From the Guidelines
Rotavirus vaccine is not contraindicated in a cytomegalovirus (CMV) positive 2-month-old infant, and it should be administered according to the routine immunization schedule. The decision to vaccinate should be based on the potential risks and benefits, considering the infant's overall health status. CMV infection alone does not represent a contraindication to receiving rotavirus vaccination, as it does not necessarily imply severe immunocompromise 1. The true contraindications for rotavirus vaccine include severe combined immunodeficiency (SCID), history of intussusception, and severe allergic reaction to a previous dose.
While CMV can cause immune system effects, simple CMV positivity without severe immunocompromise does not prevent safe administration of the rotavirus vaccine. The vaccine is a live attenuated vaccine, but it has been shown to be safe in infants with various conditions, including HIV infection (without severe immunocompromise) 1. The benefits of protecting the infant against rotavirus gastroenteritis, which can cause severe dehydration in young infants, outweigh potential risks in a CMV-positive infant without severe immunodeficiency.
Some key considerations for vaccinating infants with altered immunocompetence include:
- Consulting with an immunologist or infectious diseases specialist to weigh the potential risks and benefits 1
- Considering the severity of the immunocompromise and the potential for severe or prolonged rotavirus gastroenteritis 1
- Evaluating the infant's overall health status and medical history to determine the best course of action.
In general, the rotavirus vaccine should be administered according to the routine immunization schedule, with the first dose typically given between 6-14 weeks of age. The rotavirus vaccine is safe and effective in preventing severe rotavirus gastroenteritis, and its benefits outweigh the potential risks in a CMV-positive infant without severe immunodeficiency.
From the Research
Rotavirus Vaccination in Immunocompromised Infants
- The rotavirus vaccine is generally contraindicated in infants with severe combined immunodeficiency (SCID) due to the risk of vaccine-acquired rotavirus infection 2.
- However, the provided evidence does not specifically address the contraindication of rotavirus vaccine in cytomegalovirus (CMV) positive infants.
- Studies have shown that rotavirus vaccines are well tolerated in preterm infants and those with certain immunocompromised conditions, such as HIV-infected or HIV-exposed infants 3.
- The risk of viral shedding and transmission between vaccinated neonates and household contacts remains low and does not outweigh the benefit of vaccination 3.
Safety and Effectiveness of Rotavirus Vaccine in High-Risk Infants
- A study found that the rotavirus vaccine offered limited protection to vulnerable medical risk infants, with a vaccine effectiveness of 30% against severe rotavirus acute gastroenteritis 4.
- The vaccine was generally well tolerated in this group, but coadministration with routine vaccines was associated with a higher risk of gastrointestinal adverse events 4.
- Another study reported that rotavirus vaccine-derived virus shedding existed for nearly all infants, mostly during the first week after dose 1, but with rare transmission only described in the household setting 5.
Considerations for Rotavirus Vaccination in CMV Positive Infants
- There is no direct evidence provided to support or refute the contraindication of rotavirus vaccine in CMV positive infants.
- The decision to administer the rotavirus vaccine to a CMV positive infant should be made on a case-by-case basis, taking into account the individual infant's health status and medical history 6, 3.