Immunization: Protecting Your Health and That of the Community!

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Questions and Answers on Rotavirus Vaccination (RotaTeq)
This information is out of date and is left here for historical purposes only. For up-to-date information, see the Health New Zealand Immunisations page.
What is rotavirus and how serious is it?
Rotavirus is the most common cause of severe diarrhoea and dehydration in children under five years of age. In mild infections the child experiences vomiting and watery diarrhoea of limited duration. In severe infections the child may also have fever, and tummy pain that last for many days. In some cases the child may become dehydrated and need hospital treatment. In rare instances in industrialised countries, a child may die due to rotavirus.
Rotavirus is mostly spread by contact with the poo (faeces/stool) of an infected person. It can be spread through toys and door-knobs if these have been touched by someone who has been in contact with rotavirus.
Virtually all children have been infected by the time they reach five years old, regardless of their nationality or level of hygiene.
Rotavirus infection in figures
It has been estimated that 634 of every 100,000 children under three years old are hospitalised because of rotavirus infection in New Zealand1.
Rotavirus infection results in 1 in 43 children being hospitalised and the parents of 1 in 5 children seeking medical advice by the time they are five years old.
What are the symptoms of rotavirus?
The symptoms in children are:
• sudden onset of vomiting and watery diarrhoea which can last from three to eight days
• fever (high temperature)
• tummy pain.
Adults can catch rotavirus but generally have no symptoms.
Whilst hand washing and cleanliness are important ways to stop the spread of germs they are not enough to stop rotavirus infection. This is why the vaccine is being introduced in New Zealand.
How is rotavirus treated?
If your child has rotavirus the most important thing you can do is prevent dehydration. If your baby is less than six months old and has diarrhoea and/or vomiting you should see a doctor urgently. Babies can become dehydrated very quickly.
More information on treating children is available on kids health.
How effective is the rotavirus vaccine?
There are two brands of rotavirus vaccine approved for use in New Zealand: Rotarix and RotaTeq. RotaTeq will be funded from 1 July 2014. 
Rotavirus vaccines prevent almost all infants and children from severe disease. The vaccine protects most infants and children from any severity of rotavirus disease.
Vaccine efficacy in figures
Efficacy for RotaTeq was tested in 6,983 infants (3,484 were given vaccine). RotaTeq stopped rotavirus (of any strain) in 71.3% of infants. RotaTeq stopped severe rotavirus in 98.2% of infants2.
Since the introduction of rotavirus vaccination in Australia the number of children under five years of age being hospitalised because of rotavirus has dropped by 70%.
How is RotaTeq (rotavirus) vaccine given?
RotaTeq is a liquid that is given by mouth, not an injection. It can be safely given at the same time as other vaccines. RotaTeq needs to be given three times, the first dose should be given between six and twelve weeks.
The vaccine can be given to children if they have just eaten and if they are breast feeding.
Is RotaTeq suitable for all infants?
RotaTeq vaccine is fine for most infants, but there are some infants who shouldn’t get this vaccine.
• Infants who have had a severe allergic reaction to a dose of RotaTeq or to any of the vaccine components should not be given this vaccine.  Make sure the person giving your child’s vaccines knows about any allergies your child may have.
• Infants with ‘severe combined immunodeficiency’ should not be given RotaTeq.
• Infants who have had a bowel blockage called intussusception should not be given rotavirus vaccine.
Check with your doctor if your child has HIV infection, or is taking medicines which can affect the immune system such as steroids.
Consumer Medicine Information (CMI) for RotaTeq (PDF 128 KB, 4 pages)
What are the side effects of RotaTeq?
Like all vaccines and medicines RotaTeq can cause side effects in some infants. These side effects are usually mild and go away on their own.
Serious side effects are possible, but are very rare.
Mild effects include, mild diarrhoea or vomiting in the week after vaccination.
Serious effects include severe allergic reactions and intussusception (a type of bowel blockage).
More information on events linked to rotavirus vaccine in New Zealand can be found in the Suspected Medicine Adverse Reactions Search (SMARS).
What is intussusception?
Intussusception is a condition where one part of the bowel slides into the next (like a telescope). This can happen ‘naturally’ in some infants every year in New Zealand. The reason why this happens is unknown, but some cases may be caused by an infection.
There is a small risk of intussusception from rotavirus vaccination. The risk is highest in the week after vaccination with the first dose.
Intussusception is treated in hospital. A radiologist (specialised doctor) can usually unfold the intussusception by using air or fluid to push the folded part of the bowel back into its normal position. In about 30% (one third) of cases an operation is needed. After surgery the infant will need to stay in hospital for a few days to recover.
Most infants recover completely with no further problems. However, intussusception can reoccur in up to 10%  (1 in 10) of cases. 
Intussusception in figures
In New Zealand it is estimated that there are 65 cases of intussusception for every 100,000 children under one year old3.
The risk after vaccination with RotaTeq has been estimated in the United States around 1 infant in every 100,000 infants vaccinated.
In Australia the risk was estimated at 7 children per 100,000 vaccinated with RotaTeq4.
What should I do if my child has a serious reaction?
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing and a fast heartbeat. These usually start a few minutes to a few hours after vaccination.
If you think your child may have a severe allergic reaction you should call an ambulance.
Signs of intussusception include severe crying and tummy pain, infants might pull their legs up to their chest as if they have colic. Infants may also vomit or have blood in their poo. If this happens call an ambulance. Tell the hospital doctor when your baby got the vaccine.
Afterwards please report the reaction to the Centre for Adverse Reactions Monitoring (CARM).
Does RotaTeq contain mercury?
RotaTeq does not contain mercury (thiomersal) or aluminium.
Have there been any reactions to rotavirus vaccine in New Zealand?
You can find a summary of reports of suspected adverse reactions (adverse events following immunisation) to rotavirus vaccine in the Suspected Medicine Adverse Reaction Search (SMARS).
Search for suspected adverse reactions using SMARS.
Do the benefits of rotavirus vaccination outweigh the risks?
The overall benefits of preventing rotavirus outweigh the small risk of intussusception.
Vaccination is not mandatory in New Zealand. You should weigh up the benefits and risk of harm for your child before giving them any vaccine or medicine. If you need more advice you can talk to your healthcare professional or call the Immunisation Advisory Centre on 0800 466 863.
Benefits versus risks in figures
In Australia introduction of rotavirus vaccination has resulted in a 70% decrease in hospitalisation for rotavirus. In New Zealand, this would reduce the rate of hospitalisation by 444 children per 100,000 per year. In contrast, it is expected that the number of cases of children hospitalised for intussusception could increase by up to 7 children per 100,000 per year.

Frequently Asked Questions about Flu Vaccines
Is the flu vaccine safe? 
• The flu vaccine is safe for most people and is recommended for everyone ages 6 months and older. People who should not receive flu vaccines are those who have had a severe allergic reaction to the flu or other vaccine in the past and those who have had a condition called Guillan-Barre syndrome.  
• If you have questions about your specific medical conditions, call your doctor to ask if it’s safe for you to get a flu vaccine.  
Can a flu vaccine give me flu? 
• No, a flu vaccine cannot cause flu illness. Flu vaccines that are administered with a needle (flu shots) are currently made in two ways: the vaccine is made either with a) flu vaccine viruses that have been killed (inactivated) and are therefore not infectious, or b) with proteins from a flu vaccine virus instead of flu vaccine viruses (which is the case for recombinant influenza vaccine). The nasal spray vaccine is made with attenuated (weakened) live flu viruses, and also cannot cause flu illness. The weakened viruses are cold-adapted, which means they are designed to only cause infection at the cooler temperatures found within the nose. The viruses cannot infect the lungs or other areas where warmer temperatures exist. 
What side effects can occur after getting a flu vaccine? 
• While a flu vaccine cannot give you flu illness, there are different side effects that may be associated with getting a flu shot or a nasal spray flu vaccine. These side effects are mild and short-lasting, especially when compared to symptoms of a bad case of flu. 
A flu shot: The viruses in a flu shot are killed (inactivated), so you cannot get flu from a flu shot. Some minor side effects that may occur are: 
• Soreness, redness, and/or swelling where the shot was given 
• Headache (low grade) 
• Fever 
• Muscle aches 
• Nausea 
• Fatigue 
The nasal spray: The viruses in the nasal spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. In children, side effects from the nasal spray may include: 
• Runny nose 
• Wheezing 
• Headache 
• Vomiting 
• Muscle aches 
• Fever (low grade) 
• In adults, side effects from the nasal spray vaccine may include: 
• Runny nose 
• Headache 
• Sore throat 
• Cough 
• If these problems occur, they begin soon after vaccination and usually are mild and short-lived. A flu shot, like other injections, can occasionally cause fainting. Tell your provider if you feel dizzy or have vision changes or ringing in the ears. As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injuries, or death.  
How do flu vaccines work? 
• Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are used to make the vaccine. 
• The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Most flu vaccines in the United States protect against four different flu viruses (“quadrivalent”); an influenza A (H1N1) virus, an influenza A (H3N2) virus, and two influenza B viruses. There are also some flu vaccines that protect against three different flu viruses (“trivalent”); an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one influenza B virus. Two of the trivalent vaccines are designed specifically for people 65 and older to create a stronger immune response. 
When should I get vaccinated? 
• You should get a flu vaccine before flu viruses begin spreading in your community since it takes about two weeks after vaccination for antibodies to develop in the body and provide protection against flu. Make plans to get vaccinated early in the fall, before flu season begins. CDC recommends that people get a flu vaccine by the end of October. However, getting vaccinated early (for example, in July or August) is likely to be associated with reduced protection against flu infection later in the flu season, particularly among older adults. Vaccination should continue to be offered throughout the flu season, even into January or later. Children who need two doses of vaccine to be protected should start the vaccination process sooner of vaccine to be protected should start the vaccination process sooner because the two doses must be given at least four weeks apart. 
Why do I need a flu vaccine every year? 
• A flu vaccine is needed every season for two reasons. First, a person’s immune protection from vaccination declines over time, so an annual vaccine is needed for optimal protection. Second, because flu viruses are constantly changing, flu vaccines may be updated from one season to the next to protect against the viruses that research suggests may be most common during the upcoming flu season. For the best protection, everyone 6 months and older should get vaccinated annually. 
Does the flu vaccine work right away? 
• No. It takes about two weeks after vaccination for antibodies to develop in the body and provide protection against influenza virus infection. That’s why it’s best to get vaccinated before influenza viruses start to spread in your community. 
Should I get the flu vaccine if I'm pregnant or breastfeeding? 
• Years of studies and observation show that you can safely get a flu shot at any time, during any trimester, while you are pregnant or breastfeeding. Babies cannot get the vaccine until six months old. Because antibodies from the vaccine pass onto a fetus in the womb and through breast milk, you protect your baby even more by getting vaccinated.  
•  Pregnant people should not get the nasal spray form of the flu vaccine. Those with a life-threatening egg allergy should not get the flu vaccine, whether pregnant or not.   
 Sources
Flu Vaccine Safety and Pregnancy-CDC   
Flu & Pregnancy- CDC  
Can I get seasonal flu even though I got a flu vaccine this year? 
Yes. It’s possible to get sick with flu even if you have been vaccinated (although you won’t know for sure unless you get a flu test). This is possible for the following reasons: 
• You may be exposed to a flu virus shortly before getting vaccinated or during the period that it takes the body to gain protection after getting vaccinated. This exposure may result in you becoming ill with flu before the vaccine begins to protect you. (Antibodies that provide protection develop in the body about 2 weeks after vaccination.) 
• You may be exposed to a flu virus that is not included in the seasonal flu vaccine. There are many different flu viruses that circulate every year. A flu vaccine is made to protect against the three or four flu viruses that research suggests will be most common. 
• Unfortunately, some people can become infected with a flu virus a flu vaccine is designed to protect against, despite getting vaccinated. The protection provided by the flu vaccination can vary widely, based in part on the health and age factors of the person getting vaccinated. In general, a flu vaccine works best among healthy younger adults and older children. Some older people and people with certain chronic illnesses may develop less immunity after vaccination. Flu vaccination is not a perfect tool, but it is the best way to protect against flu infection. 
What protection does a flu vaccine provide if I do get sick with the flu? 
• Some people who get vaccinated may still get sick. However, flu vaccination has been shown in some studies to reduce the severity of illness in people who get vaccinated but still get sick. A 2017 study showed that flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized adults with flu. Another study in 2018 showed that a vaccinated adult who was hospitalized with the flu was 59 percent less likely to be admitted to the ICU than someone who had not been vaccinated.  Among adults in the ICU with flu, vaccinated patients on average spent 4 fewer days in the hospital than those who were not vaccinated. 
What are the benefits of flu vaccination? 
There are many reasons to get an influenza (flu) vaccine each year.  Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits. 
• Flu vaccination can keep you from getting sick with the flu. 
• Flu vaccination can reduce the risk of flu-associated hospitalization for children, working-age adults, and older adults. 
• Flu vaccination is an important preventive tool for people with chronic health conditions. 
• Flu vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who had had a cardiac event in the past year. 
• Flu vaccination can reduce worsening and hospitalization for flu-related chronic lung disease, such as in persons with chronic obstructive pulmonary disease. 
• Flu vaccination also has been shown in separate studies to be associated with reduced hospitalizations among people with diabetes and chronic lung disease. 
• Flu vaccination helps protect women during and after pregnancy. 
• Flu vaccines can be lifesaving in children. 
• Flu vaccination has been shown in several studies to reduce the severity of illness in people who get vaccinated but still get sick. 
Click here to view the Key Facts About the Seasonal Flu Vaccine - CDC
Will there be flu along with COVID-19 in the fall and winter? 
• While it’s not possible to say with certainty what will happen in the fall and winter, CDC believes it’s likely that flu viruses and the virus that causes COVID-19 will both be spreading. In this context, getting a flu vaccine will be more important than ever. CDC recommends that all people 6 months and older get a yearly flu vaccine. 
Can I have flu and COVID-19 at the same time? 
• Yes. It is possible to have flu, as well as other respiratory illnesses, and COVID-19 at the same time. Health experts are still studying how common this can be. 
• Some of the symptoms of flu and COVID-19 are similar, making it hard to tell the difference between them based on symptoms alone. Diagnostic testing can help determine if you are sick with flu or COVID-19. 
Will the flu vaccine prevent COVID? 
• The flu vaccine won’t prevent COVID, but it can lower your risk of getting severely ill from COVID by preventing severe flu illness. People can get both COVID and flu at the same time or one after the other, and these individuals are at more risk of severe illness. 
Does a flu vaccine increase your risk of getting COVID-19? 
• There is no evidence that getting a flu vaccine increases your risk of getting sick from a coronavirus, like the one that causes COVID-19. 
• You may have heard about a study published in January 2020 that reported an association between flu vaccination and the risk of four commonly circulating seasonal coronaviruses, but not the one that causes COVID-19. This report was later found to be incorrect. 
• The results from that initial study led researchers in Canada to look at their data to see if they could find similar results in their population. The results from Canada’s study showed that flu vaccination did not increase the risk for these seasonal coronaviruses. The Canadian findings highlighted the protective benefits of flu vaccination. 
• The Canadian researchers also identified a flaw in the methods of the first study, noting that it violated the part of the study design that compares vaccination rates among patients with and without flu (test-negative design). This flaw led to the incorrect association between flu vaccination and seasonal coronavirus risk. When these researchers reexamined data from the first study using the correct methods, they found that flu vaccination did not increase the risk for infection with other respiratory viruses, including seasonal coronaviruses. 
If I am at high risk for serious illness from COVID-19 or flu, where is the safest place for me to get a flu vaccine? 
• You can safely get a flu vaccine at multiple locations including your doctor’s office, health departments, and pharmacies. You can use VaccineFinder.org to find where flu vaccines are available near you. When going to get a flu vaccine, be sure to practice everyday preventive actions. 
2020 - 2021 Flu Season Summary (CDC)