71,725 infants were evaluated in 3 placebo-controlled clinical trials including 36,165 infants who received RotaTeq and 35,560 infants who received placebo. Parents/guardians were contacted on days 7, 14, and 42 after each dose regarding intussusception and any other serious adverse events.
Rotateq is generally well tolerated.
In the large-scale (34,837 vaccine recipients and 34,788 placebo recipients), placebo-controlled Rotavirus Efficacy and Safety Trial (REST), RotaTeq did not increase the risk of intussusception relative to placebo (see Table 1). Active surveillance was employed to identify potential cases of intussusception at days 7, 14, and 42 after each dose and every 6 weeks thereafter for 1 year after dose one. There were no confirmed cases of intussusception during the 42-day period after dose one, and there was no clustering of cases among vaccine recipients at any time period after any dose. Following the 1-year safety follow-up period, 4 cases of intussusception were reported in children who had received placebo during the study.
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Kawasaki's disease was reported in the phase III clinical trials in <0.1% (5/36,150) of vaccine recipients and <0.1% (1/35,536) of placebo recipients within 42 days of any dose (not statistically significant).
In 11,711 infants (6,138 recipients of RotaTeq) from the 3 studies, a Vaccination Report Card was used by parents/guardians to record the child's temperature and any episodes of diarrhea and vomiting on a daily basis during the first week following each vaccination. Table 2 summarizes the frequencies of these adverse events, regardless of cause. (See Table 2.)
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Parents/guardians of the 11,711 infants were also asked to report the presence of other events on the Vaccination Report Card for 42 days after each dose. The following vaccine-related adverse experiences were observed among recipients of RotaTeq at a frequency of at least 0.3% greater than that observed among placebo recipients.
Very Common (≥1/10); Common (≥1/100, <1/10); Uncommon (≥1/1000, <1/100); Rare (≥1/10,000, <1/1000); Very Rare (<1/10,000).
Infections and infestations:
Uncommon: nasopharyngitis (0.6% vaccine recipients, 0.3% placebo recipients).
Very Common: diarrhea (17.6% vaccine recipients, 15.1% placebo recipients), vomiting (10.1% vaccine recipients, 8.2% placebo recipients).
General disorders and administration site conditions:
Very Common: pyrexia (20.9% vaccine recipients, 18.7% placebo recipients).
Other Adverse Events:
Otitis media and bronchospasm occurred in more vaccine than placebo recipients (14.5% versus 13.0% and 1.1% versus 0.7%, respectively) overall; however, among cases that were considered to be vaccine-related in the opinion of the study investigator, the incidence was the same for vaccine and placebo recipients for otitis media (0.3%) and bronchospasm (<0.1%).
Administration of other licensed vaccines was permitted in all studies. The safety of RotaTeq when administered concomitantly with pre-specified licensed vaccines including Haemophilus influenzae
type b and hepatitis B vaccine, diptheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, inactivated polio vaccine (IPV), pneumococcal conjugate vaccine, and hexavalent vaccines was evaluated in all 3 phase III placebo-controlled studies. In subsequent controlled studies, the safety and immunogenicity of RotaTeq when administered concomitantly with oral poliovirus vaccine, meningococcal group C conjugate vaccine, or hexavalent vaccine were evaluated. In all these studies, concomitant use with these vaccines was well tolerated; the frequency of adverse experiences observed was generally similar to that seen in the control group.
The following adverse experiences have been spontaneously reported during post-approval use of RotaTeq. Because these experiences were reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or to establish a causal relationship to vaccine exposure.
Immune system disorders:
Skin and subcutaneous tissue disorders:
gastroenteritis with vaccine viral shedding in infants with Severe Combined Immunodeficiency Disease (SCID), intussusception.
Post-Marketing Observational Safety Surveillance Study:
In a prospective post-marketing observational study conducted using a large medical claims database, the risks of intussusception or Kawasaki disease resulting in emergency department visits or hospitalizations during the 30 days following any dose of vaccine were analyzed among 85,150 infants receiving one or more doses of RotaTeq. Medical charts were reviewed to confirm these diagnoses. In addition, general safety was monitored by electronic search of the automated records database for all emergency department visits and hospitalizations. The study included an independent, external Safety Monitoring Committee.
During the 0-30 day follow-up period after vaccination, there were no statistically significant differences in the rates of intussusception or Kawasaki disease compared with the expected background rates. In addition, there was no statistically significant increased risk of these adverse events during the 0-30 day follow-up period when comparing the 17,433 person-years of follow-up among infants receiving RotaTeq (n=85,150) with the 12,339 person-years of follow-up among a concurrent control group of infants who received DTaP, but not RotaTeq (n=62,617). There were 6 confirmed cases of intussusception among infants vaccinated with RotaTeq compared with 5 among the concurrent controls vaccinated with DTaP (relative risk = 0.8, 95% CI: 0.22-3.52). There was one chart-confirmed case of Kawasaki disease identified among infants vaccinated with RotaTeq and one chart-confirmed case of Kawasaki disease among concurrent DTaP controls (relative risk = 0.7, 95% CI: 0.01-55.56). In the general safety analyses, the Safety Monitoring Committee did not identify any specific safety concerns (see Precautions).