Rotavirus, a condition that can cause severe vomiting and diarrhea, has potentially fatal effects, particularly in young children. A vaccination can be given to prevent the condition, but the vaccine does have one potentially fatal adverse effect – intussusception, a form of bowel obstruction. In fact, it is reported that 1-4 children per 100,000 who receive the rotavirus vaccine develop the disorder. For this reason, the World Health Organization had placed age restrictions on who should receive the vaccine.
Because older children have a higher risk of naturally occurring intussusception, the vaccine is supposed to be initiated before the age of 15 weeks and should be completed before 32 weeks. Unfortunately, in low and middle income countries where rotavirus is very common, health care may not be accessible and the child may not get vaccinated before the cut-off time. This leaves the unprotected children highly susceptible to the condition.
In a modeling study by the Centers for Disease Control and Prevention and the London School of Hygiene and Tropical Medicine, authors analyzed the benefits and risks of removing the age restrictions previously placed on the rotavirus vaccination in countries where deaths from the condition are common. They’ve found that the benefits greatly outweigh the risk.
In their analysis, the authors estimated that keeping the age restrictions would prevent 155,800 rotavirus deaths and cause approximately 253 intussusception deaths. Lifting the age restrictions would prevent an estimated 203,000 rotavirus deaths and cause 547 intussusception deaths. Overall, they found that lifting the age restriction would prevent an additional 47,200 rotavirus deaths but cause 294 intussusception deaths. This basically translates into 154 rotavirus deaths being prevented for every one death caused by complications from the vaccine.
“Our analysis suggests that in low- and middle-income countries the additional lives saved by removing age restrictions for a rotavirus vaccination would far outnumber the potential excess vaccine-associated intussusception deaths,” the authors said. “Age restrictions will ultimately be decided at country level, but this analysis has shown a clear case for a change in policy that will be particularly instrumental for saving lives in settings where mortality from rotavirus is high and delays in timing of vaccination are common.”
Experts from the World Health Organization have reviewed the analysis and say they are no longer recommending universal age restrictions; they now support removing the age restrictions in locations where the benefits would outweigh the risks. However, they are still encouraging timely vaccinations to decrease the number of vaccine-related deaths.
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