(Also see Diarrhea Vaccines)

What is the Rotavirus vaccine, and who should receive it? G.N.

Dear G.N.: The rotavirus causes a diarrheal illness in infants and toddlers. It can spread rapidly in daycare centers. Several attempts have been made to develop a vaccine to prevent rotavirus infections.

A vaccine called RotaShield was licensed 1998. RotaShield was withdrawn in 1999 after it was observed that infants receiving the vaccine were more likely than non-vaccinated infants to develop a condition called intussusception, in which the intestine rolls into itself.

A second vaccine, RotaTeq was licensed in 2006 and a third, RotaRix was licensed in 2008. Both vaccines are given bymouth. On March 22, 2010 the FDA recommended that the use of the RotaRix vaccine be suspended in the United States because DNA from a pig virus, porcine circovirus 1 (PCV1), had been detected in the vaccine. Subsequently, DNA from PCV1 and another pig virus, PCV2 were found in RotaTeq.

PCV2 causes a condition called postweaning multisystemic wasting syndrome in pigs. The effects of PCV1 and PCV2 in humans are unknown. In spite of this uncertainty the FDA updated their recommendations for the use of rotavirus vaccines on May 14, 2010 based on a review of the literature and the input from experts. The FDA released a statement that it is "appropriate for clinicians and health care professionals to resume the use of RotaRix and to continue the use of RotaTeq” because both vaccines have excellent safety records and the benefits of the vaccines aresubstantial.

This is a prime example of making a decision based upon what is called "the science of the immediate experience.” In the short time that RotaTeq and RotaRix have been in use the pig viruses have not been found to cause disease in children. This is hardly reassuring.

One of the panel members justified the reinstatement of the vaccine by stating, "To get ‘good disease in pigs with PCV2,’ one must infect them with the virus and then stimulate their immune system, either by reinfecting them with the virus or vaccinating them.” Unfortunately, the current vaccination schedule assures that the infants and children receiving these vaccines will have their immune systems challenged repeatedly moving forward. Only time will tell whether the pig viruses will cause disease in humans, but if they do it will be too late for those who were unfortunate enough to have received the vaccine. I would err on the side of caution and refuse to have the vaccine administered.

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