Information about rotavirus disease, vaccines and recommendations for vaccination from the Australian Immunisation Handbook
No new updates available.
Before rotavirus vaccines were available, rotavirus infection was the most common cause of severe gastroenteritis in infants and young children. The illness usually begins suddenly with vomiting followed by diarrhoea. Rotavirus infection can result in dehydration and hospitalisation.
All infants <6 months of age are recommended to receive a course of oral rotavirus vaccine.
All infants <6 months of age are recommended to receive a course of either Rotarix or RotaTeq.
The vaccination course of Rotarix is 2 doses, at 2 and 4 months of age.
The vaccination course of RotaTeq is 3 doses, at 2, 4 and 6 months of age.
Infants and children can be infected with rotavirus several times during their lives. Rotavirus vaccination significantly reduces rotavirus-specific and all-cause hospital presentations for gastroenteritis.
Infants aged <6 months are recommended to receive rotavirus vaccine
All infants are recommended to receive a course of oral rotavirus vaccine before they are 6 months old.
Infants can receive the 1st dose of rotavirus vaccine as early as 6 weeks of age (see Table. Upper age limits for dosing of oral rotavirus vaccines). Infants should receive the next scheduled rotavirus vaccine dose(s) according to Table. Upper age limits for dosing of oral rotavirus vaccines.
Infants and children >6 months of age should not receive rotavirus vaccines.
Age of routine administration
Age limit for 1st dose
Age limit for 2nd dose
Age limit for 3rd dose
Minimum interval between doses
Rotarix (GlaxoSmithKline Australia)
2 oral doses (1.5 mL/dose)
2 and 4 months
6–14 weeks (before turning 15 weeks of age)
10–24 weeks (before turning 25 weeks of age)
RotaTeq (Merck Sharp & Dohme)
3 oral doses (2 mL/dose)
2, 4 and 6 months
6–12 weeks (before turning 13 weeks of age)
10–32 weeks (preferably before turning 28 weeks of age, to allow at least 4 weeks between the 2nd and 3rd doses)
14–32 weeks (before turning 33 weeks of age)
Rotarix (human monovalent rotavirus vaccine)
The vaccination course of Rotarix is 2 doses, at 2 and 4 months of age:
- Give the 1st dose between 6 and 14 weeks of age — that is, before turning 15 weeks old.
- Give the 2nd dose by 24 weeks of age — that is, before turning 25 weeks old.
- Ensure that the interval between the 2 doses is at least 4 weeks.
RotaTeq (pentavalent human–bovine reassortant rotavirus vaccine)
The vaccination course of RotaTeq is 3 doses, at 2, 4 and 6 months of age:
- Give the 1st dose between 6 and 12 weeks of age — that is, before turning 13 weeks old.
- Give the 2nd dose at least 4 weeks later.
- Give the 3rd dose by 32 weeks of age — that is, before turning 33 weeks old.
- Ensure that the interval between doses 2 and 3 is at least 4 weeks.
For infants receiving their 2nd dose after reaching 29 weeks of age and before turning 33 weeks of age, this 2nd dose will also be their final dose.
Receiving the 1st dose after the age cut-off
Infants should start the course of rotavirus vaccination within the recommended age limits for the 1st dose — that is:
- before 15 weeks of age for Rotarix
- before 13 weeks of age for RotaTeq
If an infant receives the 1st dose of rotavirus vaccine after this age, they can receive the remaining vaccine doses as per the schedule. Maintain the minimum interval between doses within the recommended age limits for later doses.
The timing of the 1st dose should not affect the safety and efficacy of the 2nd and 3rd doses.1
Completing the schedule after rotavirus infection
Infants who develop rotavirus gastroenteritis before receiving the full course of rotavirus vaccine should still complete the full 2- or 3-dose schedule. One rotavirus infection only provides partial immunity.1
Preterm infants are recommended to receive either rotavirus vaccine starting at the chronological age of at least 6 weeks, if the infant is clinically stable. Do not correct the age for prematurity.
Preterm infants (born at <37 weeks gestation) appear to have a higher risk of hospitalisation from viral gastroenteritis.2,3
See also Vaccine information.
Vaccinating hospitalised infants, including hospitalised preterm infants, has a low risk of transmitting vaccine viruses if standard infection control precautions are maintained.4
See Contraindications and precautions for more details about hospitalised infants and other special risk groups.
Infants’ consumption of food and liquid
There are no restrictions on the infant’s consumption of food or liquid, including breast milk, before or after vaccination with either rotavirus vaccine.1,5
Infants living in households with pregnant women
Infants living in households with pregnant women can receive rotavirus vaccines. Most pregnant women will have immunity to rotavirus. However, vaccinating infant contacts may benefit adults, including pregnant women, by protecting them from transmission of wild-type infection. Vaccination outweighs any theoretical concern about exposure to vaccine viruses.
Vaccines, dosage and administration
Registered for use in infants, with an upper age limit for dose 2 of 24 weeks.
Live attenuated human rotavirus vaccine
Each 1.5 mL monodose pre-filled oral applicator or squeezable tube contains:
- ≥106.0 cell culture infectious dose 50% (CCID50) of the RIX4414 human rotavirus strain, type G1P
- di-sodium adipate
- Dulbecco’s modified Eagle medium
- sterile water
Registered for use in infants, with an upper age limit for dose 3 of 32 weeks.
Live attenuated pentavalent human–bovine reassortant rotavirus vaccine
Each 2.0 mL monodose pre-filled dosing tube contains:
- a minimum dose level of at least 2.0 x 106 infectious units of each of the rotavirus reassortants G1, G2, G3, G4 and P1A derived from rotaviruses infecting human and bovine species
- sodium citrate
- sodium phosphate monobasic monohydrate
- sodium hydroxide
- polysorbate 80
- cell culture medium
Dose and route
Rotavirus vaccines are for oral administration only. Never inject rotavirus vaccines.
Infants receive Rotarix as a 2-dose course. Upper age limits apply (see Table. Upper age limits for dosing of oral rotavirus vaccines).
Rotarix is a clear, colourless liquid formulation in an oral applicator. The applicator may be:
- a syringe-type applicator with a plunger stopper
- a squeezable tube
To administer, squeeze the 1.5 mL dose of vaccine onto the inside of the infant’s cheek. Do not dilute or reconstitute.
Infants receive RotaTeq as a 3-dose course. Upper age limits apply (see Table. Upper age limits for dosing of oral rotavirus vaccines).
RotaTeq is a pale-yellow, clear liquid that may have a pink tint. It comes in a squeezable plastic, latex-free dosing tube with a twist-off cap.
To administer, squeeze the 2 mL dose onto the inside of the infant’s cheek. Do not dilute or reconstitute.
Limited data are available on:
- the safety of giving higher than the recommended dose of rotavirus vaccine
- the efficacy of a partially administered dose
If an infant spits out or vomits most of a vaccine dose within minutes of receiving it, give 1 repeat dose during the same visit.
If an infant spits out or vomits only a small part of a vaccine dose, it is still considered valid — do not repeat the dose.
Co-administration with other vaccines
Rotavirus vaccines can be co-administered with other vaccines included on the National Immunisation Program schedule at the relevant time points. Co-administration of oral rotavirus vaccines is safe and effective. Rotavirus vaccines do not interfere with the immune response to antigens in other vaccines (DTPa [diphtheria-tetanus-acellular pertussis], Hib [Haemophilus influenzae type b], polio, hepatitis B and pneumococcal conjugate vaccines). 5-7
There are no restrictions on the timing of any other live vaccines in relation to rotavirus vaccines.8 These may include BCG (bacille Calmette–Guérin) vaccine or oral poliomyelitis vaccine given overseas.
Interchangeability of rotavirus vaccines
Try to use the same brand of vaccine for the entire vaccination course. Few studies address the interchangeability of the 2 available rotavirus vaccines. 9
However, if an infant received dose 1 or 2 as RotaTeq, give a 3rd dose of either rotavirus vaccine. The upper age limits and minimum intervals between doses must still be met, as defined in Table. Upper age limits for dosing of oral rotavirus vaccines.
Contraindications and precautions
The contraindications to rotavirus vaccines are:
- anaphylaxis after a previous dose of any rotavirus vaccine
- anaphylaxis after any component of a rotavirus vaccine
- history of intussusception
- congenital abnormality that may predispose to intussusception
- severe combined immunodeficiency in infants
If an infant has had intussusception before, their risk of having it again is about 10%.10 Certain congenital malformations that affect the gut, such as Meckel diverticulum, also increase the risk of intussusception.
Infants with severe combined immunodeficiency
Infants with severe combined immunodeficiency are unlikely to generate a protective immune response to vaccination, and there is a risk of harm from the vaccine. In case reports from the United States, infants with severe combined immunodeficiency had prolonged gastrointestinal disease after rotavirus vaccination, associated with the vaccine virus. 11-13
For infants with less severe immunocompromising conditions, the risk of vaccine-associated disease is likely to be less than the risk of natural rotavirus infection. See Infants who are immunocompromised in Precautions.
Infants with acute gastroenteritis
Do not vaccinate infants with moderate to severe acute gastroenteritis until they have recovered. Rotavirus vaccines have not been studied in infants with acute gastroenteritis.
Infants with mild gastroenteritis (including mild diarrhoea) can receive the vaccine.
Infants with underlying conditions that predispose them to severe rotavirus gastroenteritis
Conditions that predispose infants to severe or complicated rotavirus gastroenteritis include: 14
- metabolic disorders
- chronic gastrointestinal disease, such as Hirschsprung disease
- malabsorption syndromes
- short gut syndrome
Data are limited about the safety of rotavirus vaccines in these groups. In one report, 8 of 9 infants with high-output ileostomies tolerated RotaTeq, and 1 infant had an increase in ileostomy losses.15
Because of the greater risk of serious rotavirus disease, the benefits from vaccination are expected to outweigh the risk in these infants.
Infants who are immunocompromised
There are theoretical concerns that vaccine-associated gastrointestinal disease could occur in immunocompromised infants who receive rotavirus vaccines. The risk from vaccination for infants with less severe immunocompromising conditions may be lower than the risk from natural rotavirus infection. Consider the risks and benefits of vaccination in the context of the infant’s specific immunocompromising condition. Seek appropriate specialist advice.1
Infants with HIV
Infants with HIV have received rotavirus vaccines in clinical trials.16-18 Data are limited, but suggest that the vaccines are safe and immunogenic in children with HIV who are clinically stable.19,20
Infants born to mothers with immunocompromising conditions
No data are available on the use of rotavirus vaccines in infants born to women who received immunosuppressive therapy in pregnancy.
See Use of immunosuppressive therapy during pregnancy in Vaccination for women who are planning pregnancy, pregnant or breastfeeding.
Infants living in households with people who are immunocompromised
Infants living in households with people who are immunocompromised are recommended to receive rotavirus vaccine.
In general, vaccinating young children in the household protects immunocompromised household members. This should outweigh the risk of transmitting vaccine virus to the immunocompromised household member. However, no studies have addressed this question.1
Infants who recently received antibody-containing blood products
Infants who have recently received antibody-containing blood products and are of an eligible age can receive rotavirus vaccine. Rotavirus vaccine can be given at any time before or after, or at the same time as, any antibody-containing products.1
Minimal data are available on the impact of blood products on the immune response to the rotavirus vaccine in these infants. Completing the full rotavirus vaccine series will optimise protection.1
Giving rotavirus vaccine to hospitalised infants, including preterm infants, is likely to carry a low risk for transmission of vaccine viruses if standard infection control precautions are maintained.
Do not delay vaccination if the infant is medically stable. In particular, do not delay vaccination if this would mean the infant is beyond the upper age limit for vaccination. See Recommendations.
However, some studies have shown a link. See Australian studies and Overseas studies below.
Importantly, Australian22-25 and international26 studies have demonstrated the substantial impact of vaccination in preventing rotavirus morbidity and mortality. See also Epidemiology. Rotavirus vaccines continue to be recommended based on the positive benefit-to-risk profile.
Immunisation providers should inform parents and carers about the rare risk of intussusception, and how to be alert for its signs and symptoms.
The baseline risk of intussusception for Australian infants is around 80 cases per 100,000 infants.27 A post-marketing study in Australia found a 4- to 5-fold increase in intussusception risk in the 7 days after the 1st dose of either Rotarix or RotaTeq.28 However, no overall increase in the risk of intussusception was detected during the first 9 months of life.28
Another Australian study estimated the increased risk of intussusception for either vaccine to be:29
- about 9-fold in the first 7 days after dose 1
- 2-fold in the first 7 days after dose 2
This study shows that rotavirus vaccination may be associated with about 6 additional cases of intussusception for every 100,000 infants vaccinated. This equates to 14 more cases per year in Australia.29 This estimate assumes that infants who have intussusception shortly after vaccination would not have otherwise had a ‘natural’ episode of intussusception. However, this cannot be determined from current data.
An apparent increase in risk for intussusception after the 1st dose of Rotarix has been observed in Mexico, and a smaller increase after the 2nd dose of Rotarix in Brazil.26
A study in the United States found a small increased risk of intussusception after receiving RotaTeq.30 The study was underpowered to detect a risk after Rotarix.30
Other adverse events
Several studies followed up several thousand infants who received Rotarix. Vaccinated infants had no significant increase in post-vaccination vomiting, diarrhoea or fever compared with unvaccinated infants.21,31
A detailed follow-up study of 11,700 recipients of RotaTeq or placebo reported no increase in fever or irritability in the week after vaccination among vaccinated infants. There was a small increase in the incidence of vomiting (7% versus 5%) and diarrhoea (10% versus 9%).32 Post-marketing surveillance of rotavirus vaccines has not reported vomiting and diarrhoea as important adverse events after immunisation.
Infants who report an episode of diarrhoea or vomiting after vaccination should still receive subsequent rotavirus vaccine doses to complete the schedule. Potential causes of diarrhoea or vomiting after vaccination include:
- gastroenteritis that is unrelated to rotavirus vaccination or infection (that is, another virus)
- natural rotavirus infection (vaccination does not protect immediately or completely against all disease)
- symptoms from vaccine virus replication (less likely)
Detecting rotavirus in routine stool tests
If routine stool testing detects rotavirus in a recently vaccinated infant, this can indicate either natural infection or vaccine virus. Vaccine virus shedding commonly occurs after vaccination. See Vaccine information.
Nature of the disease
Rotaviruses are non-enveloped RNA viruses. They are classified according to the 2 surface proteins they contain:
- VP7, the ‘G’ glycoprotein
- VP4, the protease-cleaved ‘P’ protein
The G and P proteins are targets for the neutralising antibodies that help protect against reinfection and disease.14,33 The 2 gene segments that encode these proteins can segregate independently. A binary typing system uses both P and G types.
Rotavirus strains are most commonly referred to by their G serotype. G1, G2, G3, G4 and G9 account for around 90% of serotypes, both globally and in Australia.34,35 The most common P types found in combination with these G types are:36
- P1A, found with all common G types except G2
- P1B, usually found in combination with G2
Infected children shed high concentrations of rotaviruses in their stools. Viruses are transmitted by the faecal–oral route, through both close person-to-person contact and fomites.37 Rotaviruses might also be transmitted by other modes, such as through faecally contaminated food and water, and probably through respiratory droplets.1,38
The incubation period is 1–3 days.
Rotavirus is the main agent of severe dehydrating gastroenteritis in infants and young children in developed and developing countries.14,33 The spectrum of rotavirus infection can include:
- asymptomatic infection
- mild, watery diarrhoea of limited duration
- severe dehydrating diarrhoea with vomiting, fever, electrolyte imbalance, shock and death
Rotavirus infections are often more severe than other common causes of diarrhoea. These infections are more likely to result in dehydration and hospitalisation.1,14
The illness usually begins suddenly with vomiting, followed by diarrhoea.1 Up to one-third of patients have a temperature of >39°C in the first few days of illness. Symptoms generally resolve in 3–7 days.
Natural infection and immunity
Infection in early childhood is thought to be universal in unvaccinated children. People can be infected several times in their lives. The first infection, which typically occurs between 3 and 36 months of age, is most likely to cause severe diarrhoea and dehydration.39,40
- 40% of children are protected against any subsequent infection with rotavirus
- 75% are protected against diarrhoea from a subsequent rotavirus infection
- 88% are protected against severe diarrhoea caused by rotavirus
Repeat infections provide even greater protection.
Hospitalisation and deaths from rotavirus infection in Australia
Rotavirus vaccines were added to the National Immunisation Program in 2007. Before this, about 10,000 children <5 years of age were hospitalised because of rotavirus each year in Australia. 41 This equated to around half of all hospitalisations for acute gastroenteritis in this age group.41,42 Rotavirus affected about 3.8% of all children (1 in 27) by the age of 5 years.
In addition to hospitalisations:41,43
- about 115,000 children <5 years of age saw a general practitioner
- 22,000 children attended an emergency department because of rotavirus
On average, 1 death was attributed to rotavirus each year in Australia, but this is likely to be a minimum estimate.43
Since 2007, both rotavirus-specific and all-cause hospital presentations for gastroenteritis have reduced by more than 70%.22-25 Emergency department visits for acute gastroenteritis have also declined, as have rotavirus notifications.44,45
Patterns of rotavirus infection in Australia
In temperate Australia, rotavirus infections follow a seasonal pattern. The peak incidence is in mid to late winter.
The northern tropical and arid regions do not show a consistent seasonal pattern. Disease peaks are unpredictable, 46 and widespread epidemics cause severe strain on healthcare services.47,48
In Aboriginal and Torres Strait Islander children
Compared with their non-Indigenous peers, Aboriginal and Torres Strait Islander infants and children: 42,46,47,49
- are hospitalised with rotavirus gastroenteritis about 3–5 times more often
- are younger at hospitalisation
- have a longer duration of hospital stay (an average of 5 days, compared with 2 days for non-Indigenous infants)
Rotavirus infection in people who are immunocompromised
Immunocompromised children and adults are at increased risk of severe, prolonged and even fatal rotavirus gastroenteritis.14,50,51 This includes people with congenital immunodeficiency, or people who have received a haematopoietic stem cell transplant or solid organ transplant.
Rotavirus is an important cause of nosocomial gastroenteritis.52-56 It can also cause disease in adults, especially among people caring for children and people residing in aged care facilities.14,57,58
Two oral rotavirus vaccines are available in Australia. Their efficacy and safety in preventing rotavirus gastroenteritis have been extensively evaluated.16-18,21,59-61 Both are live attenuated vaccines given orally to infants, but the component vaccine viruses differ.
Rotarix (GlaxoSmithKline) contains 1 strain of attenuated human rotavirus (G1P strain). It protects against non-G1 serotypes based on other shared epitopes.
RotaTeq (Merck Sharp & Dohme) contains 5 human–bovine reassortant rotavirus strains: G1, G2, G3, G4 and P1A. Protective efficacy against different serotypes is similar in both vaccines.21,59,60
Efficacy and effectiveness in middle- and high-income countries
In middle- and high-income countries, a course of vaccination with either Rotarix or RotaTeq prevents:59,60,62,63
- rotavirus gastroenteritis of any severity in approximately 70% of recipients
- severe rotavirus gastroenteritis and rotavirus hospitalisation for 85–100% of recipients for up to 3 years
Vaccination is also highly effective in preventing visits to the emergency department, clinic or general practitioner.59,62 In pre-market clinical trials, rotavirus vaccination prevented around half (42–58%) of hospital admissions for acute gastroenteritis of any cause in young children. This suggests that rotavirus is responsible for more gastroenteritis than is detected using routine testing and admission practices.59,60,62
Post-marketing studies in Australia and the United States have confirmed high vaccine effectiveness and impressive reductions in both rotavirus-coded and all-cause gastroenteritis hospitalisations.23,45,64-68 Hospitalisations have also decreased in age groups that are not eligible for vaccination, suggesting that rotavirus vaccines have herd-protective effects.23,45,67
Efficacy and effectiveness in resource-poor areas
Resource-poor settings have reported more modest estimates of efficacy.16-18,69 However, post-marketing studies in Brazil and Mexico (middle-income countries) have shown substantial reductions in diarrhoea-related mortality since rotavirus vaccines were introduced.70,71
In Central Australia, Rotarix studies during consecutive rotavirus epidemics estimated lower and wider-ranging vaccine effectiveness, which requires further investigation.68,72 The remote Australian setting is unique, and these results should not be extrapolated to elsewhere in Australia.
Efficacy in preterm infants
In clinical trials, RotaTeq or placebo was given to 2070 preterm infants (25–36 weeks gestational age; median 34 weeks). Efficacy against rotavirus gastroenteritis of any severity appeared to be comparable with efficacy in full-term infants (73%; 95% CI: –2% to 95%).73
Rotarix should give the same results, because it appears to be safe and immunogenic in preterm infants.74
Vaccine virus shedding
Vaccine viruses replicate in the intestinal mucosa. Vaccinated people can shed the virus in their stools, particularly after the 1st dose.
Vaccine virus shedding is more common with Rotarix. Virus is detected in stools 1 week after vaccination in up to: 6,7
- 80% of 1st-dose recipients
- 30% of 2nd-dose recipients
In 1 study of 80 sets of twins, 15 vaccinated infants transmitted Rotarix to their unvaccinated twin.75 This suggests that vaccine virus can be transmitted to unvaccinated contacts, but the clinical implication of this has not been studied. See Contraindications and precautions.
RotaTeq is only shed after the 1st dose in up to 13% of recipients.59
Porcine circoviruses in rotavirus vaccines
Adventitious DNA fragments of porcine circoviruses have been detected in both Rotarix and RotaTeq vaccines. However, porcine circoviruses have never been shown to cause illness in humans and are considered non-pathogenic.
Transporting, storing and handling vaccines
Public health management
Rotavirus is a notifiable disease in some states and territories in Australia.
State and territory public health authorities can provide advice about the public health management of rotavirus, including management of cases and contacts.
Variations from product information
The product information for Rotarix states that the vaccine should not be given to people with any chronic gastrointestinal disease.
The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that pre-existing chronic gastrointestinal disease is not a contraindication to rotavirus vaccination. The exceptions are conditions that may predispose to intussusception. See Contraindications and precautions.
The product information for RotaTeq states that if a dose of vaccine is spat out or vomited, a replacement dose should not be given.
ATAGI recommends that infants who spit out or vomit most of a dose can receive a single replacement dose. See Vaccines, dosage and administration.
- Centers for Disease Control and Prevention (CDC), Cortese MM, Parashar UD. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). [erratum appears in MMWR Recomm Rep. 2010 Aug 27;59(33):1074]. MMWR. Recommendations and Reports 2009;58(RR-2):1-25.
- Newman RD, Grupp-Phelan J, Shay DK, Davis RL. Perinatal risk factors for infant hospitalization with viral gastroenteritis. Pediatrics 1999;103:e3.
- Dennehy PH, Cortese MM, Bégué RE, et al. A case-control study to determine risk factors for hospitalization for rotavirus gastroenteritis in US children. Pediatric Infectious Disease Journal 2006;25:1123-31.
- Thrall S, Doll MK, Nhan C, et al. Evaluation of pentavalent rotavirus vaccination in neonatal intensive care units. Vaccine 2015;33:5095-102.
- Dennehy PH, Brady RC, Halperin SA, et al. Comparative evaluation of safety and immunogenicity of two dosages of an oral live attenuated human rotavirus vaccine. Pediatric Infectious Disease Journal 2005;24:481-8.
- Phua KB, Quak SH, Lee BW, et al. Evaluation of RIX4414, a live, attenuated rotavirus vaccine, in a randomized, double-blind, placebo-controlled phase 2 trial involving 2464 Singaporean infants. Journal of Infectious Diseases 2005;192 Suppl 1:S6-16.
- Salinas B, Pérez-Schael I, Linhares AC, et al. Evaluation of safety, immunogenicity and efficacy of an attenuated rotavirus vaccine, RIX4414: a randomized, placebo-controlled trial in Latin American infants. Pediatric Infectious Disease Journal 2005;24:807-16.
- World Health Organization (WHO). Summary of WHO position papers – recommended routine immunizations for children. 2018. (Accessed May 2018).
- Cortese MM, Immergluck LC, Held M, et al. Effectiveness of monovalent and pentavalent rotavirus vaccine. Pediatrics 2013;132:e25-33.
- Daneman A, Alton DJ, Lobo E, et al. Patterns of recurrence of intussusception in children: a 17-year review. Pediatric Radiology 1998;28:913-9.
- Patel NC, Hertel PM, Estes MK, et al. Vaccine-acquired rotavirus in infants with severe combined immunodeficiency. New England Journal of Medicine 2010;362:314-9.
- Bakare N, Menschik D, Tiernan R, Hua W, Martin D. Severe combined immunodeficiency (SCID) and rotavirus vaccination: reports to the Vaccine Adverse Events Reporting System (VAERS). Vaccine 2010;28:6609-12.
- Werther RL, Crawford NW, Boniface K, Kirkwood CD, Smart JM. Rotavirus vaccine induced diarrhea in a child with severe combined immune deficiency [letter]. Journal of Allergy and Clinical Immunology 2009;124:600.
- Estes MK, Kapikian AZ. Rotaviruses. In: Knipe DM, Howley PM, Griffin DE, et al., eds. Fields virology. 5th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2007.
- Fang AY, Tingay DG. Early observations in the use of oral rotavirus vaccination in infants with functional short gut syndrome. Journal of Paediatrics and Child Health 2011;48:512-6.
- Madhi SA, Cunliffe NA, Steele D, et al. Effect of human rotavirus vaccine on severe diarrhea in African infants. New England Journal of Medicine 2010;362:289-98.
- Armah GE, Sow SO, Breiman RF, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial. The Lancet 2010;376:606-14.
- Zaman K, Dang DA, Victor JC, et al. Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. The Lancet 2010;376:615-23.
- Steele AD, Cunliffe N, Tumbo J, et al. A review of rotavirus infection in and vaccination of human immunodeficiency virus-infected children. Journal of Infectious Diseases 2009;200 Suppl 1:S57-62.
- Steele AD, Madhi SA, Louw CE, et al. Safety, reactogenicity, and immunogenicity of human rotavirus vaccine RIX4414 in human immunodeficiency virus-positive infants in South Africa. Pediatric Infectious Disease Journal 2011;30:125-30.
- Soares-Weiser K, MacLehose H, Bergman H, et al. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database of Systematic Reviews 2012;(2):CD008521. doi:10.1002/14651858.CD008521.pub2.
- Buttery JP, Lambert SB, Grimwood K, et al. Reduction in rotavirus-associated acute gastroenteritis following introduction of rotavirus vaccine into Australia's national childhood vaccine schedule. [erratum appears in Pediatr Infect Dis J. 2011 Oct; 30(10):916]. Pediatric Infectious Disease Journal 2011;30(1 Suppl):S25-9.
- Macartney KK, Porwal M, Dalton D, et al. Decline in rotavirus hospitalisations following introduction of Australia's national rotavirus immunisation programme. Journal of Paediatrics and Child Health 2011;47:266-70.
- Clarke MF, Davidson GP, Gold MS, Marshall HS. Direct and indirect impact on rotavirus positive and all-cause gastroenteritis hospitalisations in South Australian children following the introduction of rotavirus vaccination. Vaccine 2011;29:4663-7.
- Dey A, Wang H, Menzies R, Macartney K. Changes in hospitalisations for acute gastroenteritis in Australia after the national rotavirus vaccination program. Medical Journal of Australia 2012;197:453-7.
- Patel MM, López-Collada VR, Bulhões MM, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. New England Journal of Medicine 2011;364:2283-92.
- Justice F, Carlin J, Bines J. Changing epidemiology of intussusception in Australia. Journal of Paediatrics and Child Health 2005;41:475-8.
- Buttery JP, Danchin MH, Lee KJ, et al. Intussusception following rotavirus vaccine administration: post-marketing surveillance in the National Immunization Program in Australia. Vaccine 2011;29:3061-6.
- Carlin JB, Macartney KK, Lee KJ, et al. Intussusception risk and disease prevention associated with rotavirus vaccines in Australia's national immunization program. Clinical Infectious Diseases 2013;57:1427-34.
- Yih WK, Lieu TA, Kulldorff M, et al. Intussusception risk after rotavirus vaccination in US infants. New England Journal of Medicine 2014;370:503-12.
- Cheuvart B, Friedland LR, Abu-Elyazeed R, et al. The human rotavirus vaccine RIX4414 in infants: a review of safety and tolerability. Pediatric Infectious Disease Journal 2009;28:225-32.
- Dennehy PH, Goveia MG, Dallas MJ, Heaton PM. The integrated phase III safety profile of the pentavalent human-bovine (WC3) reassortant rotavirus vaccine. International Journal of Infectious Diseases 2007;11 Suppl 2:S36-42.
- Cunliffe NA, Nakagomi O. A critical time for rotavirus vaccines: a review. Expert Review of Vaccines 2005;4:521-32.
- Bishop RF, Masendycz PJ, Bugg HC, Carlin JB, Barnes GL. Epidemiological patterns of rotaviruses causing severe gastroenteritis in young children throughout Australia from 1993 to 1996. Journal of Clinical Microbiology 2001;39:1085-91.
- Kirkwood CD, Bogdanovic-Sakran N, Cannan D, Bishop RF, Barnes GL. National Rotavirus Surveillance Program annual report, 2004–05. Communicable Diseases Intelligence 2006;30:133-6.
- Cunliffe NA, Bresee JS, Gentsch JR, Glass RI, Hart CA. The expanding diversity of rotaviruses. The Lancet 2002;359:640-2.
- Butz AM, Fosarelli P, Dick J, Cusack T, Yolken R. Prevalence of rotavirus on high-risk fomites in day-care facilities. Pediatrics 1993;92:202-5.
- Dennehy PH, Nelson SM, Crowley BA, Saracen CL. Detection of rotavirus RNA in hospital air samples by polymerase chain reaction (PCR). [1998 abstract The American Pediatric Society and The Society for Pediatric Research]. Pediatric Research 1998;43 Suppl 2:143A.
- Franco MA, Angel J, Greenberg HB. Immunity and correlates of protection for rotavirus vaccines. Vaccine 2006;24:2718-31.
- Velázquez FR, Matson DO, Calva JJ, et al. Rotavirus infection in infants as protection against subsequent infections. New England Journal of Medicine 1996;335:1022-8.
- Galati JC, Harsley S, Richmond P, Carlin JB. The burden of rotavirus-related illness among young children on the Australian health care system. Australian and New Zealand Journal of Public Health 2006;30:416-21.
- Newall AT, MacIntyre R, Wang H, Hull B, Macartney K. Burden of severe rotavirus disease in Australia. Journal of Paediatrics and Child Health 2006;42:521-7.
- Carlin JB, Chondros P, Masendycz P, et al. Rotavirus infection and rates of hospitalisation for acute gastroenteritis in young children in Australia, 1993–1996. Medical Journal of Australia 1998;169:252-6.
- Belshaw DA, Muscatello DJ, Ferson MJ, Nurkic A. Rotavirus vaccination one year on. Communicable Diseases Intelligence 2009;33:337-40.
- Lambert SB, Faux CE, Hall L, et al. Early evidence for direct and indirect effects of the infant rotavirus vaccine program in Queensland. [erratum appears in Med J Aust. 2010 May 3;192(9):525]. Medical Journal of Australia 2009;191:157-60.
- Blumer C, Roche P, Kirkwood C, Bishop R, Barnes G. Surveillance of viral pathogens in Australia. Rotavirus. Communicable Diseases Intelligence 2003;27:496-503.
- Armstrong P. Rotaviral gastroenteritis in the NT: a description of the epidemiology 1995–2001 and future directions for research. The Northern Territory Disease Control Bulletin 2001;8(3):1-5.
- Williams G, Zerna L. Rotavirus outbreak in central Australia. Australian Infection Control 2002;7:51-8.
- Schultz R. Rotavirus gastroenteritis in the Northern Territory, 1995–2004. Medical Journal of Australia 2006;185:354-6.
- Saulsbury FT, Winkelstein JA, Yolken RH. Chronic rotavirus infection in immunodeficiency. Journal of Pediatrics 1980;97:61-5.
- Yolken RH, Bishop CA, Townsend TR, et al. Infectious gastroenteritis in bone-marrow-transplant recipients. New England Journal of Medicine 1982;306:1009-12.
- Fischer TK, Bresee JS, Glass RI. Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children. Vaccine 2004;22 Suppl 1:S49-54.
- Frühwirth M, Heininger U, Ehlken B, et al. International variation in disease burden of rotavirus gastroenteritis in children with community- and nosocomially acquired infection. Pediatric Infectious Disease Journal 2001;20:784-91.
- Ringenbergs ML, Davidson GP, Spence J, Morris S. Prospective study of nosocomial rotavirus infection in a paediatric hospital. Australian Paediatric Journal 1989;25:156-60.
- Gleizes O, Desselberger U, Tatochenko V, et al. Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease. Pediatric Infectious Disease Journal 2006;25(1 Suppl):S12-21.
- Snelling T, Cripps T, Macartney K, et al. Nosocomial rotavirus infection in an Australian children's hospital [letter]. Journal of Paediatrics and Child Health 2007;43:327.
- Anderson EJ, Weber SG. Rotavirus infection in adults. The Lancet Infectious Diseases 2004;4:91-9.
- Marshall J, Botes J, Gorrie G, et al. Rotavirus detection and characterisation in outbreaks of gastroenteritis in aged-care facilities. Journal of Clinical Virology 2003;28:331-40.
- Vesikari T, Matson DO, Dennehy P, et al. Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. New England Journal of Medicine 2006;354:23-33.
- Ruiz-Palacios GM, Pérez-Schael I, Velázquez FR, et al. Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. New England Journal of Medicine 2006;354:11-22.
- Vesikari T, Karvonen A, Prymula R, et al. Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study. The Lancet 2007;370:1757-63.
- Vesikari T, Giaquinto C, Huppertz HI. Clinical trials of rotavirus vaccines in Europe. Pediatric Infectious Disease Journal 2006;25:S42-7.
- Vesikari T, Karvonen A, Ferrante SA, Kuter BJ, Ciarlet M. Sustained efficacy of the pentavalent rotavirus vaccine, RV5, up to 3.1 years following the last dose of vaccine. Pediatric Infectious Disease Journal 2010;29:957-63.
- Field EJ, Vally H, Grimwood K, Lambert SB. Pentavalent rotavirus vaccine and prevention of gastroenteritis hospitalizations in Australia. Pediatrics 2010;126:e506-12.
- Curns AT, Steiner CA, Barrett M, et al. Reduction in acute gastroenteritis hospitalizations among US children after introduction of rotavirus vaccine: analysis of hospital discharge data from 18 US states. Journal of Infectious Diseases 2010;201:1617-24.
- Wang FT, Mast TC, Glass RJ, Loughlin J, Seeger JD. Effectiveness of the pentavalent rotavirus vaccine in preventing gastroenteritis in the United States. Pediatrics 2010;125:e208-13.
- Cortese MM, Tate JE, Simonsen L, Edelman L, Parashar UD. Reduction in gastroenteritis in United States children and correlation with early rotavirus vaccine uptake from national medical claims databases. Pediatric Infectious Disease Journal 2010;29:489-94.
- Snelling TL, Schultz R, Graham J, et al. Rotavirus and the Indigenous children of the Australian outback: monovalent vaccine effective in a high-burden setting. Clinical Infectious Diseases 2009;49:428-31.
- World Health Organization (WHO). Meeting of the immunization Strategic Advisory Group of Experts, April 2009 – conclusions and recommendations. Weekly Epidemiological Record 2009;84:220-36.
- Lanzieri TM, Linhares AC, Costa I, et al. Impact of rotavirus vaccination on childhood deaths from diarrhea in Brazil. International Journal of Infectious Diseases 2011;15:e206-10.
- Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, et al. Effect of rotavirus vaccination on death from childhood diarrhea in Mexico. New England Journal of Medicine 2010;362:299-305.
- Snelling TL, Andrews RM, Kirkwood CD, Culvenor S, Carapetis JR. Case-control evaluation of the effectiveness of the G1P human rotavirus vaccine during an outbreak of rotavirus G2P infection in Central Australia. Clinical Infectious Diseases 2011;52:191-9.
- Goveia MG, Rodriguez ZM, Dallas MJ, et al. Safety and efficacy of the pentavalent human-bovine (WC3) reassortant rotavirus vaccine in healthy premature infants. Pediatric Infectious Disease Journal 2007;26:1099-104.
- Omenaca F, Sarlangue J, Szenborn L, et al. Safety, reactogenicity and immunogenicity of the human rotavirus vaccine in preterm European Infants: a randomized phase IIIb study. Pediatric Infectious Disease Journal 2012;31:487-93.
- Rivera L, Peña LM, Stainier I, et al. Horizontal transmission of a human rotavirus vaccine strain – a randomized, placebo-controlled study in twins. Vaccine 2011;29:9508-13.
- National vaccine storage guidelines: Strive for 5. 2nd ed. Canberra: Australian Government Department of Health and Ageing; 2013.
- diphtheria-tetanus-acellular pertussis vaccine
- bacille Calmette-Guérin
- ribonucleic acid
- confidence interval
- deoxyribonucleic acid
- Australian Technical Advisory Group on Immunisation
- World Health Organization
- severe combined immunodeficiency
- polymerase chain reaction
- Japanese encephalitis