All the publicly funded programs use the GSK vaccine, Rotarix, which is administered at two and four months of age. Childhood vaccines are centrally purchased by the Public Health Agency of Canada, then the costs are passed on to the provinces and territories.
On Jan. 1, Alberta will begin a publicly funded vaccination program to protect children from rotavirus.
It's about time.
Rotavirus is the most common cause of gastroenteritis – the fancy name given the dreadful combination of diarrhea and vomiting. Young babies are most at risk of infection, and they are at risk of life-threatening dehydration.
The National Advisory Committee on Immunization, a blue-ribbon panel of public-health scientists, recommended way back in 2010 that all Canadian children receive the vaccine.
Because rotavirus is so deadly – it kills about 450,000 babies a year worldwide and sickens tens of millions – sixty-four countries have so far instituted universal vaccine programs.
Yet, in Canada, the dithering continues.
Even after Alberta gets with the program, babies in Nova Scotia, New Brunswick, Newfoundland and Labrador, and Nunavut will still not be routinely protected against rotavirus.
"I find it astounding that we still have provinces and territories without a program," Shelley Deeks, medical director of immunization and vaccine-preventable diseases at Public Health Ontario, said in a talk at the recent Canadian Immunization Conference.
"Unconscionable" would be a better descriptor.
What is astounding is how quickly rotavirus vaccination programs can have an impact.
Ontario began its rotavirus program in 2011 and today "we've pretty well wiped out the disease in the province," Dr. Deeks said.
That doesn't mean Ontario's children no longer suffer from diarrhea and vomiting, because there are many pathogens that can cause these symptoms.
But emergency-room visits and hospitalizations of babies with rotavirus infection are down dramatically, about 80 per cent. This echoes what has occurred in virtually every country where kids are immunized.
That's not only a relief to parents but to the treasury because, before vaccination, rotavirus accounted for one in every 62 pediatric hospitalizations.
The other good-news aspect of this story for parents is that rotavirus vaccine does not require babies to get another needle. It is an oral vaccine – meaning it's squirted in the mouth.
There are two rotavirus oral vaccines available in Canada: RotaTeq, a product of Merck Canada Inc., requires three doses, and Rotarix from GlaxoSmithKline Inc., two doses.
All the publicly funded programs use the GSK vaccine, Rotarix, which is administered at two and four months of age. Childhood vaccines are centrally purchased by the Public Health Agency of Canada, then the costs are passed on to the provinces and territories.
In jurisdictions without a publicly funded program, parents can get a prescription for the vaccine and purchase it for approximately $165, plus pharmacy dispensing fees (which vary by province).
It should be noted that the rotavirus vaccine has a bit of a rocky history.
A vaccine called RotaShield was first sold in the United States in the late 1990s, but was pulled from the market in 1999 after it was linked to a sharp increase in intussusception, a rare, life-threatening blockage of the intestine. That vaccine was never approved or sold in Canada.
Because of safety fears, the clinical trials for the new vaccines were among the largest in history and there has been on-going safety monitoring.
The vaccine used in Canada, Rotarix, has a good safety profile. Ongoing research is showing that there is a tiny increased risk of intussusception for a few days after vaccination.
But what parents need to keep in mind is that, regardless of vaccination status or rotavirus infection, intussusception occurs in about 35 in every 100,000 babies, usually when they are five to eight months of age, and it is much more common in boys.
Vaccination is associated with an increased risk of about 1.5 cases per 100,000 after the first dose, an almost negligible amount. But children should be monitored for signs of intussusception for a week after getting the vaccine.
As always, sound health decisions, both individually and collectively, are about balancing benefits and risks. In the case of rotavirus vaccination, the balance tips clearly in favour of vaccinating all children.
When NACI first recommended universal rotavirus vaccination, it estimated the program would result in 33,000 fewer physician visits, 15,000 fewer emergency room visits, 5,000 fewer hospitalizations and two fewer deaths.
Canada is on track to meet those projections, and then some. But being spared the misery of gastroenteritis should not depend on where people live. It should be a benefit afforded all Canadian babies.
Editor's note: Alberta Health now says it will make a final decision on a rotavirus vaccine program in February, after the National Advisory Committee on Immunization publishes an updated review.