Vaccinations and Cloth Nappies

We've seen quite a bit of advice around recently suggesting that parents who use cloth nappies should switch to disposables when their child is receiving their vaccinations. The reasoning behind this is, that if live vaccine-virus (note it's 'vaccine-virus' not the actual virus, so a much weaker version) sheds in poo, the cloth nappies can become contaminated, increasing the chance of transmission of the vaccine virus to other members of the household.

We've spoken to several professionals regarding this, including the Immunisation Centre at the Royal Children's Hospital, Melbourne, and can offer the following information.

The only vaccination currently on the Australian Immunisation Schedule that can shed live vaccine virus in poo and has any risk of transmission to a person is the rotavirus vaccine (usually given in two or three doses by 6 months). There are two brands used in Australia. The Rotateq brand (currently used in Victoria, Queensland, South Australia & WA)  has up to a 13% chance of it shedding (on the first dose only). The Rotarix brand (given in Tasmania, NSW, ACT & NT) can shed in up 80% of cases for the first dose and up to 30% for the second dose.

However, the shed vaccine-virus, which is attenuated (so a genetically weakened strain), is generally considered to only be of concern to those who are immuno-compromised in some way.


The standard recommendation for care of infants who have received the Rotavirus vaccine to prevent transmission of the vaccine-virus is simple handwashing. So long as diligent handwashing with soap, and good laundry practices are carried out, there is very little risk of transmitting the vaccine-virus to someone with a normal immune system if you're using cloth nappies.

So what does good laundry practice mean?

- Wash the nappies as soon as you can, so there is less chance of someone coming in contact with the poo before it's washed.
- Run a rinse first, and wash at 60 degrees for a week or so after the vaccine, if you can. There are indications that higher temperatures are more effective at removing similar viruses than washing in cold or warm.
- Line dry in the sun if possible.
- And wash your hands whenever you come into contact with dirty nappies (which you do anyway).

Please note that use of anti bacterial/anti fungal laundry rinses like Dettol and Canestan have no effect on viruses.

If your child regularly come in contact with a friend or relative who is immuno-compromised, then additional care needs to be taken, and it may be worth switching to disposable nappies for a week or two after the rotavirus immunisations.

Please note that there have been no studies done examining the rotavirus vaccines and home laundering with specific regards to cloth nappies, so the above information is based on existing scientific research about how the rotavirus vaccines operate and current recommendations on how to minimise transmission of the vaccine virus.

Additional Information

You can find more information in the Australian Immunisation Handbook, but here are some relevant extracts:

The use of live attenuated viral vaccines in contacts of immunocompromised persons (MMR, MMRV, varicella and rotavirus vaccines, where indicated) is safe, and strongly recommended to reduce the likelihood of contacts infecting the immunocompromised person. ... Although there is no risk of transmission of the MMR vaccine viruses, and an almost negligible risk of transmission of varicella-zoster vaccine virus (from varicella or zoster vaccine), there is a small risk of transmission of the rotavirus vaccine virus. Hand washing and careful disposal of soiled nappies is recommended to minimise transmission. Source.

Infants living in households with immunocompromised persons should be vaccinated. In general, immunocompromised household members are afforded protection by vaccination of young children in the household and this is considered to outweigh the risk of transmitting vaccine virus shed in stools to the immunocompromised household member. However, there have been no studies to specifically address this question. Hand washing and the careful disposal of soiled nappies are likely to minimise any risk of vaccine transmission to other household members. Source.

Vaccine viruses replicate in the intestinal mucosa and can be shed in the stool of vaccine recipients, particularly after the 1st dose. Vaccine virus shedding is more common with Rotarix and is detected in the stool a week after vaccination in up to 80% of 1st dose recipients, and in up to 30% of 2nd dose recipients. RotaTeq is only shed after the 1st dose (in up to 13% of recipients). In one study of 80 sets of twins, transmission of Rotarix was observed to occur from 15 vaccinated infants to their unvaccinated twin, indicating that transmission of vaccine virus to unvaccinated contacts is likely to occur, but the clinical implication of this has not been studied. Source.