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A diagnostic quandary: Rotavirus vaccine associated diarrhea
Benjamin L Hamel1, Jenny Patel1, Jenna Still1
1Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55902, United States.
Insights
A healthy infant developed prolonged rotavirus (RV5) infection after vaccination, showing mild T-cell defects. This case highlights the importance of addressing parental concerns about vaccine safety and efficacy.
Area of Science:
- Pediatrics
- Immunology
- Vaccinology
Background:
- Routine childhood vaccinations are crucial for public health.
- The rotavirus pentavalent vaccine (RV5) is a widely administered vaccine.
- Understanding vaccine-related adverse events is essential for informed medical practice.
Purpose of the Study:
- To report a case of prolonged rotavirus infection following RV5 vaccination in an infant.
- To investigate potential immunodeficiency in the affected child.
- To explore the implications for vaccine counseling and parental education.
Main Methods:
- Clinical case presentation of a two-month-old boy.
- Diagnostic workup including stool antigen testing and functional T-cell assessment.
- Genetic testing for primary immunodeficiencies.
Main Results:
- The infant developed prolonged diarrhea and positive rotavirus antigen post-RV5 vaccination.
- Mild defects in functional T-cell immunocompetence were identified.
- Genetic testing excluded hereditary primary immunodeficiencies.
- Rotavirus cleared by four months post-vaccination.
Conclusions:
- While rare, rotavirus infection can occur following RV5 vaccination.
- Subtle immune system variations may influence vaccine response.
- Addressing parental misconceptions and fostering trust are vital for vaccine acceptance.
Abstract:
The patient is an otherwise healthy two-month-old boy who received the recommended vaccinations for his age group, which included the rotavirus pentavalent vaccine (RV5; RotaTeq) at his two-month well child visit. Three days later, he developed prolonged non-bloody diarrhea and was found to have persistently positive rotavirus antigen in his stool. Subsequent workup revealed mild defects in his functional T-cell immunocompetence. Genetic testing was obtained through the Invitae panel and was negative for hereditary forms of primary immunodeficiencies. The rotavirus antigen was found to have cleared from his stool around four months after receiving the RV5. Unfortunately, the source of the rotavirus infection was unable to be determined. The caregivers had misconceptions about the vaccine and the child's immune system function which led to refusal of any further vaccinations. Healthcare providers should strive to develop honest and respectful relationships with parents to have thoughtful dialogues regarding vaccine safety and efficacy.
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