Rotavirus Vaccine: Timing, Safety and Care

March 6, 2025

Information checked: 22 October 2026. Educational guidance, not an individual vaccination prescription.

What the rotavirus vaccine does

Rotavirus vaccination protects babies against an important cause of severe diarrhoea, vomiting and hospital treatment. It is given by mouth, not by injection. The most useful questions for a parent are which product is being offered, whether the baby is still within the permitted age window, and what symptoms after the appointment need medical attention. This guide separates those decisions rather than treating every country’s schedule as interchangeable. During the first year of life, CDC estimates protection of 85% to 98% against severe rotavirus illness and hospitalisation, compared with 74% to 87% against illness of any severity. [1]

Those figures describe studied populations, not a guarantee for an individual child. A vaccinated baby can still develop a stomach infection. Vaccination reduces risk; it does not replace assessment when a baby is unwell. Two products are used in the United States: Rotarix and RotaTeq. Both are oral vaccines, but their routine courses contain different numbers of doses. [1]

Why protection is offered so early

Rotavirus spreads mainly when tiny amounts of infected stool reach another person’s mouth, including through hands, objects or contaminated food and water. Babies do not have to drink visibly dirty water to become infected. In childcare or a busy household, the route can be much less obvious. Symptoms commonly begin about two days after exposure, not after a fixed week-long incubation period. [9]

Watery diarrhoea and vomiting can continue for several days, with fever, abdominal discomfort and reduced appetite. A first infection often causes the most severe illness. The practical concern in a young baby is fluid loss: repeated vomiting and diarrhoea can make it difficult to replace what is being lost. Offering vaccination in early infancy aims to provide protection before that vulnerable period of exposure. If your baby already has significant vomiting or diarrhoea, however, the immediate task is clinical assessment and hydration, not using a vaccine to treat the current episode. [9]

Protection is important, but not unlimited

There is no specific medicine that cures rotavirus itself. Treatment focuses on the child’s condition, particularly replacing lost fluid and salts. That makes prevention valuable, while also explaining why vaccination and a plan for illness belong together. Good hygiene matters, but handwashing alone is not enough to control this easily spread infection. Neither a previous infection nor vaccination produces complete lifelong protection from every future episode. [17]

A child may encounter rotavirus again, and vomiting or diarrhoea can also come from entirely different causes. Do not decide that an illness cannot be serious merely because the vaccination record is up to date. Likewise, one later stomach bug does not demonstrate that the vaccine offered no benefit. The goal includes reducing severe disease, not making all digestive symptoms impossible. For more background on the infection rather than the vaccination appointment, see our guide to rotavirus illness and care. [17]

Why effectiveness figures differ between countries

WHO recommends including rotavirus vaccines in national immunisation programmes, particularly where severe diarrhoeal disease causes substantial childhood deaths. Its evidence review found that effectiveness against severe disease varies between settings. A percentage from one country therefore should not be presented as a universal outcome for every baby worldwide. Differences in the burden of disease also matter: even where measured efficacy is lower, preventing a proportion of severe cases can have important public-health benefits. [7]

WHO places vaccination within a wider diarrhoeal-disease strategy that includes breastfeeding support, safer water and sanitation, handwashing and appropriate treatment. These measures complement one another rather than compete. Families moving between countries may encounter products other than Rotarix or RotaTeq, including Rotavac or Rotasiil. Bring the actual product name and dates to the next clinic. A familiar-looking abbreviation or a remembered number of visits is not enough to reconstruct a course safely. [7]

United States: routine doses and catch-up limits

Under US ACIP guidance, Rotarix is routinely given at two and four months, while RotaTeq is given at two, four and six months. The minimum starting age is six weeks. The first dose must be given by 14 weeks and six days, and the maximum age for any dose is eight months and zero days. The minimum interval is four weeks. [4]

These are programme recommendations; some age limits differ from the manufacturer’s licence. If any previous dose was RotaTeq, or the brand is unknown, US guidance uses a total of three doses within the permitted ages. The same product is preferred when possible, but lack of that product does not automatically mean starting over. This is a clinician’s catch-up decision. Do not borrow a later age limit from another country or assume that an older child can simply receive missed infant doses now. [4]

Programme examples, not a personalised catch-up plan
Programme	Routine course	Important age rule
US ACIP [4]	Rotarix: 2 and 4 months. RotaTeq: 2, 4 and 6 months.	First by 14 weeks 6 days; final by 8 months 0 days.
England [3]	Rotarix: 8 and 12 weeks.	First before 15 weeks; final before 24 weeks.

England: the NHS course and exact upper ages

England routinely gives Rotarix at eight and twelve weeks. UKHSA guidance updated on 22 September 2026 specifies a latest first dose of fourteen weeks and six days and a latest second dose of twenty-three weeks and six days, with at least four weeks between planned doses. [3]

Overseas courses need product-specific assessment: for example, two documented RotaTeq doses need no further dose under this English guidance. Do not apply the US mixed-course rule to an appointment in England. Bring the actual record. [3]

Canada: check the provincial programme as well

Canadian guidance also distinguishes a two-dose monovalent course from a three-dose pentavalent course. Its routine schedule information places the first dose from six weeks and before fifteen weeks of age, with all doses before eight months. The monovalent doses are at least four weeks apart; the pentavalent schedule specifies four to ten weeks between doses. Provincial and territorial delivery arrangements still need to be checked with the clinic providing the vaccine. [27]

This matters when a family changes province, moves internationally or receives a first dose during travel. A website from the previous location may describe a different product or service. Ask the receiving clinic to review the dated record, identify which recommendation it is applying and write down the next appointment. The purpose is not to make parents experts in competing schedules, but to prevent a delay while each service assumes another service has arranged the remaining dose. [27]

Premature babies: chronological age and hospital planning

For a premature baby, chronological age means time since birth, rather than time since the expected due date. CDC generally uses chronological age when vaccinating clinically stable premature infants. Rotavirus needs a specific plan if the baby has remained in hospital since birth: CDC’s special-situations guidance recommends deferring it until discharge, while still respecting the maximum age for starting. Other national and hospital policies may differ, so ask the neonatal team which guidance applies. [26]

Do not assume that the routine community appointment has already been arranged. Before discharge, establish whether the baby has received any doses, whether the first-dose age window remains open and who will organise the next step. A long hospital stay can make this discussion time-sensitive. Small size alone is not a reason for parents to postpone all vaccination, but clinical stability, the hospital setting and product eligibility belong in the professional assessment. Never split a vaccine dose yourself because a baby is small. [26]

If an appointment has been missed

Contact the vaccination service promptly when an appointment is missed, cancelled or never offered. In the NHS, parents do not have to wait for an invitation if they know a child is due: they can contact the GP practice themselves. Explain that the question concerns rotavirus, because its infant age windows make timing particularly important. Give the baby’s date of birth and the dates of any previous doses. [23]

Ask for a definite plan, including what to do if the baby becomes unwell before the rearranged visit. A generic message that most childhood vaccines can be caught up later should not be read as permission to ignore rotavirus’s specific limits. If your baby is already beyond a permitted age, ask the clinician to review the whole vaccination record. Missing this particular opportunity should not lead to missing other vaccines that can still be given. Keep the conversation practical and focused on the protection that remains available. [23]

What to bring when records are incomplete

If a vaccination card has been lost, start with the clinics that actually gave the doses. In the United States, state or local immunisation information systems may also help locate records; CDC itself does not hold a national personal vaccination record for your child. Tell the new provider which places and approximate dates may have relevant information. A photograph of a card, a clinic printout or a discharge summary can give the team a useful starting point, but the provider should establish what can be accepted as documented vaccination. [29]

Keep product names visible when forwarding records, especially after an international move. “Two baby appointments” does not necessarily mean two rotavirus doses, since a visit can include several different vaccines. Ask the clinic to resolve the uncertainty promptly rather than waiting until the next routine check. This reduces the chance that the remaining age window closes while paperwork is being requested. [29]

Rotarix: a live oral product, not an injection

Rotarix contains live, weakened rotavirus and is supplied for oral use. It is not an inactivated injection. The current US prescribing information describes a ready-to-use oral applicator and a two-dose course; the licence covers infants from six weeks through twenty-four weeks. Product information and public-health schedules serve different purposes, so a parent should not independently substitute one age limit for another. [10]

The vaccinator must apply the relevant local recommendation. Tell the team about previous intussusception, an intestinal birth defect that could predispose to it, severe immune deficiency or a serious reaction to a previous dose or ingredient. The package information also matters when discussing allergies and a change of presentation. Do not rely on an old photograph of packaging to decide whether a current product is suitable. There is no reason for a family to prepare, dilute or administer this vaccine at home; it belongs within a trained vaccination service. [10]

RotaTeq: why the name on the record matters

RotaTeq is also a live oral vaccine, but its US product information describes a three-dose course. Its label and the national programme recommendation are not interchangeable documents. The current label describes first administration at six to twelve weeks and completion by thirty-two weeks, whereas clinicians using US ACIP guidance follow that programme’s age recommendations. This apparent difference is a reason to ask which guidance the clinic is using, not to choose whichever deadline is later. [11]

The brand also affects interpretation of an incomplete or mixed course. Ordinary feeding, including breast milk, is not restricted before or after RotaTeq. The label discusses caution in babies with immune problems or significant gastrointestinal histories, and acknowledges that vaccination cannot protect every recipient. Bring the product name to any consultation about a suspected reaction. It helps the clinician assess the relevant information without guessing from the colour of the tube or the number of other vaccines given that day. [11]

Spitting out a dose: do not apply a universal rule

Tell the vaccinator immediately if the baby spits out or vomits the liquid. US CDC administration guidance says not to repeat a rotavirus dose after regurgitation, spitting or vomiting during or after administration; the remaining recommended doses are then given on schedule. Other countries give different instructions, so online advice that says “always repeat” or “never repeat” without naming the programme can be misleading. The professional administering the vaccine should make the decision using the applicable guidance and product. [12]

Do not request an extra dose at a different clinic without explaining what happened, and do not interpret a small dribble as proof that the entire vaccination failed. A record of the event is more useful than trying to estimate the swallowed volume at home. Feeding immediately before or after an oral dose is allowed under CDC guidance. The clinician delivers the liquid carefully inside the cheek and allows time for swallowing; this is not a medicine to squirt directly down the throat. [12]

How local advice can differ at the same visit

Australia’s handbook illustrates why country-specific instructions matter. It advises one repeat dose during the same visit when an infant spits out or vomits most of the vaccine within minutes, but not when only a small amount is lost. It also notes that this Australian recommendation differs from RotaTeq’s product information. Parents do not need to adjudicate that difference themselves: ask the vaccinator to explain and document the local approach. [6]

The handbook allows rotavirus vaccination alongside other vaccines and immunisation products, including an RSV-specific monoclonal antibody. Receiving several preventive products at one visit does not make them the same medicine. Ask which product protects against which infection and where each is being recorded. If your baby has a feeding tube or a complex feeding plan, tell the clinic in advance so the team can follow appropriate administration guidance. Do not improvise an alternative route or mix the vaccine into a feed yourself. [6]

Common reactions and normal feeding afterwards

In NHS guidance, common reactions include irritability and diarrhoea; some babies may also vomit, have a temperature, eat less or develop a rash. These possibilities do not mean that every symptom appearing after vaccination should automatically be attributed to it. Babies can develop unrelated infections around the same time. Normal feeding and usual activities can continue after the appointment when the baby is well. [2]

NHS advice also says that a baby who immediately brings up the oral liquid may be given another dose, which differs from US CDC guidance. Ask the service that gave the vaccine if you are uncertain what happened. Keep the information leaflet so you can distinguish expected mild effects from warning signs. A baby who stops feeding, has fewer wet nappies or repeatedly vomits needs medical advice rather than reassurance based only on having recently been vaccinated. Follow the clinician’s advice about any medicines; do not use adult doses or leftover prescriptions. [2]

When a cold is different from significant illness

A minor illness does not automatically require cancelling a vaccination visit. CDC guidance explains that a mild cold, ear infection or similar minor illness usually does not prevent vaccination, and antibiotics for a mild illness are not by themselves a reason to delay vaccines. However, moderate or severe illness may justify postponement. Rotavirus-specific advice about active vomiting and diarrhoea also needs to be considered by the vaccinator. [24]

Call the clinic and describe the symptoms rather than deciding from a temperature reading alone. Useful information includes whether the baby is feeding normally, how often vomiting occurs, whether wet nappies have decreased and whether the baby is behaving normally. If the clinician recommends waiting, ask when to reassess and how the upper age limit affects the plan. This is different from withholding necessary treatment to keep a vaccine appointment. A sick baby’s clinical needs come first, and the vaccination plan can then be reviewed within the local rules. [24]

Who needs an immune-system assessment first?

Canadian guidance advises expert consultation before rotavirus vaccination for infants known or suspected to be immunocompromised. “Weakened immunity” is not a single diagnosis, and different conditions or medicines can create different risks. Tell the clinician about an immune disorder, cancer treatment, transplantation-related medicines or an investigation for recurrent or unusual infections. [5] Also provide the names of medicines used by the mother during pregnancy and breastfeeding, especially biological treatments, because the infant’s exposure may affect live-vaccine advice. [3]

Do not stop a prescribed medicine or breastfeeding to try to make the baby eligible. The relevant clinicians should coordinate the decision. Previous intussusception is another important reason not to give a routine dose without review. Parents may understandably focus on the next birthday or the last possible date, but an approaching deadline does not override a contraindication. The aim is an appropriate plan for this child, not completion of a checklist regardless of medical history. [5]

SCID screening: a result that must be communicated

Severe combined immunodeficiencies, usually shortened to SCID, are genetic conditions in which an infant’s immune system does not work adequately. Newborn blood-spot screening can identify babies who need further assessment before serious infections occur. An out-of-range screening result is not itself a confirmed diagnosis, but it does require prompt follow-up. HRSA explains that additional blood or genetic testing may be needed, and that babies should be assessed even if they are not yet showing symptoms. [16]

Tell the vaccination team if you have received an abnormal result, a request for repeat testing or an immunology appointment. Do not assume that a baby who looks well has been cleared. Equally, do not diagnose SCID from an internet list of symptoms. Take the actual screening communication or specialist letter to the appointment. If records are missing, ask the healthcare team to clarify the status and follow the local screening pathway rather than making an independent decision to vaccinate or delay indefinitely. [16]

When the vaccine must not be given

Rotavirus vaccine must not be given to a baby with SCID, a previous episode of intussusception, or a severe allergic reaction to an earlier rotavirus dose or a vaccine ingredient. These are contraindications, not simply reasons to move the appointment by a few days. Tell the vaccination team before administration if any applies or is being investigated. Other immune conditions and moderate or severe current illness need individual assessment and may lead to postponement or specialist advice. [8]

The distinction matters: a mild cold is not equivalent to a diagnosed severe immune deficiency, and an expected mild reaction is not equivalent to anaphylaxis. If you are uncertain what a previous reaction was called, bring the emergency or discharge record rather than choosing a label yourself. Ask the clinician to document the decision and explain which other childhood vaccines can still proceed. A contraindication to this vaccine does not automatically rule out every preventive vaccine. [8]

Pregnant or immunosuppressed people in the household

Living with an immunosuppressed person is not itself a reason to withhold an otherwise indicated rotavirus vaccine. CDC recommends age-appropriate rotavirus vaccination for susceptible household contacts of immunocompromised patients. Vaccine virus can be shed in stool, so everyone should wash their hands after changing the vaccinated baby’s nappy. This precaution reduces the opportunity for transmission and remains important during the following weeks. Explain the household member’s situation to the clinic, particularly if their specialist has advised additional precautions. [32]

Do not assume that ordinary cuddling, feeding or sharing a home is prohibited. Make sure other caregivers know the hygiene routine and the baby’s aftercare instructions. Pregnancy in a household member is also not a contraindication to the baby’s rotavirus vaccination. [1] That is different from a baby’s exposure to a mother’s biological medicines during pregnancy or breastfeeding, which needs its own clinical review. A reassuring answer about household contact should never be used to bypass that medication assessment. [3] [32]

Intussusception: understand the small additional risk

Intussusception means that part of the bowel folds into another part, causing a blockage. It can occur in babies who have not been vaccinated as well as after vaccination. CDC describes a small additional risk after rotavirus vaccine, usually within a week of the first or second dose, estimated at about one extra case for every twenty thousand to one hundred thousand vaccinated US infants. That is an additional-risk estimate for that setting, not a prediction for an individual baby and not the total background rate of bowel obstruction. [31]

The important practical response is knowing what to look for and seeking care promptly. Episodes of severe crying with apparent abdominal pain, drawing the legs up, repeated vomiting or blood in the stool should not be dismissed as ordinary fussiness. Tell the clinician when vaccination occurred. If you suspect intussusception and cannot quickly reach a doctor, take the baby to hospital rather than waiting for the next scheduled appointment. [31]

Do not wait for every bowel-blockage symptom

Intussusception needs urgent medical assessment because untreated obstruction can damage the bowel and lead to dehydration, loss of blood supply, perforation, infection or shock. NIDDK describes severe cramp-like pain, inconsolable crying, pulling the knees upward, vomiting, unusual lack of energy and stool containing blood and mucus. These are possible features, not a checklist that must be completed before seeking help. A baby who has repeated painful episodes or becomes unusually lethargic deserves assessment even if you have not seen a characteristic stool. [13]

Clinicians may use examination and imaging, often ultrasound, to investigate. Treatment is performed in hospital and may involve a procedure to unfold the bowel or surgery, depending on the circumstances. Parents should not try abdominal massage, laxatives or a home enema to correct a suspected blockage. The useful information to bring is the timing and pattern of symptoms, feeding and nappies, plus the vaccination record. Do not delay leaving in order to collect a perfect symptom diary. [13]

Severe allergy is an emergency

A sudden severe allergic reaction can progress quickly. Call your local emergency number if a baby develops serious breathing difficulty, swelling of the mouth or tongue, becomes limp or floppy, or stops responding normally. Blue, grey or very pale colour is also concerning; on darker skin, changes may be easier to notice on the palms or soles. A rash can occur, but breathing problems or collapse do not become safe merely because a rash is absent. [21]

Tell emergency staff about the recent vaccine and any other exposure or medicine. If a clinician has already supplied an emergency allergy plan for the child, follow it while help is being called. Do not wait for a routine clinic callback when the baby is struggling to breathe or is unresponsive. The vaccinating team is trained to respond to immediate reactions at the appointment, which is one reason to follow their instructions about remaining nearby afterwards. [21]

Recognising dehydration after vomiting or diarrhoea

Watch the baby’s feeding, wet nappies and alertness, not just the number of loose stools. Fewer wet nappies, unusual drowsiness, a dry mouth or other concerning changes can indicate dehydration. A baby who is losing fluid and cannot replace it needs prompt medical advice. Continue breastfeeding or usual-strength formula unless the treating clinician advises otherwise; smaller, more frequent feeds may be easier to tolerate. Do not dilute formula to make it seem gentler. [14]

Ask a clinician or pharmacist which oral rehydration solution is suitable and how to use it for your baby. These solutions replace salts as well as water, but advice must fit the child’s age and condition. Fruit juice and fizzy drinks are not appropriate substitutes and can worsen diarrhoea. If the child is difficult to wake, has abnormal breathing or seems seriously ill, seek emergency help. A recent vaccine does not remove the need to consider other causes of fluid loss or deterioration. [14]

Other urgent symptoms must not be labelled side effects

Green or yellow-green vomit in a child, sudden severe abdominal pain, blood in vomit, serious breathing difficulty or an abnormal level of responsiveness require emergency assessment. Repeated vomiting with inability to keep fluid down, stopping breast or bottle feeds, or bloody diarrhoea also needs urgent clinical advice. These symptoms are not a situation for waiting several days to see whether a presumed vaccine reaction settles. Tell the service the baby’s age and the exact symptoms rather than saying only “a reaction to the vaccine,” since that label may hide important detail. [22]

During less severe illness, keep feeds going as advised and avoid giving medicines to stop diarrhoea to a young child without medical instruction. NHS guidance specifically advises against antidiarrhoeal medicines in children under twelve. Infection-control advice still applies if the baby has a stomach bug: clean contaminated items and follow local nursery or childcare exclusion rules. Being vaccinated does not mean that an ill child cannot spread an infection. [22]

Nappy-changing hygiene after a live oral vaccine

Prepare a clean nappy and supplies before starting, so dirty and clean items can be kept apart. Keep the baby secure on the changing surface throughout. Dispose of used wipes and disposable nappies appropriately, or put reusable items into the designated container without spreading stool onto nearby surfaces. After dressing the baby, clean the child’s hands and place them safely before cleaning the changing area and washing your own hands thoroughly with soap and water. [20]

Clean visible contamination from a suitable changing surface and then disinfect it according to the product instructions. Do not use the same area for preparing bottles or food. The point is a manageable routine, not treating the baby as dangerous. Make sure grandparents, babysitters and other caregivers follow the same steps. Hand hygiene is especially worth discussing when someone in the home is immunosuppressed, and it remains useful well beyond the days following vaccination because natural gut infections spread in the same everyday environment. [20]

Keep feeding equipment clean without changing the milk

Vaccination does not create a need for a special formula or a new supplement. Ordinary safe feeding practices remain important. CDC advises taking bottle components apart, rinsing them and washing them in a clean basin used for infant feeding equipment rather than directly in a potentially contaminated sink. Items should be allowed to air-dry thoroughly rather than rubbed dry with a used towel. Extra sanitising is particularly relevant for babies younger than two months, premature infants and children with weakened immunity. [30]

Follow the equipment manufacturer’s instructions and your local infant-feeding guidance. Keep clean items away from the nappy-changing area and handle them with washed hands. This is a practical way to reduce avoidable exposure while continuing normal feeding. If the baby is unwell, ask for an age-appropriate feeding and rehydration plan instead of changing the concentration of milk or adding ingredients. The vaccine is only one part of protecting a baby; clean preparation and prompt attention to feeding difficulties still matter. [30]

Preparing for a calm, useful appointment

Write down the questions that matter before the visit, particularly anything about age limits, previous reactions or a changed medical history. Bring the vaccination record and any relevant specialist letters. Ask to see the information sheet for each product being offered and give yourself permission to ask for an explanation in plain language. A familiar blanket, cuddling and a calm voice can help during a busy infant appointment. [15]

Although rotavirus is oral, other vaccines given at the same visit may be injections, so ask the team what will happen in what order. Before leaving, confirm which mild symptoms to expect, which signs require urgent help and whom to contact outside normal hours. Ask whether any pain- or fever-relief medicine is appropriate for this baby and what instructions to follow; do not assume that advice for an older sibling applies. Finally, book or confirm the next visit while the dates and product names are available, rather than relying on memory later. [15]

What should appear in the vaccination record?

A useful record identifies the date, vaccine product or manufacturer and the dose that was given. The clinical record also contains details such as the lot number and administering professional. Ask the service to update your child’s personal record and check that it agrees with the appointment you attended. This is particularly helpful when oral vaccine is administered alongside several injections, because a parent may remember the visit without remembering every product. [18]

Keep a readable copy in a secure place and bring it when changing providers. If a planned dose was postponed, distinguish that from a dose actually administered; a booked appointment is not proof of vaccination. Record the next agreed date separately so it is clear what remains outstanding. For families coordinating several childhood vaccines, our varicella vaccination guide explains another vaccine with country-dependent schedules. Its timing should not be copied onto the rotavirus course, which has its own early-infant limits. [18]

How to report a suspected reaction in the United States

Seek medical care first when symptoms need assessment. A safety report is not a substitute for treatment or an urgent advice service. In the United States, parents and caregivers can submit a report to the Vaccine Adverse Event Reporting System, known as VAERS, even when they are unsure whether a vaccine caused the problem. The system helps identify patterns that may need further investigation. [19]

A report alone does not prove causation, and the number of raw reports cannot reliably tell a parent the chance of a particular event happening to their baby. Include accurate dates, the vaccine name if known, symptoms and any treatment received. Avoid guessing missing details; your clinic may be able to supply them. It is reasonable both to report a concerning event and to remain open to another explanation. The baby’s subsequent vaccination plan should be discussed with the treating clinician using the actual diagnosis, not decided solely from an unreviewed report. [19]

Reporting in the UK and discussing the next dose

In the UK, the Yellow Card scheme accepts suspected adverse reactions to medicines and vaccines. A parent does not have to prove a causal connection before reporting a concern. The information contributes to ongoing safety monitoring, particularly when unusual or serious events occur. Keep the account factual: describe what happened, when it began, which product was given and whether a clinician made a diagnosis. [25]

Do not use the reporting process instead of contacting emergency or clinical services when a baby is currently unwell. If an event led to hospital care or a diagnosis such as intussusception, make sure the routine vaccination service knows before another dose is planned. Mild expected symptoms and a diagnosed serious adverse event are not equivalent situations. Ask the clinician to explain whether the event changes eligibility, whether specialist advice is needed and how the decision will be documented. This helps prevent both an inappropriate repeat exposure and unnecessary abandonment of unrelated vaccinations. [25]

Making sense of benefits, risks and online claims

Safety and effectiveness are evaluated using more than stories about events that happened after a vaccine. Surveillance examines disease trends, clinical findings and population-level patterns. CDC’s rotavirus surveillance review describes major declines in rotavirus disease after vaccination programmes were introduced, while also recognising the small increased intussusception risk identified after licensure. Both findings belong in an honest discussion. [28]

Saying that the vaccine has benefits does not mean dismissing a parent’s concern about symptoms; acknowledging a rare risk does not mean that severe rotavirus disease is harmless. Ask whether a number refers to illness of any severity, hospitalisation, a background condition or an additional vaccine-associated risk. Those are different measures and should not be compared as though they were identical. For an individual baby, the most useful decision combines the local schedule, the child’s medical history and clear aftercare instructions. It should not depend on a dramatic headline or a promise of zero risk. [28]