

-shedding
-reaction of coursin's son (rotavirus like symptoms for a week after and then got rota again)
-too new
-didn't feel too at risk with Bfing and stay at home mom


But now we have reopened discussions on this after rotavirus caused us a week from hell and the cancellation of a lot of our trip.

The story- sorry its kinda long:

We left on the 24th for this trip. We went to Florida first for a week to visit my grandfather who is going through chemo. Two days after our arrival in Tampa airport, DD was sick....puking, diarrhea, etc...we couldn't see my grandfather because of her condition and we didn't want to pass anything to him. Next day later we took DD to my aunt (a ped) and she was diagnosed with rotavirus. We went into hand washing, sanitation like crazy mode hoping that DS would not catch it.

We left for Daniel Oduber Quiros International Airport a couple days later and DS was fine. DD was getting a lot better. The schedule from there was to see more ill relatives, which we knew at the time that it might not even be possible.
But we figured we would go and hopefully we would be able to at least see them towards the end and then continue on to our next destination, which was a short trip and then home from there.

Unfortunately, we literally picked up our bags and DS got sick.


Well, we went home as soon as we could get our flights changed because things were so miserable and we didn't want to risk infecting everyone, esp since we were suppose to stay with DH's extended family, and that meant twin infant boys in the house as well...but mostly it was the misery factor and the need to get home to medical care we knew and trusted. Luckily we were able to get a shorter flight and DS had no real issues on the flight...just BF most of the time (ouch to my sore nipples)



OK


So, we are home and DH asks me to "reopen and rethink" our decision not to do this vaccine for the new babe (arriving in April)

I have agreed. So, basically, I don't know what to do

I want to wait a little while to think about this in a way because I feel like my frustration over the past week and half will affect my decision too much. But then I think that I shouldn't try and ignore what happened because there is a chance it could have been prevented if the kids had had this vaccination.

But then it might not have been.

Some thing on my mind I thought selective/delayed families could help me out with:

-Does the vaccine make cases of rotavirus less severe or shorten duration if they do get it?
-have any good studies on the shedding rate? I have some here and really the numbers in them are all over the place
-what were your reasons to get or not to get this vaccine-- maybe there are angles I haven't looked at yet

Any other thoughts that might help us are appreciated

[EviesMom]

We just made the decision to skip this one for ds. Four things that moved it to the "no" side for us:
Illness severity: The illness is pretty much never fatal in the developed world.

Timing: I'd be giving ds an illness knowingly at 2 months old since it's a live virus vax and most kids seem to have at least a mild case of it after the vax. This would be a horribly sucky time for me to deal with it, dd out of preschool, dh working crazy hours, sitter away for 3 weeks, etc. I'll take my chances that when he gets it naturally it will be at a less sucky time.

Scheduling: I'm only comfortable with 2 vaxes per visit max, and I'm more worried about Pertussis and Pneumoccocal (mostly because ds was hospitalized at 9 days old out of fear of meningitis; which he didn't have thankfully, but the vax lets me not worry so much about it from an emotional perspective.) Theoretically I could have done DTaP and Prevnar at 2 months and still done Rota at 3 months, but that would mean going back in less than 2 weeks for it with the way our 2 month visit got scheduled. Rota has to be started at 12 weeks or less.

Seizures: The final straw was the mention in the Sears Vaccine book that seizure side effects are 1 in 1300 for this vax, as compared to 1 in 20,000 for Prevnar.

I'm curious what you decide though!

[carriebft]

The timing is something to really think about for us, too. DS and DD didn't start vaccinations until more around 5/6 monthish...but, with the new babe, we have already decided to do HIb, which starts at 2 months.

We HAD planned on that being the only vaccine until starting Dtap and IPV at 5-6 monthsish.

I think that is another barrier in my mind to doing this one.

[hapersmion]

I still wouldn't do it. Like you said, even getting the vaccine might not have prevented what happened. They might have gotten sick from the vaccine, and still gotten sick during your trip, like what happened to your cousin's son.

The way I look at it is: Kids get sick. Sometimes they make everyone miserable, ruin vacations, spread their ick to everyone around them, etc. (Believe me, I know - my son came down with a noravirus last Christmas and gave it to the ENTIRE family, sigh.) But it's just part of life, even though it is really inconvenient and troublesome sometimes. You can't prevent ALL sickness.

But eek, EviesMom, that's a scary statistic. 1 in 1300 get some kind of seizures? If rotavirus had ever been on my list, it would be off it now. :

[carriebft]

I will have to go back and relook at that seizure number, all I can find online in studies is this:

Seizures reported as serious adverse experiences occurred in <0.1% (27/36,150) of vaccine and <0.1% (18/35,536) of placebo recipients (not significant). Ten febrile seizures were reported as serious adverse experiences, 5 were observed in vaccine recipients and 5 in placebo recipients.

I'll have to see where he got his number from. (quote above from package insert: http://www.eddcontrol.org/files/Rota...ert%202006.pdf)

Edit:


Ok, so he got 1/1300 from the package insert (just simplified and rounded off the 27/36150 number from the study).

But considering the number in the placebo group and the lack of significance I guess that one doesn't really affect my decision too much.

[Proverbs31]

Originally Posted by carriebft

But considering the number in the placebo group and the lack of significance I guess that one doesn't really affect my decision too much.

I keep reading in the package insert things like "Well-tolerated, compared to placebo" "No significant risk of intussipation, compared to placebo." But if they don't tell us what's in the placebo, how is it accurate to make a comparison?

[cloak]

The placebo was everything in the vaccine except the rotavirus antigen. Not really a placebo by my standards. I know there's a thread with that info in it somewhere around here.

[carriebft]

Well, I don't really want to debate the placebo question as it has been done in other recent threads and I don't want this thread closed. But, suffice to say that the 'no true placebo' argument is one am I currently researching but that, so far, it hasn't changed my mind on the trials I see and there is info out there on the "other stuff" in the placebo, its testing, why it's used, etcetc.

You can also see what is in the placebo by google scholaring the actual studies on the vaccine. I found most of them by using the citations in a few books here and the CDC site.

_______

So DH and I discussed a little tonight. The two vaccine per visit point that Eviesmom brought up is a big thought...though with us it has always been one at a time. Do we want to do two?

My husband feels it's a mental block because of all my research He doesn't feel there is significant risk increase for two shots at a time.

I feel that the one big thing would be that if there was a reaction, we would not know which one it was from..unless it was localized...but with rota you really wouldn't get that obviously.

But we do combo vaccines (MMR and DTaP), so I am not sure if it really is just a block for me...since with those vaccines we would not know which component the possible reaction was from either.

[carriebft]

A question I have not been able to get an answer to:

Has administration of the Rotavirus vaccine been shown to be like the pertussis where, if you DO get the virus, cases have been shown to be milder in vaccinated individuals?

I'm reading that it significantly cuts the risk of severe rotavirus, but I am not sure if that translates to my question here.

[Jenny_Jen]

Just wanted to add it's not on the schedule here in Canada, you can get it but you have to pay for it, so one has to ask themselves, if Health Canada won't pay for it, is it really worth it?

Just playing devil's advocate.

[carriebft]

I would definitely take money into account if it was a big issue for us...but it is covered by our insurance here. (yes, I know that doesn't mean it is free but it isn't out of pocket).

But I could definitely see that playing a role to many.

[cloak]

Originally Posted by carriebft

Well, I don't really want to debate the placebo question

Not debating, just providing info here. In the case of this vaccine, the placebo was a completely new formulation. It's not like in Gardasil where they used an aluminum placebo that had been used in other trials as a placebo or in other vax trials where they used another vax currently on the market as a placebo. This was a never been tested, brand new formulation that they used as a placebo.

[carriebft]

The two studies I am looking at used the vaccine ingredients minus the virus, which ended up being:

sucrose, sodium citrate, sodium phosphate monobasic monohydrate, sodium
hydroxide, polysorbate 80 and also fetal bovine serum.

Another one:

Enrolled infants were randomly assigned 1:1 by using computer-generated allocation schedules to receive either vaccine or visibly indistinguishable placebo in a sucrose-citrate buffer administered orally as three 2-mL doses 4 to 10 weeks apart. The placebo was identical to the vaccine except that it did not contain the rotavirus reassortants or trace trypsin.

http://pediatrics.aappublications.or.../full/119/1/11

Again, this would be the ingredients listed above.

[runes]

Originally Posted by carriebft

I would definitely take money into account if it was a big issue for us...but it is covered by our insurance here. (yes, I know that doesn't mean it is free but it isn't out of pocket).

But I could definitely see that playing a role to many.

indeed. it's $100 per dose if you pay out of pocket.

[carriebft]

I know there was a thread somewhere about fetal bovine serum, can anyone point me to it? search is not hitting for me.

nvm got it:

http://www.mothering.com/discussions...bovine%2Bserum

[mommy2maya]

Ok, my biggest question would be first of all, how was the rotavirus diagnosed? Just based on symptoms? So many stomach viruses are the similar, without lab or similar results, how do you really KNOW? My kids are all vaxed, yet none have had the rotavirus, and when ds was a baby our ped was part of the trial. Anyway, it was never pushed, and since we don't do daycare, it wasn't even advised for us. Now, that said, my kids all just got over a stomach virus over the holidays, along with most of their cousins. It happens once or twice a winter, we deal with the yuckiness of it, and move on. Now, if you told me that a single vax could eliminate ALL stomach virus, I *might* look into it further.

[mamakay]

About how the vaccine works...

Yeah, it is a bit like pertussis in that someone can be "immune" as far as personal symptoms go, but still shed the pathogen to others. That's the way natural infection and immunity works with it, at least, and it's a live attenuated virus, so I'd assume the vax works the same way.
Subclinical and asymptomatic infections are very, very common in all age groups, from newborns to adults, and people become progressively more immune each time they catch it. But on the flip side, there are a bunch of different strains out there, and cross-protection is only partial, so sometimes older kids and adults get pretty bas cases, too, even though it seems like they should be immune.

How old are your older kids, btw?
If I were going to get this vax, I'd assume that vax immunity would only last a few years. The viruses mutate pretty quickly, so if your kids are over 2 or 3 years old, getting vaxed as infants probably wouldn't have helped, and it probably wasn't their first infection, either.

-what were your reasons to get or not to get this vaccine-- maybe there are angles I haven't looked at yet

Well, we're not going to get it, basically just because it's so new, I think sometimes it takes a while for the actual adverse events to become noticed, I'm not scared of the disease, worried about adventitious agents, etc.
I don't feel strongly that the vaccine is "bad", though.

The good thing about the vaccine is that it's oral and babies actually seem to like it. To me that's a big plus. I think injections are actually pretty invasive, so I'm more in favor of (or less opposed to..) the non-traumatic types.

[EviesMom]

With the placebo being everything except rotavirus though... surely the normal, have-received-no-vaxes or even have-received-the-other-2-month- vaxes-but-not-gotten-rotavirus-vax-or-placebo rate of seizures is not 1 in 1300? That just says to me that rotavirus itself doesn't cause seizures, not that the whole vaccine doesn't. Is there something I'm missing logically?

Sorry if this was in another thread, I don't hang out here regularly, just sporadically, and hadn't seen it. Dh and I made our decision already, and ds is technically too old as of Monday anyway, but I'm honestly curious about this idea.

[carriebft]

We def got confirmation that it was rotavirus (although obviously not right away) via a sample. We weren't going to go that route, but knowing exactly what it was helped us decide whether or not to stay away from the relatives we had just paid so much money to go see. Frankly, looking back, we should have just come home before we left the country once we knew what we were dealing with.


Our kids are 18 months and almost 3.


It is possible they were infected before, although it would have not been symptomatic since they both have never had any of these issues before.



I think DH's biggest fear is that the infant will get this during the same circumstances. We are traveling again when the babe is 3 months and again at 8 months. The issue is complicated by his lack of trust for the care in some places.

[carriebft]

Well, big development on the "don't bother with it" side. Our doc office just called back and they don't even carry it as of right now.