The first human rotavirus vaccine was withdrawn from use in the USA because it was associated with an increased risk of intussusception. Two new rotavirus vaccines (Rotarix and Rotateq) were initially thought not to be associated with intussusception and were introduced into the routine infant schedule in Australia in 2007. Recent reports from Mexico and Australia have raised the possibility that the new rotavirus vaccines increase the risk of intussusception by about fivefold, but only in the week following the first dose. A paper from the Centers for Disease Control in Atlanta models data on morbidity and mortality of rotavirus gastroenteritis before vaccination, estimated vaccine uptake and intussusception rates to assess the risks and benefits of rotavirus vaccine. The authors estimate that routine infant rotavirus vaccination would cause 0.2 deaths per year from intussusception but prevent 14 from gastroenteritis (benefit–risk ratio 71 : 1), would cause 45 but prevent 53 444 hospitalisations (ratio 1093 : 1) and would cause 13 emergency department visits but prevent 169 949 (ratio 12 115 : 1). These US figures are potentially extremely useful to clinicians counselling parents on the relative risks and benefits of rotavirus vaccine.
Reviewer: Prof David Isaacs, Children's Hospital at Westmead, firstname.lastname@example.org