Match Day 2026: The countdown ends, the journey begins

What To Expect After Rotavirus Vaccination

Your baby might be extra fussy or experience mild side effects after each dose of the rotavirus vaccine, but this should go away in a few days. Complications from the vaccine are very rare, and the benefits far outweigh the risks.

Rotavirus is a contagious virus that causes diarrhea, vomiting, and fever. It mostly affects babies and children under age 5. Severe cases of rotavirus may require emergency medical treatment for dehydration.

Rotavirus used to be a common illness among children younger than 5 years. Today, vaccination against rotavirus prevents up to 50,000 hospitalizations of babies and young children in the United States.

The Centers for Disease Control and Prevention (CDC) recommends that all newborn infants receive several doses of the vaccine starting at 2 months old.

Here's what you can expect after your child receives the rotavirus vaccine.

The rotavirus vaccine comes with a risk of side effects. In general, though, the risks associated with getting the vaccine are lower than the risks associated with contracting the virus.

In fact, most babies don't experience any side effects of rotavirus vaccination at all.

In other cases, side effects are mild and can include a temporary bout of gas, diarrhea, or vomiting the week after vaccination. Some infants might seem fussier than usual in the days following the vaccine.

Some healthcare professionals administer additional vaccines alongside the rotavirus vaccine. If that's the case, your baby might experience other side effects following vaccination.

Your doctor should explain what to expect regarding the side effects of vaccination and when to seek medical care.

Severe complications of rotavirus vaccination are very rare and can include intussusception or allergic reactions.

Intussusception occurs when part of the small intestine slides into the large intestine, creating a blockage. It's a life threatening condition that requires immediate treatment. It affects approximately 1 out of every 20,000 to 1 out of every 100,000 infants who receive the rotavirus vaccine, typically within a week after either the first or second dose, according to the CDC.

Allergic reaction to the rotavirus vaccine is extremely rare. The risk of a severe reaction is approximately 1 out of 1 million doses, with symptoms appearing in the first hours after vaccination.

When taken as recommended, rotavirus vaccines are highly effective. The vaccine significantly decreases your child's chances of developing symptoms after being exposed to the virus.

Plus, rotavirus vaccination has had population-wide effects. Since the introduction of the vaccine more than a decade ago, disease rates have decreased significantly in the United States.

According to a 2019 study, hospitalizations for rotavirus among children ages 4 and under decreased by more than 85% between 2000 and 2013.

Because of rotavirus vaccination, your child is less likely to be exposed to the virus in the first place.

If your child was recently vaccinated against rotavirus, you might be wondering what to expect.

When does diarrhea start after getting the rotavirus vaccine?

Mild diarrhea is a rare side effect of rotavirus vaccination. It can start anytime within a week after vaccination.

How long does a baby stay unsettled after the rotavirus vaccine?

Following the rotavirus vaccine, your baby might be fussy, cranky, or agitated. This side effect shouldn't last more than a few days.

How long does rotavirus remain in a baby's stool after vaccination?

Your child will receive the rotavirus vaccine rally via droplets. After vaccination, your baby excretes the virus in their stool. It can take up to 10 days for the virus to leave your baby's stool.

Although rotavirus is much less common than it once was, it's still important to get your child vaccinated. When fewer children are vaccinated, the chances of a rotavirus outbreak increase.

Vaccinated infants and children are much less likely to develop rotavirus symptoms or require hospitalization compared with unvaccinated infants and children. In addition, symptoms are less likely to be severe.

Your child might experience mild side effects, like fussiness, gas, or diarrhea. Severe complications are very rare. It's clear that the benefits of the vaccine far outweigh the risks.

Talk with a doctor to learn more about how to protect your child from rotavirus.

Does This Infant Have A Post-vaccine Adverse Event—or Another Infection?

Primary care and emergency room visits of infants due to adverse events following immunization (AEFI) are commonly seen. In fact, there has been an uptick since the 2015 approval of the capsular group-B meningococcal vaccine (4CMenB) in the UK.1

Take Note

"Our study has shown that routinely measuring inflammatory markers in children presenting to ED post vaccination is probably unhelpful in the majority of patients, because they are typically modestly raised in AEFI patients." -- Samuel W. Channon-Wells, PhD, Imperial College, London

While infants typically present with mild symptoms such as fever, AEFIs are still taken seriously because the timing of the first three courses of infant vaccination (8, 12, and 16 weeks of age) coincides with the time period (<3 months of age) for the greatest risk of invasive bacterial infection (IBI), a potentially fatal condition.1 Uncovering the difference between AEFIs and IBI, though, has been challenging for healthcare professionals, given their similar clinical presentations: fever and elevated inflammatory markers.1

National guidelines aim to help risk-stratify patients using the National Institute for Health and Care Excellence (NICE) "traffic light" system for determining disease severity. These guidelines call for routine blood tests, including full blood count and C-reactive protein (CRP) in all infants with fever who are <3 months, regardless of other symptoms.2

However, these tests are invasive and have limitations, as Samuel W. Channon-Wells, a Clinical PhD Fellow in Paediatric Infectious Disease at Imperial College London, explains in an interview with MedPage Today. "Many existing clinical prediction tools don't account for possible vaccine responses in their decision algorithms, and so children presenting with transient post-vaccination illness are often subject to significant medical intervention."

To further distinguish and compare clinical features among AEFIs and IBIs, Channon-Wells and other researchers from the UK conducted an observational study of 232 infants with IBI (n=40), urinary tract infection (UTI; n=27), AEFI (probably: n=97; possible: n=24), and those infants determined to be post vaccination "well" infants (n=44). The percentage of infants who had blood tests administered were 98% in the IBI group, 44% in the UTI group, and 28% and 50% in the probable and possible AEFI groups, respectively.1

Patients presented to the hospital from 2011 to 2018, the time-period during which the 4CMedB vaccine was introduced into the UK immunization schedule. The findings of this retrospective review were published in a recent issue of BMJ Pediatrics Open.1

"Our study has shown that routinely measuring inflammatory markers in children presenting to ED post vaccination is probably unhelpful in the majority of patients, because they are typically modestly raised in AEFI patients," primary investigator, Channon-Wells, told MedPage Today. "In fact, inflammatory markers are only helpful in picking out patients with a likely IBI when the CRP levels are substantially elevated. Our results suggest that the complete blood count is likely to be even less diagnostically helpful in this clinical setting." 

Channon-Wells' conclusions are confirmed from the study results, demonstrating that while all inflammatory markers were commonly raised in all groups, CRP was the only discriminatory blood marker significantly different between IBI and probable AEFI (P=.012). The widest range in inflammatory markers was in the IBI group (CRP 0.1–393, WCC 1.6–34.4, Neutrophil count 0.2–27.4) and CRP values above 83 mg/L, which are rarely seen post vaccination, were only found in infants with IBI or UTI.1

Additional clinical features of fever, seizures, and rashes were all frequent among infants, with fever being more common in patients with probable AEFI. In those with IBI, diarrhea, clinician-reported irritability, or rigors were more commonly seen.1

Channon-Wells urges the need for additional resources. "It's clear that additional research into diagnostics and clinical prediction tools is required to help clinicians make decisions in this particular scenario."

This recent study also evaluated the NICE "traffic light" risk strategy, wherein risk was found to be different between groups, but still missed cases of IBI. Classification as "high risk" was found to be more common in the IBI group versus those infants with probable AEFI (40% vs 13%, adjusted ORs 5.47, 95% CI 1.85 to 16.14).1

Channon-Wells discussed the need for adjustments in the current standards of care. "Future clinical risk assessments must take recent vaccinations into account when setting thresholds for investigations and treatment. I hope that our findings will reduce unnecessary blood draws in children presenting post-vaccination, which would obviously be a positive from the perspective of the parents and child, as well as healthcare providers."

Because limitations inevitably still exist, Channon-Wells discusses the need to be aware of them. "In addition to conducting the vital necessary research mentioned above, it's important for paediatric, emergency care, and general practice physicians to be aware of the limitations of our current diagnostic methods, and to raise awareness of these issues to any colleagues who may see these patients during their practice."

Published: March 13, 2023

Kate Hannum, a freelance medical writer, has 20 years' experience in various disease categories.

What Are The Lessons Learned From The Tuberculosis Vaccine Rollout?

Science first: "While the neonatal BCG vaccination is partially effective in reducing the risk and severity of serious forms of TB, like miliary TB and TB meningitis in infants and young children, it is poorly protective against pulmonary disease in adolescents and adults. There is a critical need for new TB vaccines that are more effective than the existing BCG vaccine in preventing pulmonary as well as extra-pulmonary forms of TB in all age groups," said Prof Surya Kant, scientific Chairperson of 77th National Conference of Tuberculosis and Chest Diseases held in Agra, India.

BCG vaccine is contraindicated in those with cell-mediated immune deficiency. While HIV infected, non-symptomatic infants should be immunized with BCG vaccine according to standard schedules, infants with clinical (symptomatic) AIDS should not receive it. BCG vaccine was first administered in humans in 1921. Despite the crippling burden of TB, it took almost another half a century for governments to begin resolving issues, which marred its rollout in TB affected nations, including manufacturing and supply-chain related issues.

Advertisement

"In 1970s and early 1980s, supply of BCG vaccine was very erratic for a very long time. So, we did not have much vaccine stock. BCG immunization picked up only after mid-1980s," said Dr. Jacob John, Professor, Community Health department, Christian Medical College (CMC) Vellore, India. Vaccine shortage was so acute back then that "we had to import it from Denmark. Moreover, as it is not easy to maintain these doses, there was lot of wastage of the doses," said Dr. John.

"In those days not just BCG vaccine uptake was low, but all other vaccination rates were low too. Institutional delivery rate was also low. Institutional delivery rates began picking up in mid-1980s," said Dr. John. "BCG vaccination is now a part of institutional deliveries - when babies are born people know they have to give them vaccines, including BCG vaccine."

Agrees Dr. Shibu Vijayan, a noted public health crusader who currently serves as Medical Director (Global Health) at Qure.Ai. "Births that earlier happened at homes are now happening at medical facilities. The route of BCG vaccine is a health facility-based function. So, if the baby is not delivered in a medical facility, he/ she/ they may not get the vaccine."

A similar situation thrives in Nigeria: The nurse in charge of primary health centre (PHC) Angwan Maikai, Keffi, Nasarawa State in Nigeria, said that, like other PHCs, mothers are informed of the various vaccines, including BCG, during antenatal care. The challenge comes for those who do not attend antenatal or delivery at health facilities.

"I do not think it was an issue of vaccine hesitancy in those times, but an issue of the reach of immunization services, including those for BCG," said Dr. Jacob John. "When your vaccine coverage is quite low, then issue of vaccine hesitancy is also low."

A TB case worker with APIN Public Health Initiative, Mercy Depuun noted that the uptake of vaccines in Nigeria has been generally low because of hesitancy from the public, and this was because of a lack of trust in the vaccines. There were various myths surrounding vaccines in this part of the world, including getting infected with diseases from taking the vaccine, life-threatening side effects from the vaccine, and birth control plots by the west.

However, she pointed out that BCG vaccine coverage in Nigeria is commendable. Its initial low uptake was not completely linked to hesitancy but to parents' access to health facilities for their infants' BCG vaccination. Thus, while the availability of a new TB vaccine will be welcome in Nigeria, easy access to the new vaccine will effectively combat hesitancy.

Mercy further observed that generally this would not be an issue as the government agency responsible for the expanded programme on immunisation has some mechanism to deal with it. A massive vaccination campaign has addressed this for all childhood vaccinations, including BCG. There was some house-to-house vaccination of children eligible for BCG vaccine. Also, the eventual lifting of movement restrictions imposed due to COVID-19 has increased and improved access to health facilities for parents of infants.

Among the people who administer BCG vaccines in India are frontline community health workers or ASHA (Accredited Social Health Activist) workers. We spoke with Reshma Adagale, who is an ASHA worker in Maharashtra state of India and a part of Nagpur Municipal Corporation Employees Union: "During the 6-7 years of my working as ASHA worker, I have not had to convince much, as most people know it is important for children to get BCG vaccination and they are willing to get their babies vaccinated. Very few (around 1-2%) need to be counselled about its benefits or any hesitation they may have.

They may need to be informed about its public health benefits, about possible side effects, etc. Some people make flimsy excuses for not getting their child vaccinated, like 'when children get injection they keep crying for a long time; or kids get fever after vaccination and then parents have to leave their work and take the kid to the hospital (which results in loss of wages)'; or that 'we will get our child vaccinated if the family elders permit us to do so'; or 'we did not get this vaccine in the past , so why should our child get it'. These are some myths and misconceptions we come across at times. We try our best to convince them and get their kids vaccinated." However, she confirmed that she had to work hard with people to counter vaccine hesitancy against COVID-19 vaccine.

Bhagyashree, another ASHA worker in Nagpur, India, told us that in the past 5 years of her work life, she has not encountered any vaccine hesitancy against BCG. Like Reshma, she said that COVID-19 vaccine hesitancy was there. "I had to convince them on vaccine benefits, educate them on side effects, and bust myths and misconceptions like 'it will make us impotent' etc, and eventually we got our whole area vaccinated against COVID-19."

"We need to recognize the role of Auxiliary Nurse Midwives (ANMs) and ASHA workers who have been going door-to-door around the villages in raising awareness and health education about importance of these vaccines and other health interventions since years. Ultimately it is about involvement of healthcare workers and health literacy in the field. People may not know what is 'BCG,' but they are likely to understand that its shot will help protect their child from disease in future. Role of healthcare workers on the ground is phenomenal," said Jibin TC, National Working Secretary of United Nurses Association.

In May 1948, Indian Government had issued a press note stating that TB was "assuming epidemic proportions," and that it had "after careful consideration" decided to introduce BCG vaccination. Government-run BCG Vaccine Laboratory was set up in Chennai, India, in 1948, which continues to produce this vaccine till to date.

BCG vaccine was introduced and has been used in Nigeria since 1921. However, in India the first BCG shots were given in August 1948. Later when India's National TB Control Programme (now called the National TB Elimination Programme) began in 1962, BCG vaccination became its part.

Since there were questions on efficacy of BCG vaccine in preventing TB of the lungs from the early days, a large BCG clinical trial (Feasibility Study for TB Prevention Trial) was conducted in Chingelput, Tamil Nadu, India, during 1968-1987. This study showed that BCG vaccination did not offer significant protection against TB of the lungs which occurs mostly in adults.

That is why BCG vaccination policy was revised in India, recommending BCG vaccine to be given to young children within first year of the birth, by integrating it under Universal Immunization Programme. Other countries tweaked their BCG vaccine policy too due to the study's findings. BCG is now given to infants soon after birth or later, but preferably before exposure to persons with active TB disease. The same is the practice in Nigeria, where the BCG vaccine is given within the first week of birth.

In 1958, World Health Assembly of the WHO, had passed a resolution to eradicate smallpox, following which India started its National Smallpox Eradication Programme in 1962 with the goal to give smallpox jab to all population. But the uptake of this vaccine (which was discovered in 1778) remained low in the following years for myriad reasons.

India eventually became smallpox free in 1977 and Nigeria in 1980. It is important to note that in India the first smallpox vaccine shot was administered in 1802. But it took almost 200 years to make India smallpox free in 1977.

After achieving its 'smallpox-free' milestone, India launched a nationwide Expanded Programme of Immunization in 1978 which included the goal to vaccinate 80% of infants in major urban hospitals with BCG vaccine. As was expected, coverage remained abysmally low. In 1985, India's Expanded Programme of Immunization evolved as Universal Immunization Programme with major changes and a broader scope.

After about five decades of its setup, it was only in 2000-2001, when Indian government's BCG Vaccine Laboratory was producing enough BCG vaccines to meet 100% requirement of Universal Immunization Programme, as well as to export the vaccine to other nations in need. Consequently, it stopped import of BCG vaccine. Private BCG manufacturers, including Serum Institute of India, began BCG vaccine production in 2002 onwards.

"Current BCG coverage is high in most parts of India. If there are better vaccines people will take it - if its safety and efficacy is not in doubt. That is because a general idea that 'vaccines are good for infants' is accepted. But when we talk about vaccines for adults and/or older children (more than one year of age), then there are a whole lot of reasons why people may not want to opt for it," said Dr. Jacob John. "Reluctance in some people to take adult vaccination or get older children vaccinated is more of a sociological issue than hesitancy."

We spoke to some leaders who are major influencers of TB response in India. "The existing BCG vaccine is a part of the universal immunization programme and is given to all infants born on day-zero. But the new vaccines that are being researched will hopefully be applicable to a larger population, if proven to be safe and effective. Research is currently underway so we will hopefully get to know soon if these new TB-vaccine candidates under research will be prioritised for most-at-risk populations, household contacts of TB patients, and for re-vaccination of those who got BCG shots earlier. The last word on the new vaccine(s) is not yet out to be used on a programmatic scale," said Dr. Kuldeep Singh Sachdeva, former head of India's national TB programme who has been deeply involved in the fight against TB for around two decades now. He currently heads the Southeast Asia regional office of International Union Against Tuberculosis and Lung Disease (The Union).

There are several new TB vaccine candidates that are currently under different stages of research. Dr. C Padmapriyadarsini, who is a noted scientist and the Director of government-run National Institute for Research in Tuberculosis. (NIRT), Indian Council of Medical Research, said: "NIRT is involved with the study of recombinant BCG vaccine, which is a TB preventive (prophylaxis) vaccine meant for the household contacts of TB patients. This study has been going on for almost 3 years now and is being done at 12 sites across India. In the study, household contacts of TB patients (who are above 14 years of age) were screened for TB and those who tested negative for TB disease, were given this TB preventive vaccine. There was a follow up period of 2 years to see whether they developed (or not developed) TB. While we are expecting good results, the interim results will be available by end of March 2023 or early April 2023. Only then will it be known if this vaccine is helpful in preventing TB."

The recombinant BCG vaccine is also being tested in Bangladesh (and a few centres in India) to see if it can prevent TB recurrence when given to treated TB patients. Results of this are also expected around end of March 2023 or early April 2023.

India is also planning a study to investigate BCG revaccination or BCG vaccination in adult population. "We will investigate whether the BCG vaccine (that is currently used to vaccinate infants) can be used for adult vaccination to prevent TB. Some countries are already trying this BCG vaccine in adults to see whether it would prevent TB. A few small studies have shown that it increases the immunity of an individual," said Dr. Padmapriyadarsini.

"There could be hesitancy when a new TB vaccine is introduced. And to overcome that and increase its acceptance we need to create awareness in the public. We saw a similar thing in COVID-19 vaccine where initially there was a lot of hesitancy. So, we must create awareness in the public that the vaccine is safe, and from what does it protect. That type of confidence building will go a long way in removing vaccine hesitancy and increase uptake of any vaccine," rightly said Dr. Padmapriyadarsini.

Currently, feasibility and acceptability studies are also going on regarding the possible new TB vaccine in India, to find out if and why people might be hesitant to take it. "By the time the vaccine is ready we will have these results also. It would help if the vaccine became a part of the government vaccine immunization programme. For faster uptake, vaccine rollout must be a joint venture involving the manufacturer, government, public and private sector, and all other stakeholders who can help," said Dr. Padmapriyadarsini.

Dr. Sachdeva agrees: "We will have to take along other stakeholders to help improve the acceptance of a possible new TB vaccine (currently under research) and scale up its uptake in the targeted populations. An important element for the roll out of new TB vaccine will be capacity building of the healthcare providers and the community. Lessons learned from COVID-19 vaccination will go a long way to reduce vaccine hesitancy to a large extent in the rollout of any new vaccine for TB or any other disease in the future."

Not only was the TB programme adversely impacted due to the COVID-19 pandemic, but there was also a decline of TB funding from US$ 5.8 billion to US$ 5.3 billion, which resulted in a drop in the number of children who got BCG shots.

If we are to end TB, we must stop neglecting TB prevention - be it infection control or other measures that reduce risk of getting active TB disease. A safe and effective TB vaccine for all age groups is an important cog-in-the-wheel of the TB combination prevention cascade.

Source: CNS

---