LOGIC No 1: March 2017 | Page 34

protection to both adults and older children .
The efficacy of rotavirus vaccine appears highest in developed countries but is less efficacious in sub-Saharan Africa , Latin America and Southern Asia possibly due to differences in environmental influences , other co-pathogens and co-existing conditions .
Additional Bonuses of Vaccination
Rotavirus is linked to childhood seizures , both febrile and afebrile ; it is well described that a small proportion of young children with rotavirus infection experience a simple seizure perhaps due to the high fever .
In both America and Australia a reduction of childhood febrile and afebrile seizures of 15-20 % in the first year of life has been seen with introduction of the rotavirus vaccine . Thus there is an additional benefit of rotavirus vaccine reducing the annual burden of childhood hospitalisations , emergency visits and unnecessary investigations from simple febrile seizures .
Side effects of vaccination
The most concerning potential adverse effect of rotavirus vaccination is the association with intussusception . This is where one part of the bowel folds into itself and if not reversed can cut off the blood supply to part of the intestine or lead to bowel perforation and serious infection , sepsis and rarely death . If recognised early it is easily reversed by a simple rectal procedure or less commonly by abdominal surgery . The cause of intussusception is not known although preceding infection may be a trigger . Intussusception is the most common cause of intestinal obstruction in children aged under 3 years . The usual peak age for intussusception is known to be first 6-8months of life .
Intussusception rates are variable across different countries and ethnicities with an estimated worldwide incidence of 74 per 100,000 , ranging from 40 / 100,000 in the US to 80 / 100000 in Australia and up to 300 / 100,000 in South Korea .
The association between intussusception and rotavirus vaccine was first seen in 1998 with an early vaccine used in the United States called RotaShield . There appeared to be an excess of one case of intussusception per 10,000 vaccine recipients and these were occurring in the first week post vaccination . This led to this vaccine being withdrawn in 1999 .
The new generation vaccines Rotateq and Rotarix also have an association with intussusception but this is a very uncommon . Appropriate data from Australia looking at both vaccines has shown an increased risk of intussusception in the first 1-3
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