Is the rotavirus (rota) vaccine contraindicated in infants with a history of intussusception?

Rotavirus Vaccine in Infants with History of Intussusception

Rotavirus vaccine should not be administered to infants with a previous history of intussusception, as these infants are at higher risk for a repeat episode of intussusception. 1

Understanding the Risk

The Advisory Committee on Immunization Practices (ACIP) clearly identifies a previous history of intussusception as a precaution for rotavirus vaccination. While current rotavirus vaccines (RV5 and RV1) have not shown the same level of risk as the previously withdrawn RRV-TV vaccine, special consideration is needed for infants with prior intussusception:

• Infants with a history of intussusception are naturally at higher risk for developing subsequent episodes
• No specific safety data exists on administering rotavirus vaccines to infants with a history of intussusception 1
• The risk-benefit calculation differs significantly for these infants compared to the general population

Evolution of Recommendations

The approach to this issue has evolved over time:

• In 2006, ACIP noted that "risks and benefits should be considered" when vaccinating infants with previous intussusception 1
• By 2009, ACIP strengthened their position, specifically listing previous history of intussusception under precautions 1

Evidence on Intussusception Risk with Rotavirus Vaccines

While current vaccines appear safer than the withdrawn RRV-TV vaccine, post-licensure studies have identified small but significant risks:

• RV5 (RotaTeq): Associated with approximately 1.5 excess cases of intussusception per 100,000 recipients of the first dose 2
• RV1 (Rotarix): A 2014 study found a significant relative risk of 8.4 for intussusception within 7 days after vaccination 3
• A 2017 meta-analysis found increased risk following the first dose (OR: 8.45,95% CI: 4.08-17.50) and following all doses (OR: 1.59,95% CI: 1.11-2.27) 4

Clinical Decision Algorithm

For infants with a history of intussusception:

1. Do not administer rotavirus vaccine

   • The risk of recurrent intussusception outweighs the benefits in this specific population
   • No safety data exists for this specific group

2. Focus on alternative preventive measures:

   • Emphasize hand hygiene and other infection control measures
   • Ensure close contacts are vaccinated (herd immunity)
   • Educate caregivers about signs of rotavirus infection

3. Monitor for rotavirus symptoms if exposure occurs:

   • Diarrhea
   • Vomiting
   • Fever
   • Signs of dehydration

Important Considerations

• The contraindication applies to both available rotavirus vaccines (RV5 and RV1)
• This contraindication is distinct from the general population, where the benefits of vaccination clearly outweigh the small risk
• The decision not to vaccinate is based on the naturally higher baseline risk of recurrent intussusception in these infants, which would be further increased by vaccination

Avoiding Common Pitfalls

• Do not confuse this precaution with the general population recommendation, where rotavirus vaccination is strongly recommended
• Do not attempt to "time" the vaccine differently or use a different dosing schedule - the contraindication applies regardless
• Remember that while the absolute risk increase is small, the risk-benefit calculation changes significantly for infants with prior intussusception