Rotavirus Is Still With Us--How to Prevent an Outbreak

Hello. I'm Dr Rachel Burke, an epidemic intelligence service officer at the CDC. I'm here to talk about rotavirus disease and recent outbreaks that illustrate some general characteristics of rotavirus outbreaks in the post-vaccine era.

Rotavirus disease is a common cause of severe diarrhea and vomiting among infants and young children. Rotavirus vaccines are 85%-98% effective at preventing severe rotavirus disease.^[1] Eligible infants should receive rotavirus vaccine according to CDC's recommended immunization schedule for children.^[2]

While rotavirus disease has decreased significantly since rotavirus vaccine was introduced in 2006, cases and outbreaks still occur, usually in a winter-spring seasonal pattern.^[3]

CDC recently published a report^[3] that described three rotavirus outbreaks that occurred in California in 2017. The first outbreak occurred in a childcare center and caused mild illness in otherwise healthy children. Staff and household members also became ill. This outbreak illustrates that rotavirus outbreaks occur in the post-vaccine era even among healthy populations with many vaccinated individuals. While rotavirus vaccines are highly effective against severe illness, they do not necessarily prevent all infection or milder disease.

The second outbreak we examined happened in an adult assisted living and memory care facility, affecting both residents and staff members. This outbreak demonstrates that rotavirus can cause illness in adult populations and can spread easily in close living quarters, such as nursing homes. While adults do not receive rotavirus vaccine, vaccinated children may provide indirect protection to adult populations.

The third outbreak occurred in a subacute inpatient care facility and affected children with complex medical needs, the majority of whom were unvaccinated. This outbreak was associated with the highest attack rate among the three outbreaks, with 24 out of 25 patients and three staff members falling ill. A 22-month-old child with preexisting respiratory failure died; the cause of death was attributed to dehydration from rotavirus disease. We don't know the exact reasons why so many of the children in this outbreak were not vaccinated; however, most of them had spent time in neonatal or pediatric intensive care units, where use of live viral vaccines is discouraged, and they were too old to begin rotavirus vaccine after they were discharged.

These outbreaks provide important information about rotavirus outbreaks in the post-vaccine era. While most people had mild-to-moderate rotavirus disease, one child died. Both vaccinated and unvaccinated children were affected, as well as adults, especially those in close living quarters.

Rotavirus vaccination is the best way to reduce disease burden in the United States. Coverage of rotavirus vaccination among children lags behind other childhood vaccines, leaving many children susceptible to severe rotavirus disease.^[4] Healthcare providers can help protect children by giving the recommended doses of rotavirus vaccines on schedule. In healthcare settings, healthcare providers and staff should follow infection-control practices to prevent the spread of rotavirus.

Thank you.