Division of Disease Control and Health Protection

The Advisory Committee on Immunization Practices (ACIP) recommended today that Rotashield, the only U.S.-licensed rotavirus vaccine, no longer be recommended for infants in the United States. Today’s action is based on the results of an expedited review of scientific data presented to the ACIP by CDC in cooperation with the FDA, NIH, and Public Health Service officials, along with Wyeth-Lederle. Data from the review indicate a strong association between Rotashield and intussusception (bowel obstruction) among some infants during the first 1-2 weeks following vaccination. Use of the vaccine was suspended in July pending the data review by the ACIP. Parents should be reassured that their children who received rotavirus vaccine before July and remain well are not at increased risk for intussusception now.

Rotavirus and other causes of severe diarrhea remain a serious health concern for young children in the United States. In the U.S., rotavirus disease has been associated with approximately 50,000 hospitalizations and at least 20 deaths per year.

CDC announced today the start of a national education program to help parents manage severe diarrhea in children, the most serious complication of rotavirus illness. Education efforts will include outreach to parents through their health care providers and directly to parents through popular media such as parent magazines and radio public service announcements, in English and Spanish. Parents are urged to learn steps to relieve diarrhea symptoms in their children. Most importantly, parents are urged to learn the signs that their child may be suffering from severe dehydration from diarrhea and needs immediate medical care. Signs of severe dehydration in children include crying without tears, sunken eyes, unusual drowsiness or fussiness and dry, sticky mouth.

In July, the Public Health Service recommended to parents and health care providers that they postpone use of Rotashield as a precautionary measure following reports, from its early alert system, of intussusception among some infants following rotavirus vaccination. Also at that time, the manufacturer in consultation with the FDA voluntarily ceased distribution of the vaccine and, last week, withdrew the vaccine from the U.S. market. Experts agree that continued research is needed to clarify the relationship between intussusception and this rotavirus vaccine and to develop new vaccines against this disease.

Most importantly, health care providers should reassure parents that continued immunization of children against other life-threatening diseases is critical to prevent illness and disease outbreaks. Overall, vaccines are one of the safest and most effective medical interventions of our time, and the decision to immunize children against diseases like polio, whooping cough, bacterial meningitis and diphtheria is a sound one. For more information about vaccines, contact CDC’s National Immunization Information Hotline at 1-800-232-2522 (English) or 1-800-232-0233 (Spanish). For more information about managing diarrhea in children, visit CDC’s website at www.cdc.gov

David Satcher, MD, PhD, U.S. Surgeon General and Assistant Secretary, Public Health and Science, Department of Health and Human Services, invites all interested parties to join him for a satellite broadcast on Wednesday, December 1, 1999, entitled "Healthy People 2000 Progress Review:  Immunization and Infectious Diseases." The primary objectives of this meeting are to 1) assess progress made in achieving the "Healthy People 2000" objectives for immunization and infectious diseases, 2) highlight effective programs, and 3) learn how to translate the "Healthy People 2000" national objectives into local action.  Dr. Satcher will be joined by a panel of experts who will respond to participants' questions. The target audience includes state and local public health officials, health care providers and students, professionals and students of public health, health educators, consumer advocates, and others involved in policy development. The broadcast is scheduled from 2-4 pm ET. Sponsors include the Office of the Assistant Secretary of Health, the Office of Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), and the Public Health Training Network.

This outbreak of food poisoning was very interesting and very unusual in that dill pickles were determined to be the vehicle for transmitting the causative organism, Salmonella sendai. So far as I know, this is the first case of food poisoning that has been attributed to pickles and while Salmonella sendai was first isolated in 1925 from cases of enteric fever in Japan, it seems that few cases of food poisoning have been traced to this particular organism.

Epidemiological investigation revealed that the pickles were [sic] the only food common to all of the cases. The restaurant in question has the most modern equipment and refrigeration and at the time of the food poisoning, everything was in excellent condition. Samples of all foods that possibly could have been the source were examined bacteriologically but none were found to contain the organism except the dill pickles and a sample of the brine from the barrel which contained pickles. It is not clear how the pickles became contaminated, whether by repeated handling in the process of removing pickles from the barrel by a carrier or, as seems much more probable, by fecal contamination of the pickles or of the barrel before the pickles were placed in the barrel.

Stool cultures were taken from 35 persons employed in this restaurant and 11 of them showed positive for Salmonella sendai. It is felt that all 11 of these persons, however, received their infection from the pickles and were not the source of infection. All 11 of the food handlers were stopped from handling food until repeated stool examinations showed them to be free from the infecting organism. Most of the 11 cleared up promptly but one case continued to discharge the organism for a number of weeks.