08/01/2025
For the past few weeks I have been doing a series on vaccine illnesses and financial transparency with vaccines. I only have a couple more posts planned, because I feel like the news has focused a lot on measles and you might be familiar with others, for example whooping cough, so I’ve tried to highlight a few vaccines for diseases with which you might be a little more unfamiliar.
The last vaccine preventable illness I have decided to highlight is Rotavirus. And it’s because I have a personal story to go with this one.
When I was a kid living in Guatemala, I definitely knew and heard about local kids dying from vomiting and diarrhea. Which is why, when I was in medical school and learned Rotavirus (a virus that causes awful vomiting and diarrhea) was the leading cause of death in children world wide (at that time) I wasn’t surprised. But, I thought of it as more a nuisance in the US. A cause of many many hospital admissions and healthcare costs, along with time missed from work, but not necessarily a bad virus or a life threatening one in a country with good medical care.
So when the vaccine first came out, while I was still in medical school - 1998 - I admit I thought it was a bit unnecessary for kids in the US. I thought for sure it should be distributed to developing countries where the death rate was high, but I didn’t think we needed it here.
That first rotavirus vaccine was withdrawn from the market in 1999 because of side effect to the gut that could be harmful. It was an oral vaccine. Historically speaking oral vaccines have not always been the best because the effect on the gut cannot always be fully measured in research prior to widespread implementation, and often these type of vaccines end up pulled off the market. They are attractive because of the ability to distribute them easily to developing countries but not always the best vaccines.
I graduated medical school in 1999, so the vaccine was no longer available and Rota was running wild when I was in residency (my training after medical school specifically in pediatrics). And it was during residency something happened to change my mind.
I was on call overnight and leaving for a vacation the morning after I got off work. At the beginning of my call shift a 20 month old child was admitted. The child had a fever and was too sleepy, actually - you couldn’t really wake him up. As he came into the room and I walked in to assess him, ask his mom all my questions and decide on his treatment plan, he stopped breathing.
This story is one of those stories from training that sticks with you for your whole life. (I call them teaching moments when I teach medical students now). I yelled, “code blue” out to the nurses who were in the hall outside the room. A code blue means a whole team of people should come running to help. In the hospital that team typically includes a respiratory therapist who brings the breathing equipment to the room. When I was in training, you didn’t necessarily have all the right sized equipment you needed in a normal hospital room (non ICU rooms).
A respiratory therapist came running, or so I thought. But, she was a RT student and was scared. She ran into the room with a newborn mask and bag (the thing we squeeze air with). I grabbed the bag valve mask from her and then froze. It was a newborn mask that barely covered this boy’ s nose - much less his mouth - and the bag wasn’t big enough to give the size breath he needed.
All this happened in what was seconds but felt much longer to me. I froze because I had never been in a code in the hospital before where I didn’t have the correct equipment.
And when I came to - or unfroze- I started mouth to mouth on this child, while his mother cried and lost it the whole time beside me. And before the correct equipment could be found and brought to the room, or his mom was escorted out of the room, he started breathing again.
The gossip in pediatrics ran wild by the next day. Attendings were coming into the room before I left in the morning congratulating me for saving a child with mouth to mouth. I didn’t know what to say. I was shocked I had to do it. I didn’t feel like a hero, I felt embarrassed because of how I initially froze. In our life support training courses, I was always made to feel like giving mouth to mouth was normal. But, in reality, in the hospital setting it’s almost unheard of.
That was the first time I ever had to do it.
And in less than 48 hours into my vacation… you guessed it. I had the worst vomiting and diarrhea I had ever experienced in my life. I couldn’t get out of bed for 3 days. I lost way too much weight and almost had to go to the hospital myself.
And yes. The boy had rotavirus.
Afterwards I couldn’t help but think 3 things: 1. What if he had been at home instead of the hospital when that happened? 2. If it made me that sick, I had seriously “blown off” or “downplayed” the effects of this virus in my mind while studying it in medical school. 3. How American arrogant I was to think that only developing countries needed a vaccine and that nothing bad would happen to a child with it in our healthcare system.
An injectable rotavirus vaccine was approved in 2006. Prior to the vaccine rotavirus infected 2.7 million children in the US every year. It was responsible for 55-70 thousand US hospitalizations every year. And while the virus has never been fully eliminated (if it had been then we could stop giving the shot like we did smallpox) it has drastically reduced illnesses and hospitalizations.
There are two vaccines approved now for rotavirus. The vaccine is given at 2 and 4 months or at 2,4, and 6 months depending on which injectable vaccine is given.
This Xray shows the incredibly distention caused by rotavirus in a child. Looks pretty dramatic doesn’t it? Trust me it felt dramatic when I was giving mouth to mouth.
This nears the end of my current series of posts on vaccines, unless you reach out with questions that inspire me. I hope you have been finding them educational.
And I hope this one, in particular, shows you the emotional impact these diseases have made on us as providers (particularly us older providers who dealt with many of them regularly) and why we try so hard to keep your kids from being ones like this little boy - through vaccination. It’s personal for us. Because even if we hide it with our calm facial expressions and steady voices - it doesn’t mean we aren’t scared and crying on the inside with you.
Dr Hill
