Neonatal administration of rhesus rotavirus tetravalent vaccine

Administration of the first dose of rhesus rotavirus-based tetravalent (RRV-TV) vaccine is followed by a transient febrile reaction at 3-4 days postvaccination in about one-third of vaccinees. We hypothesized that giving the first dose of RRV-TV vaccine during the neonatal period might reduce the reactogenicity of RRV-TV vaccine without compromising the utilization of the vaccine.

A double blind placebo-controlled safety and immunogenicity trial of 90 infants who received RRV-TV vaccine at 0-4-6, 0-2-4 or 2-4-6 months of age was conducted. Reactions were evaluated for 1 week after each vaccination and, in addition, serum specimens were collected before vaccination and at 5 and 7 months of age.

Febrile reactions were not observed in 62 infants receiving the first dose of RRV-TV vaccine during the neonatal period. Five of the 28 (18%) infants receiving the first dose at 2 months were febrile on 1 or more days, whereas none of the 30 infants who had received a neonatal dose developed a fever when vaccinated again at 2 months of age. An enzyme-linked immunosorbent assay IgA antibody response after 3 doses was observed significantly less frequently (77%) in infants who had received a neonatal dose, a second dose at 2 months of age, and a third dose at 4 months of age compared with those who received their first dose at 2 months and a second dose at 4 months (100%, P < 0.02). Also, the frequency of a neutralizing antibody response to RRV and human rotavirus serotypes G1-4 tended to be lower in the group that had received the vaccine at 0-2-4 months compared with those who received it at 2-4-6 months. When the 2 tests were combined, the frequency of a seroresponse following the 0-2-4 month schedule (94%) was comparable with that following the 2-4-6 month schedule (100%).

Infants who received the first dose of RRV-TV vaccine during the neonatal period did not develop a febrile reaction. The immune response in a 3-dose schedule initiated in the neonatal period is somewhat dampened but still acceptable. Neonatal immunization might also reduce the very small risk of intussusception, which has been associated with administration of RRV-TV vaccine to older infants.