What are the differences between the rotavirus vaccines Rotateq (pentavalent) and Rotarix (monovalent)?

Key Differences Between RotaTeq and Rotarix

Both RotaTeq (RV5) and Rotarix (RV1) are safe and effective rotavirus vaccines with no preference expressed by ACIP, but they differ fundamentally in composition, dosing schedule, and viral origin. 1

Vaccine Composition

RotaTeq (RV5) - Pentavalent Vaccine

• Contains five live reassortant rotavirus strains derived from human and bovine parent rotavirus strains 1
• Four reassortants express human outer-capsid proteins (G1, G2, G3, or G4) with bovine attachment protein P75 1
• The fifth reassortant expresses human attachment protein P1A8 with bovine outer-capsid protein G6 1
• Parent bovine strain (WC3) was isolated from a calf with diarrhea in Pennsylvania 1

Rotarix (RV1) - Monovalent Vaccine

• Contains a single live attenuated human rotavirus strain (RIX4414) of G1P8 specificity 1
• Derived entirely from human rotavirus strain 89-12, originally isolated from a child in Cincinnati, Ohio 1
• No bovine components 1

Dosing Schedule

RotaTeq Administration

• Requires 3 oral doses administered at 2,4, and 6 months of age 1, 2
• Each dose is 2 mL 1
• Minimum 4-week interval between doses 3

Rotarix Administration

• Requires only 2 oral doses administered at 2 and 4 months of age 1, 2, 3
• Each dose is 1.5 mL 3
• Minimum 4-week interval between doses 3

Critical Age Restrictions (Identical for Both)

• First dose must be given between 6 weeks and 14 weeks, 6 days of age 2, 3
• All doses must be completed by 8 months, 0 days of age 2, 3
• These age restrictions are absolute and apply equally to both vaccines 2

Vaccine Shedding Patterns

RotaTeq Shedding

• 9% of recipients shed virus after the first dose, rarely after subsequent doses 1

Rotarix Shedding

• 25% of recipients shed virus after the first dose, with peak excretion around day 7 1
• This higher shedding rate reflects the live human viral origin 2

Efficacy Profiles

RotaTeq Efficacy

• 74% efficacy against any rotavirus gastroenteritis 1
• 98% efficacy against severe rotavirus gastroenteritis 1

Rotarix Efficacy

• 87% efficacy against any rotavirus gastroenteritis 1
• 85-96% efficacy against severe rotavirus gastroenteritis 1

Despite these numerical differences, both vaccines demonstrate >90% field effectiveness against severe disease in developed countries, with similar real-world performance 4, 5, 6

Safety Profile

• Both vaccines show no increased risk of intussusception when administered within the recommended age windows 1
• RotaTeq shows no increase in fever or irritability, with slight increase in mild diarrhea and vomiting 1
• Rotarix shows no difference versus placebo in diarrhea, fever, vomiting, or irritability within 14 days of any dose 1
• Both vaccines are contraindicated in severe combined immunodeficiency (SCID) due to their live viral nature 2

Storage and Formulation

RotaTeq Storage

• Stored refrigerated at 2°-8°C (36°-46°F) for up to 24 months 1
• Ready-to-use liquid formulation 1

Rotarix Storage

• Requires reconstitution from lyophilized vaccine with liquid diluent 1
• After reconstitution, must be administered within 24 hours 1
• Contains latex in tip cap and rubber plunger of oral applicator (important for latex-allergic patients) 1

Clinical Decision-Making

ACIP expresses no preference between the two vaccines 1, 2, so the choice is typically based on:

• Logistical considerations: Rotarix requires one fewer visit (2 doses vs 3 doses)
• Storage capabilities: RotaTeq is ready-to-use; Rotarix requires reconstitution
• Latex allergy concerns: Rotarix applicator contains latex 1
• Vaccine availability at your practice

Common Pitfalls to Avoid

• Never attempt "catch-up" vaccination in children who missed the age window—there is no catch-up schedule for rotavirus vaccines 3
• Do not use corrected age for preterm infants—always use chronological age from birth, which may cause some preterm infants to age out before clinical stability 3
• Do not interchange vaccine products—complete the series with the same vaccine product when possible, though ACIP allows completion with either vaccine if the original product is unknown 1
• Do not delay the first dose beyond 14 weeks, 6 days of age under any circumstances 2, 3