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Rotavirus vaccination compliance and completion in a Medicaid infant population

Girishanthy Krishnarajah¹, Pamela Landsman-Blumberg², Elnara Eynullayeva²

¹USHO & MP, NAMA, GSK 5 Crescent Drive, Philadelphia, PA 19112, United States.

|June 26, 2014

Insights

Rotavirus (RV) vaccination compliance is low among Medicaid infants, with less than 30% completing the recommended doses. The 2-dose Rotarix (RV1) vaccine showed higher compliance and completion rates than the 3-dose RotaTeq (RV5).

Area of Science:

Pediatric Vaccinology
Public Health Surveillance
Health Services Research

Background:

Rotavirus (RV) infection is a leading cause of severe diarrheal disease in infants globally.
Vaccination is a key strategy to prevent rotavirus gastroenteritis, with two main vaccines available in the US: Rotarix (RV1) and RotaTeq (RV5).
Understanding vaccination completion and compliance is crucial for assessing vaccine program effectiveness, particularly in vulnerable populations like those covered by Medicaid.

Purpose of the Study:

To evaluate the completion and compliance rates of rotavirus (RV) vaccination among US infants covered by Medicaid.
To compare the performance of the 2-dose Rotarix (RV1) and 3-dose RotaTeq (RV5) vaccines regarding compliance and completion.
To identify potential areas for public health intervention to improve RV vaccination coverage.

Main Methods:

Retrospective analysis of healthcare claims data from the Truven Health MarketScan Multi-State Medicaid Database (May 2008-June 2012).
Infants under one year of age were categorized into cohorts based on adherence to either the Food and Drug Administration's Prescribing Information (PI) or the Advisory Committee on Immunization Practices (ACIP) recommendations.
Vaccination compliance and completion rates were calculated for RV1 and RV5 vaccines within both PI and ACIP cohorts.

Main Results:

Overall compliance rates were 24.5% (PI) and 28.2% (ACIP), with completion rates of 30.3% (PI) and 32.6% (ACIP).
Infants receiving the 2-dose RV1 vaccine demonstrated significantly higher compliance (65.2% PI, 68.8% ACIP) and completion rates (65.3% PI, 73.5% ACIP) compared to those receiving the 3-dose RV5 vaccine (31.3% PI, 45.9% ACIP; 46.4% PI, 48.8% ACIP).
Despite a year-over-year increase, overall RV vaccination compliance remained suboptimal, with over 40% of eligible infants unvaccinated.

Conclusions:

Rotavirus vaccination compliance and completion rates among US Medicaid-enrolled infants are suboptimal.
The 2-dose Rotarix (RV1) vaccine exhibits superior compliance and completion rates compared to the 3-dose RotaTeq (RV5) vaccine in this population.
Targeted public health initiatives are needed to address low vaccination rates and improve protection against rotavirus infection in Medicaid-covered infants.

Read full analysis

Abstract:

We examined completion and compliance rates of rotavirus (RV) vaccination according to the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Food and Drug Administration approved Prescribing Information (PI) for Rotarix® (RV1, GlaxoSmithKline Vaccines) and RotaTeq® (RV5, Merck and Co.) among infants under one year of age covered by Medicaid programs. Healthcare claims data from state Medicaid programs that constituted the Truven Health MarketScan® Multi-State Medicaid Database were retrieved from May 2008-June 2012. Infants were grouped under PI and ACIP cohorts based on the dosing regimens followed. The overall compliance per PI (n=673,956) and ACIP (n=695,612) recommendations were 24.5% and 28.2%, respectively; completion rates were 30.3% and 32.6%, respectively. In the PI cohort, infants who received RV1 had significantly higher compliance as compared with infants who received RV5 (65.2% vs. 31.3%; p<0.0001); completion rates among infants receiving RV1 and RV5 were 65.3% and 46.4%, respectively (p<0.0001). In the ACIP cohort, compliance with RV1 was significantly higher than RV5 (68.8% vs. 45.9%; p<0.0001) as was the overall completion rate (73.5% vs. 48.8%; p<0.0001). While compliance is increasing year over year, overall compliance of RV vaccines is suboptimal, with over 40% of eligible infants unvaccinated in both populations. The 2-dose RV vaccine showed better completion rates and higher compliance than the 3-dose RV vaccine in the United States. Public health initiatives focusing on suboptimal compliance and completion rates of RV vaccination in the Medicaid population could improve these metrics, thereby offering protection against RV infection.

Keywords:

Completion Compliance Medicaid Rotavirus United States

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