Rotarix oral suspension in pre-filled oral applicatorRotavirus vaccine, live

Rotarix is a vaccine that is given by mouth. It is available in two forms:

a powder and solvent that are made up into an oral suspension in an oral applicator

an oral suspension in a prefilled oral applicator or a tube.

Rotarix contains a live attenuated (weakened) form of the human rotavirus (RIX4414 strain).

Rotarix is used in babies aged from six to 24 weeks to protect against gastroenteritis (diarrhoea and vomiting) caused by rotavirus infections. Rotarix is given according to official recommendations.

The vaccine can only be obtained with a prescription.

Rotarix is given as two doses, at least four weeks apart. The first dose is given when the baby is older than six weeks. Ideally, both doses should be given before the baby is aged 16 weeks and they must be given by the time the baby is 24 weeks old. The same vaccination course can be used in babies born up to 13 weeks prematurely (from 27 weeks gestational age).

If the powder and solvent are used, they should be mixed together just before the vaccine is given, and the resulting suspension given directly into the mouth of the baby using the oral applicator provided. If the ready-made oral suspension is used, the contents of the prefilled oral applicator or tube should be given into the mouth of the baby. Rotarix can be given at the same time as other vaccines.

Rotarix contains small amounts of rotavirus, a virus that causes gastroenteritis. The virus is alive, but it has been weakened so that it does not cause the disease, which makes it suitable for use in a vaccine. When an infant is given the vaccine, the immune system (the system that fights diseases) recognises the weakened virus as ?foreign? and makes antibodies against it. An antibody is a special protein that can neutralise or destroy an antigen, such as a virus. After vaccination, the immune system is able to produce antibodies more quickly when it is exposed to the virus again. This helps to protect against gastroenteritis caused by rotavirus. Between 78 and 95% of babies receiving Rotarix make antibodies against rotavirus after vaccination.

Overall, the clinical studies of Rotarix involved over 75,000 babies and took place in various countries worldwide. The main study compared Rotarix with placebo (a dummy vaccine) in over 63,000 babies who were born at full term (after a pregnancy of at least 36 weeks). The study was very large because it was designed to see if the vaccine caused a very rare, serious side effect called intussusception, a condition in which part of the bowel becomes enfolded within another part of the bowel, leading to a blockage. The benefit of the vaccine was measured by looking at how many babies developed severe rotavirus gastroenteritis in the months after they had been vaccinated and before they had reached one year of age.

A further study looked at the safety of Rotarix and its ability to stimulate the production of antibodies in 1,009 babies born up to 13 weeks prematurely. These results were compared with the findings of a study in babies born at full term who were vaccinated with Rotarix.

Four additional studies were carried out in over 3,000 infants, to confirm that the two forms of the vaccine were as safe and as effective as each other in stimulating the production of antibodies against rotavirus.

Rotarix was more effective than placebo in preventing severe gastroenteritis due to rotavirus. In the main study, the number of cases of severe rotavirus gastroenteritis was lower following vaccination with Rotarix: 0.1% of the babies vaccinated with Rotarix in whom effectiveness was assessed developed severe rotavirus gastroenteritis (12 out of over 9,000) compared with 0.9% of the babies who received placebo (77 out of almost 9,000).

The study in premature babies showed that Rotarix was well tolerated and produced similar levels of antibodies as in infants born at full term.

In the main study, in which over 31,500 babies received Rotarix and over 31,500 received placebo, nine babies developed intussusception following vaccination with Rotarix, compared with 16 who developed it after receiving placebo. This study did not show an increased risk of intussusception with Rotarix. The most common side effects with Rotarix (seen in between 1 and 10 patients in 100) are diarrhoea and irritability. For the full list of all side effects reported with Rotarix, see the package leaflet.

Rotarix should not be used in babies who may be hypersensitive (allergic) to any of the ingredients of the vaccine. It must not be given to babies who showed signs of allergy after receiving a dose of rotavirus vaccine in the past, who have had intussusception in the past, or who have problems with their bowel that could put them at risk of intussusception. Vaccination with Rotarix should be postponed in babies who have a sudden high fever, diarrhoea or vomiting. For the full list of restrictions, see the package leaflet.

Rotarix should never be injected under any circumstances.

The CHMP decided that Rotarix?s benefits are greater than its risks and recommended that it be given marketing authorisation.