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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Rotavirus Vaccines - Drugs and Lactation Database (LactMed®) - NCBI Bookshelf</title>
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<meta name="citation_inbook_title" content="Drugs and Lactation Database (LactMed®) [Internet]">
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<meta name="citation_title" content="Rotavirus Vaccines">
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<meta name="citation_publisher" content="National Institute of Child Health and Human Development">
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<meta name="citation_date" content="2024/11/15">
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<meta name="citation_keywords" content="Rotarix">
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<meta name="citation_keywords" content="Rotateq">
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<meta name="DC.Title" content="Rotavirus Vaccines">
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<meta name="description" content="Rotavirus vaccines are used only in infants and are not indicated for use in women of childbearing age. Breastfeeding protects infants against acute gastroenteritis caused by rotavirus.[1,2] However, breastfeeding can reduce the immune response of an infant to rotavirus vaccines in low- and middle-income countries.[3-9] Breastfeeding might also reduce viral shedding in the stool by the vaccinated infants.[6] Maternal antibodies are probably an important cause of the lower response rate, but lactadherin, a milk glycoprotein, and infant genetics may also be factors.[8-10] The extent of the effect depends on the maternal anti-rotavirus antibody titer in breastmilk with higher titers found in less developed areas.[11-15] Withholding breastfeeding for up to 2 hours before and after vaccine administration has been recommended to minimize the interference.[11,16,17] However, other studies found that withholding breastfeeding for either one hour before and after immunization,[18,19] or for 30 minutes before vaccination had no effect on seroconversion.[20] Reviews have concluded that withholding of breastfeeding at the time of vaccination has no effect on seroconversion of infants.[8,21] A new vaccine strain (RV3-BB) has been developed that is not as susceptible to maternal milk antibodies and provides good protection by 18 weeks of age.[22]">
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<meta name="og:title" content="Rotavirus Vaccines">
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<meta name="og:description" content="Rotavirus vaccines are used only in infants and are not indicated for use in women of childbearing age. Breastfeeding protects infants against acute gastroenteritis caused by rotavirus.[1,2] However, breastfeeding can reduce the immune response of an infant to rotavirus vaccines in low- and middle-income countries.[3-9] Breastfeeding might also reduce viral shedding in the stool by the vaccinated infants.[6] Maternal antibodies are probably an important cause of the lower response rate, but lactadherin, a milk glycoprotein, and infant genetics may also be factors.[8-10] The extent of the effect depends on the maternal anti-rotavirus antibody titer in breastmilk with higher titers found in less developed areas.[11-15] Withholding breastfeeding for up to 2 hours before and after vaccine administration has been recommended to minimize the interference.[11,16,17] However, other studies found that withholding breastfeeding for either one hour before and after immunization,[18,19] or for 30 minutes before vaccination had no effect on seroconversion.[20] Reviews have concluded that withholding of breastfeeding at the time of vaccination has no effect on seroconversion of infants.[8,21] A new vaccine strain (RV3-BB) has been developed that is not as susceptible to maternal milk antibodies and provides good protection by 18 weeks of age.[22]">
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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501632_"><span class="title" itemprop="name">Rotavirus Vaccines</span></h1><p class="fm-aai"><a href="#_NBK501632_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 5 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="LM733.Drug_Levels_and_Effects"><h2 id="_LM733_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM733.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Rotavirus vaccines are used only in infants and are not indicated for use in women of childbearing age. Breastfeeding protects infants against acute gastroenteritis caused by rotavirus.[<a class="bibr" href="#LM733.REF.1" rid="LM733.REF.1">1</a>,<a class="bibr" href="#LM733.REF.2" rid="LM733.REF.2">2</a>] However, breastfeeding can reduce the immune response of an infant to rotavirus vaccines in low- and middle-income countries.[<a class="bibr" href="#LM733.REF.3" rid="LM733.REF.3">3</a>-<a class="bibr" href="#LM733.REF.9" rid="LM733.REF.9">9</a>] Breastfeeding might also reduce viral shedding in the stool by the vaccinated infants.[<a class="bibr" href="#LM733.REF.6" rid="LM733.REF.6">6</a>] Maternal antibodies are probably an important cause of the lower response rate, but lactadherin, a milk glycoprotein, and infant genetics may also be factors.[<a class="bibr" href="#LM733.REF.8" rid="LM733.REF.8">8</a>-<a class="bibr" href="#LM733.REF.10" rid="LM733.REF.10">10</a>] The extent of the effect depends on the maternal anti-rotavirus antibody titer in breastmilk with higher titers found in less developed areas.[<a class="bibr" href="#LM733.REF.11" rid="LM733.REF.11">11</a>-<a class="bibr" href="#LM733.REF.15" rid="LM733.REF.15">15</a>] Withholding breastfeeding for up to 2 hours before and after vaccine administration has been recommended to minimize the interference.[<a class="bibr" href="#LM733.REF.11" rid="LM733.REF.11">11</a>,<a class="bibr" href="#LM733.REF.16" rid="LM733.REF.16">16</a>,<a class="bibr" href="#LM733.REF.17" rid="LM733.REF.17">17</a>] However, other studies found that withholding breastfeeding for either one hour before and after immunization,[<a class="bibr" href="#LM733.REF.18" rid="LM733.REF.18">18</a>,<a class="bibr" href="#LM733.REF.19" rid="LM733.REF.19">19</a>] or for 30 minutes before vaccination had no effect on seroconversion.[<a class="bibr" href="#LM733.REF.20" rid="LM733.REF.20">20</a>] Reviews have concluded that withholding of breastfeeding at the time of vaccination has no effect on seroconversion of infants.[<a class="bibr" href="#LM733.REF.8" rid="LM733.REF.8">8</a>,<a class="bibr" href="#LM733.REF.21" rid="LM733.REF.21">21</a>] A new vaccine strain (RV3-BB) has been developed that is not as susceptible to maternal milk antibodies and provides good protection by 18 weeks of age.[<a class="bibr" href="#LM733.REF.22" rid="LM733.REF.22">22</a>]</p><p>A European study found no difference in rotavirus infection rates during the first season between infants who were breastfed and formula-fed when they received rotavirus vaccination. In the second season, protection against infection was slightly less in breastfed infants.[<a class="bibr" href="#LM733.REF.4" rid="LM733.REF.4">4</a>] A German study found that exclusive or partial breastfeeding increased the risk of breakthrough infection fourfold.[<a class="bibr" href="#LM733.REF.5" rid="LM733.REF.5">5</a>] A study in Indonesia found that rotavirus vaccine was cost-effective for the health system, even with improved breastfeeding rates.[<a class="bibr" href="#LM733.REF.23" rid="LM733.REF.23">23</a>]</p><p>Studies have found that breastfeeding decreases the risk of intestinal intussusception caused by rotavirus vaccine by about half.[<a class="bibr" href="#LM733.REF.24" rid="LM733.REF.24">24</a>,<a class="bibr" href="#LM733.REF.25" rid="LM733.REF.25">25</a>]</p></div><div id="LM733.Drug_Levels"><h3>Drug Levels</h3><p><i>Maternal Levels.</i> Relevant published information was not found as of the revision date.</p><p><i>Infant Levels.</i> Relevant published information was not found as of the revision date.</p></div><div id="LM733.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>A subset of 300 infants in a multicenter European rotavirus efficacy trial had antirotavirus IgA titers measured 1 to 2 months after the second rotavirus dose (Rotarix - GSK). Breast-fed infants had an 85.5% conversion rate compared with 89.2% rate in exclusively formula-fed infants, which was not statistically different. The serum antirotavirus IgA concentrations were 185.8 units/mL and 231.5 units/mL in the breastfed and exclusively formula-fed infants, respectively.[<a class="bibr" href="#LM733.REF.4" rid="LM733.REF.4">4</a>]</p><p>Two hundred fifty breastfed infants were randomized to receive their routine rotavirus vaccination (Rotarix) with either unrestricted breastfeeding or withholding breastfeeding from 1 hour before to 1 hour after the vaccination. No difference were found in the rate of seroconversion between the two groups of infants.[<a class="bibr" href="#LM733.REF.19" rid="LM733.REF.19">19</a>]</p><p>Four hundred infants in India were randomized to either be breastfed before receiving rotavirus vaccine (Rotarix) or to not be breastfed within 30 minutes of their vaccination. Vaccinations were given at 6 to 7 weeks and at 10 to 14 weeks of age. Of the 388 infants with evaluable information, no difference was found in the seroconversion rate between the two groups.[<a class="bibr" href="#LM733.REF.20" rid="LM733.REF.20">20</a>]</p><p>Among 45 breastfed (at least 4 times daily) Nicaraguan infants who were given a rotavirus vaccination (Rotateq-MSD), 31 infants seroconverted and 14 infants did not. The seroconversion failures were mostly in infants who had high preimmunization IgA levels and whose mothers had high serum IgG antibody levels against rotavirus. No correlation was found between breastmilk IgA or neutralizing antibodies and seroconversion, although the sample size was small.[<a class="bibr" href="#LM733.REF.26" rid="LM733.REF.26">26</a>]</p><p>In a monovalent G1P[<a class="bibr" href="#LM733.REF.8" rid="LM733.REF.8">8</a>] rotavirus vaccine (Rotarix) trial in Bangladesh, rotavirus-specific plasma IgA antibody seroconversion rates were higher among infants of maternal non-secretors of antibodies (39%) compared to mothers who secreted anti-rotavirus antibodies (23%). Maternal secretor status was a significant predictor of infant response to the vaccine.[<a class="bibr" href="#LM733.REF.15" rid="LM733.REF.15">15</a>]</p></div><div id="LM733.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information was not found as of the revision date.</p></div><div id="LM733.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM733.REF.1">Plenge-Bönig
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Effect of withholding breastfeeding on the immune response to a live oral rotavirus vaccine in North Indian infants.
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Vaccine
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2014;32 (Suppl 1):A134-9.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/25091668" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25091668</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="LM733.REF.21">Mwila
|
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K, Chilengi
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R, Simuyandi
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M, et al.
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Contribution of maternal immunity to decreased rotavirus vaccine performance in low and middle income countries.
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Clin Vaccine Immunol
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2017;24:e00405-16.
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[<a href="/pmc/articles/PMC5216432/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5216432</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27847365" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27847365</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="LM733.REF.22">Morgan
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B, Lyons
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EA, Handley
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A, et al.
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Rotavirus-specific maternal serum antibodies and vaccine responses to RV3-BB rotavirus vaccine administered in a neonatal or infant schedule in malawi.
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Viruses
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2024;16:1488.
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[<a href="/pmc/articles/PMC11437397/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC11437397</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/39339964" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 39339964</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="LM733.REF.23">Suwantika
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AA, Postma
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MJ. Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia.
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BMC Public Health
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2013;13:1106.
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[<a href="/pmc/articles/PMC3879064/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3879064</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24289227" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24289227</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="LM733.REF.24">Oberle
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D, Hoffelner
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M, Pavel
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J, et al.
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Retrospective multicenter matched case-control study on the risk factors for intussusception in infants less than 1 year of age with a special focus on rotavirus vaccines - the German Intussusception Study.
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Hum Vaccin Immunother
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2020;16:2481-94.
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[<a href="/pmc/articles/PMC7644239/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7644239</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32271647" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32271647</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="LM733.REF.25">Restivo
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V, Costantino
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C, Giorgianni
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G, et al.
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Case-control study on intestinal intussusception: Implications for anti-rotavirus vaccination.
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Expert Rev Vaccines
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2018;17:1135-41.
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[<a href="https://pubmed.ncbi.nlm.nih.gov/30407079" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30407079</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="LM733.REF.26">Becker-Dreps
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S, Vilchez
|
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S, Velasquez
|
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D, et al.
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Rotavirus-specific IgG antibodies from mothers' serum may inhibit infant immune responses to the pentavalent rotavirus vaccine.
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Pediatr Infect Dis J
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2015;34:115-6.
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[<a href="/pmc/articles/PMC4352718/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4352718</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25741808" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25741808</span></a>]</div></dd></dl></dl></div></div><div id="LM733.Substance_Identification"><h2 id="_LM733_Substance_Identification_">Substance Identification</h2><div id="LM733.Substance_Name"><h3>Substance Name</h3><p>Rotavirus Vaccines</p></div><div id="LM733.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Vaccines</p><p>Viral Vaccines</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501632_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">November 15, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Rotavirus Vaccines. [Updated 2024 Nov 15].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM486/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/LM887/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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