New vaccine takes aim at childhood digestive disease

Medicine: Rotavirus attacks small children, and kills many of them worldwide. The new vaccine could save young lives.

January 17, 1999|By Rick Ansorge | Rick Ansorge,Colorado Springs Gazette

Cindy Morgan was concerned last winter when her 9-month-old daughter Jamie began vomiting. But she was absolutely terrified when the vomiting continued for 10 days.

Morgan forced Jamie to drink Gatorade, Pedialyte -- anything she could hold down.

"I was in constant contact with her pediatrician," Morgan says. "It was no fun."

Jamie had rotavirus, a digestive disease that strikes about 3.5 million American newborns and preschoolers each winter, resulting in 500,000 doctor visits and 55,000 hospitalizations.

Jamie was one of the lucky ones. Thanks to her parents' efforts, she didn't become so dehydrated that she needed to go to the hospital. Since rotavirus can't be cured, severe cases respond only to intravenous rehydration therapy.

In the United States, where such therapy is available at any hospital, the disease kills nearly 100 children a year. The toll is most horrific in developing countries, where rotavirus claims nearly 1 million lives a year.

Today, however, there's every reason to believe that the disease will soon become as extinct as smallpox and polio. A new vaccine that's nearly 100 percent effective in preventing severe cases of diarrhea was approved Aug. 31 by the U.S. Food and Drug Administration.

Both the American Academy of Pediatrics and the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommend that most infants be immunized. For maximum protection against rotavirus, scientists say, infants should receive the oral vaccine at 2, 4 and 6 months, along with their other routine immunizations.

The vaccine, called RotaShield, isn't free of side effects. Since it's a live vaccine, it often causes a low-grade fever. The vaccine shouldn't be given to children who have developed persistent diarrhea or vomiting, those who are immunocompromised, or those who are allergic to latex or any of the vaccine's components. These include aminoglycoside antibiotics, amphotericin B and monosodium glutamate.

Another down side: The vaccine is expensive -- up to $50 a dose -- and it may or may not be covered by insurance.

The disease progresses so quickly that a baby can appear healthy one day and be at death's door the next. Ignoring symptoms -- which include lethargy, no urination and no tears when the baby cries -- can be deadly.

Typically, rotavirus cases stay in the hospital about a week, at a cost of about $10,000. If they must be treated in an intensive-care unit, it can boost the total cost to $15,000.

Rotavirus strikes infants and preschoolers hardest because they haven't yet developed immunity to the disease. After the child is 5, rotavirus usually results in a self-limiting case of what's commonly known as stomach flu.

In infants, the vaccine speeds the production of antibodies needed to fight the disease.

Although the vaccine promises to prevent the worst cases of childhood diarrhea, it won't prevent all diarrhea.

"If that's what parents are expecting, they'll be disappointed," says Dr. Kenneth Richeaux, a Colorado Springs pediatrician. "There are a lot of other viruses that cause diarrhea in kids."

FACTS ABOUT ROTAVIRUS

* It's the most common cause of childhood diarrhea, infecting almost all children by age 4.

* It causes about 3.5 million cases of childhood diarrhea each year in the United States, and results in the hospitalization of about 55,000 children under age 4 and costs more than $1.4 billion.

* It often causes dehydration, which can kill a child in days if bodily fluids are not replaced intravenously.

* Epidemics usually occur during the winter.

* Symptoms also include vomiting, fever and lethargy. Many infants also stop urinating and producing tears when they cry.

* It affects the gastro-intestinal tract and spreads by fecal-oral contact. Outbreaks are common where fecal exposure is increased, including child-care centers, hospitals and camps.

* Transmission can be prevented by hand- washing after changing diapers and disinfecting contaminated surfaces.

FACTS ABOUT THE VACCINE

On Aug. 31, the U.S. Food and Drug Administration approved the first rotavirus vaccine, RotaShield, for prevention of serious diarrhea.

It's 100 percent effective against diarrhea that causes dehydration, but only 50 percent effective against milder forms of diarrhea.

The live vaccine is given orally to babies at 2, 4 and 6 months, along with other vaccinations. The cost is up to $50 a dose, which may or may not be covered by insurance.

The most common side effect is a low-grade fever affecting up to a third of children who receive the vaccine.

So far, no states require children to receive the vaccine.

-- Colorado Springs Gazette

Source: Wyeth-Ayerst Laboratories, National Institute of Allergy and Infectious Diseases

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