Rotavirus Vaccine - Why bother with that one?

Rotavirus Vaccine - Why bother with that one?

Let me tell you a story.  A long, long time ago, in a world very, very different from this one, a young Dr. Fisher graduated from medical school and residency in pediatrics.  As he started his career, he expected to deal with Rotavirus season every summer.  Why?  Because every year of medical school and residency (7 years spent training in how to prevent illness and help kids stay healthy) he saw kids get admitted to the hospital during the summer for Rotavirus.  Those kids would stay 1-7 days in the hospital experiencing explosive diarrhea, fever, and since they were so sick and they refused to drink, they would have intravenous fluids until the illness went away.  There is no treatment - just intravenous fluids, which often would take repeated attempts by the hospital staff to start because the kids were so dehydrated that finding a vein was very difficult.  

As I thought about this, I wondered if maybe my memory is not accurate - I should look up what the numbers were during that time (2003-2006).  So I did, and the numbers confirmed my experience as a young physician.   The official statistics, from cdc.gov (the same place making this change) is that 2.7 million infections happened yearly, mostly children since adults are usually immune, and 95% of kids would have it at least once (one of the joys of rotavirus is you can get it multiple times) before the age of 5 years old.  These infections caused:

410,000 physician office visits a year 

200,000 ER visits a year

55,000 to 70,000 hospitalizations a year (1 in every 450 kids)

20 - 60 dead children a year

Most hospitalizations were between 3 months and 3 years

Well that sounds terrible. So what does the CDC, who took the vaccine off the recommended schedule, say about the impact of the vaccine after it was introduced in 2006?  On the CDC.gov website they say the vaccine prevented:

280,000 physician office visits a year

62,000 ER visits

45,000 hospitalizations a year (nearly all of them)

I can’t remember the last time I had a child hospitalized with rotavirus, but before the vaccine I would average a handful every summer, with many more in the office.  The above statistic of 95% chance your kid will get it, and 1 out of every  450 kids will get hospitalized means that it was very common.  As far as side effects go, I averaged about 2000 patients seeing me a year when I was at Community, and besides some loose stool, I never saw a side effect from the Rotavirus vaccine.  Every statistic in this article was from the CDC, so you have to ask yourself, why all of a sudden does the same agency want to delist the vaccine?

Another issue I want to address is the cynicism from some people that this is all about money.  Before the vaccine, the US spent 91 million dollars on rotavirus medical bills yearly (national institute of health nih.gov), but who received those dollars?  People like me, doctors, received that money.  When we vaccinate kids we make a little money on the vaccines, but we lose much more money on the appointments that never happen because the vaccines work so well!  If the medical establishment wanted to maximize profit, we would not push vaccines so hard. The less people that get vaccinated the more income it will generate for us. But instead, we push vaccines because we have dedicated a massive chunk of our lives to preventing and alleviating misery and pain, and I went into primary care because I want to build close relationships with people and help them raise healthy, wonderful kids who become amazing adults.  Vaccines are a huge part of that mission.  I just want to point this out, because we (physicians and advanced medical providers) should be a trusted resource during these times, our countless hours studying and researching these topics should hold much more credibility than facebook, lawyers, politicians, or twitter feeds.  Our office will continue to administer and require the rotavirus vaccine, in line with the AAP and other major health organizations.

As always, good luck parenting,

Dr. William J. Fisher, MD

Fisher Pediatrics