Intussusception, infection, and immunization Summary of a workshop on rotavirus

This article summarizes the proceedings of a workshop sponsored by the Nati onal Institutes of Health and the National Vaccine Program Office, and held in Bethesda, Maryland, on January 21, 2000. The objective of the meeting w as to focus research toward an understanding of the basis for the possible association between intussusception and the reassortant rhesus-human rotavi rus vaccine tetravalent (RRV-TV). After numerous reports of intussusception after administration of RRV-TV, the manufacturers of this vaccine voluntar ily withdrew it from the United States market. The American Academy of Pedi atrics, the Advisory Committee on Immunization Practices, and the American Academy of Family Physicians also withdrew their original recommendations f or administration of RRV-TV to children at 2, 4, and 6 months of age. These actions will have global implications for the prevention of morbidity and mortality attributable to rotavirus infection. Benefit-cost ratios for the use of RRV-TV will be substantially different in developing countries compa red with developed countries. Therefore, extensive research is needed in bo th of these settings, to further our understanding of the epidemiology, pat hogenesis, and pathology of both rotavirus disease and intussusception to e nable optimal prevention. The workshop reviewed the current understanding o f the possible association between RRV-TV and intussusception, as well as t he possible association between a variety of viral infections and intussusc eption. The workshop also identified critical areas of research regarding t his possible association. This research will be essential not only for the development of safe and effective rotavirus vaccines, but for the developme nt of other oral vaccines as well.