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Persistent rotavirus vaccine shedding in a new case of severe combined immunodeficiency: A reason to screen

      Rotavirus infections in the United States have decreased as a result of vaccination efforts. Before 2006, when the vaccine was implemented, the burden of disease was high, with approximately 27,000 to 70,000 children under 5 years of age hospitalized with rotavirus infection and about 20 to 60 reported deaths annually according to the Centers for Disease Control and Prevention and other studies.
      • Charles M.D.
      • Holman R.C.
      • Curns A.T.
      • Parashar U.D.
      • Glass R.I.
      • Bresee J.S.
      Hospitalizations associated with rotavirus gastroenteritis in the United States, 1993–2002.
      • Fischer T.K.
      • Vibound C.
      • Parashar U.
      • Malek M.
      • Steiner C.
      • Glass R.
      • et al.
      Hospitalizations and deaths from diarrhea and Rotavirus among children <5 years of age in the United States, 1993-2003.
      • Malek M.A.
      • Curns A.T.
      • Holman R.C.
      • et al.
      Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000.
      CDC
      Delayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.
      • Payne D.C.
      • et al.
      Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.
      Since the introduction of vaccination, rotavirus rates in the United States have diminished by more than 50%, translating to the prevention of 48,000 hospitalizations and 30 deaths.
      • Fischer T.K.
      • Vibound C.
      • Parashar U.
      • Malek M.
      • Steiner C.
      • Glass R.
      • et al.
      Hospitalizations and deaths from diarrhea and Rotavirus among children <5 years of age in the United States, 1993-2003.
      CDC
      Delayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.
      • Payne D.C.
      • et al.
      Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.
      Studies have also shown a delay in the seasonal onset of the disease by 2 to 4 months.
      CDC
      Delayed onset and diminished magnitude of Rotavirus activity—United States, November 2007—May 2008.
      • Payne D.C.
      • et al.
      Active, population-based surveillance for severe Rotavirus gastroenteritis in children in the United States.
      • Tate J.E.
      • et al.
      Decline and change in seasonality of US Rotavirus activity after the introduction of Rotavirus vaccine.
      • Turcios R.M.
      • et al.
      Temporal and geographic trends of Rotavirus activity in the United States, 1997-2004.
      Cost savings to the medical community with the vaccines are estimated to be as much as $198,000 per life-year.
      Committee on Infectious Disease
      Prevention of Rotavirus disease: updated guidelines for use of rotavirus vaccine.
      The question arises, however, as to the unforeseen costs on a population of patients with undiagnosed immune deficiency. In March 2009 there were 2 reported cases by Patel et al
      • Patel N.C.
      • et al.
      Vaccine-acquired Rotavirus infection in two infants with severe combined immunodeficiency: late breaking abstracts.
      of rotavirus infection from RotaTeq (Merck and Co, Inc, Whitehouse Station, NJ) vaccine strains in unknown cases of SCID (severe combined immune deficiency) with adenosine deaminase deficiency and IL-2 receptor-γ deficiency. Werther et al
      • Werther R.L.
      • et al.
      Rotavirus vaccine induced diarrhea in a child with severe combined immune deficiency.
      also recently described a 9-month-old girl with a new diagnosis of unspecified SCID who shed the RotaTeq virus strain for 7.5 months and finally cleared it posttransplant. All 3 of these patients presented with gastrointestinal symptoms and failure to thrive. Vaccine strains were identified by RT-PCR.
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