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• W2023674414 abstract "To the Editor: Rotavirus infections in the United States have decreased as a result of vaccination efforts. Before 2006, when the vaccine was implemented, the burden of disease was high, with approximately 27,000 to 70,000 children under 5 years of age hospitalized with rotavirus infection and about 20 to 60 reported deaths annually according to the Centers for Disease Control and Prevention and other studies.1Charles M.D. Holman R.C. Curns A.T. Parashar U.D. Glass R.I. Bresee J.S. Hospitalizations associated with rotavirus gastroenteritis in the United States, 1993–2002.Pediatr Infect Dis J. 2006; 25: 489-493Crossref PubMed Scopus (119) Google Scholar, 2Fischer T.K. Vibound C. Parashar U. Malek M. Steiner C. Glass R. et al.Hospitalizations and deaths from diarrhea and Rotavirus among children <5 years of age in the United States, 1993-2003.J Infect Dis. 2007; 195: 1117-1126Crossref PubMed Scopus (148) Google Scholar, 3Malek M.A. Curns A.T. Holman R.C. et al.Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000.Pediatrics. 2006; 117: 1887-1892Crossref PubMed Scopus (163) Google Scholar, 4CDCDelayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.Morbidity and Mortality Weekly Report. 2008; 57: 1-4PubMed Google Scholar, 5Payne D.C. et al.Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.Pediatrics. 2008; 122: 1235-1243Crossref PubMed Scopus (152) Google Scholar Since the introduction of vaccination, rotavirus rates in the United States have diminished by more than 50%, translating to the prevention of 48,000 hospitalizations and 30 deaths.2Fischer T.K. Vibound C. Parashar U. Malek M. Steiner C. Glass R. et al.Hospitalizations and deaths from diarrhea and Rotavirus among children <5 years of age in the United States, 1993-2003.J Infect Dis. 2007; 195: 1117-1126Crossref PubMed Scopus (148) Google Scholar, 4CDCDelayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.Morbidity and Mortality Weekly Report. 2008; 57: 1-4PubMed Google Scholar, 5Payne D.C. et al.Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.Pediatrics. 2008; 122: 1235-1243Crossref PubMed Scopus (152) Google Scholar Studies have also shown a delay in the seasonal onset of the disease by 2 to 4 months.4CDCDelayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.Morbidity and Mortality Weekly Report. 2008; 57: 1-4PubMed Google Scholar, 5Payne D.C. et al.Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.Pediatrics. 2008; 122: 1235-1243Crossref PubMed Scopus (152) Google Scholar, 6Tate J.E. et al.Decline and change in seasonality of US Rotavirus activity after the introduction of Rotavirus vaccine.Pediatrics. 2009; 124: 465-471Crossref PubMed Scopus (197) Google Scholar, 7Turcios R.M. et al.Temporal and geographic trends of Rotavirus activity in the United States, 1997-2004.Pediatr Infect Dis J. 2006; 25: 451-454Crossref PubMed Scopus (69) Google Scholar Cost savings to the medical community with the vaccines are estimated to be as much as $198,000 per life-year.8Committee on Infectious DiseasePrevention of Rotavirus disease: updated guidelines for use of rotavirus vaccine.Pediatrics. 2009; 123: 1412-1420Crossref PubMed Scopus (99) Google Scholar The question arises, however, as to the unforeseen costs on a population of patients with undiagnosed immune deficiency. In March 2009 there were 2 reported cases by Patel et al9Patel N.C. et al.Vaccine-acquired Rotavirus infection in two infants with severe combined immunodeficiency: late breaking abstracts.J Allergy Clin Immunol. 2009; PubMed Google Scholar of rotavirus infection from RotaTeq (Merck and Co, Inc, Whitehouse Station, NJ) vaccine strains in unknown cases of SCID (severe combined immune deficiency) with adenosine deaminase deficiency and IL-2 receptor-γ deficiency. Werther et al10Werther R.L. et al.Rotavirus vaccine induced diarrhea in a child with severe combined immune deficiency.J Allergy Clin Immunol. 2009; 124 (Epub 2009 Aug 5): 600Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar also recently described a 9-month-old girl with a new diagnosis of unspecified SCID who shed the RotaTeq virus strain for 7.5 months and finally cleared it posttransplant. All 3 of these patients presented with gastrointestinal symptoms and failure to thrive. Vaccine strains were identified by RT-PCR. The patient reported here is a 5-month-old boy born to nonconsanguineous parents who presented with lethargy, dehydration, and failure to thrive. He had developed chronic diarrhea beginning at 2 months of age and had poor weight gain over the month before admission. He had been vaccinated with RotaTeq at 2 and 4 months. Before his admission, a stool sample had grown Salmonella. His blood cultures on admission grew Salmonella that was promptly treated with antibiotics. Further testing of his stool revealed Rotavirus antigen as well as persistent Salmonella. A diagnosis of SCID was suspected and then confirmed (T-B+NK-, IL-2RG mutation). He quickly decompensated after 48 hours of admission with onset of respiratory distress and was diagnosed by bronchoscopy to have Pneumocystis jeroveci. A stool sample was assessed by RT-PCR for the genes VP6 and NSP1. They matched the RotaTeq vaccine strain exactly. One month later, he continued to demonstrate rotavirus antigen in his stool. He is currently awaiting stem cell transplant by an unrelated matched donor. RotaTeq virus shedding is expected from 1 to 15 days in 9% after first dose and in 0.3% after the third dose in healthy children. 11CDCPrevention of Rotavirus gastroenteritis among infants and children—recommendations of the Advisory Committee on Immunization Practices (ACIP).Morbidity and Mortality Weekly Report. 2006; 55: 1-13PubMed Google Scholar This case and the previously reported cases bring into question current vaccination practices. The updated American Academy of Pediatrics guidelines pose vaccination of immunocompromised children as a precaution. They clearly state that immunodeficient children might be at risk for severe or prolonged gastroenteritis.8Committee on Infectious DiseasePrevention of Rotavirus disease: updated guidelines for use of rotavirus vaccine.Pediatrics. 2009; 123: 1412-1420Crossref PubMed Scopus (99) Google Scholar However, the timing of the vaccination does not allow patients with congenital immune deficiency sufficient time to declare themselves. There is no question about the substantial benefit from the vaccine in reducing morbidity as well as health care costs in the United States for the general population. Risks of the vaccine to immunocompromised hosts do not negate its widespread use, but rather reinforce the need for neonatal screening measures of SCID in particular. We acknowledge the work of Mathew Esona, PhD, Krisztian Banyai, PhD, and all of Mike Bowen's laboratory at the Centers for Disease Control and Prevention." @default.
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• W2023674414 title "Persistent rotavirus vaccine shedding in a new case of severe combined immunodeficiency: A reason to screen" @default.
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