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Risk of Rotavirus Nosocomial Spread After Inpatient Pentavalent Rotavirus Vaccination
Annika M Hofstetter1,2, Kirsten Lacombe2, Eileen J Klein3,2
1Department of Pediatrics, University of Washington, Seattle, Washington; annika.hofstetter@seattlechildrens.org.
Insights
Delaying rotavirus vaccination until hospital discharge misses opportunities for infants, especially those in neonatal care. The pentavalent human-bovine reassortant rotavirus vaccine (RV5) showed no vaccine-type rotavirus transmission in unvaccinated infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Infants in neonatal care face higher risks of severe rotavirus disease.
- Current recommendations suggest rotavirus vaccination post-neonatal discharge, balancing protection with theoretical nosocomial transmission risks.
- Early vaccination is crucial as the first dose must be given by 104 days of age.
Purpose of the Study:
- To evaluate the impact of delaying rotavirus vaccination until hospital discharge on vaccination rates in high-risk infants.
- To assess the risk of nosocomial transmission of vaccine-type rotavirus in a neonatal intensive care setting.
Main Methods:
- A prospective cohort study of infants admitted to an urban academic medical center (birth to 104 days).
- Weekly stool specimen collection and analysis for rotavirus strains using real-time reverse transcription-polymerase chain reaction.
- Collection of demographic and vaccine administration data for infants receiving the pentavalent human-bovine reassortant rotavirus vaccine (RV5).
Main Results:
- Over 40% of unvaccinated infants were discharged past the 104-day age limit for rotavirus vaccination.
- Vaccine-type rotavirus strains were detected in 9 RV5-vaccinated infants, with no cases found in unvaccinated infants.
- The incidence rate of vaccine-type rotavirus in unvaccinated infants was 0.0 per 1000 patient days at risk.
Conclusions:
- Delaying rotavirus vaccination until hospital discharge can result in missed vaccination opportunities.
- The study suggests that delaying vaccination may be unnecessary in healthcare settings utilizing the RV5 vaccine with robust infection control.
- Early administration of rotavirus vaccine (RV5) in neonatal care settings appears safe and effective in preventing disease.
Background:
Infants born prematurely or with underlying conditions are at increased risk of severe rotavirus disease and associated complications. Given the theoretical risk of nosocomial transmission of vaccine-type rotavirus, rotavirus vaccination is recommended for infants at or after discharge from neonatal care settings. Because the first dose should be administered by 104 days of age, some infants may be age-ineligible for vaccination if delayed until discharge.
Methods:
This prospective cohort included infants admitted to an urban academic medical center between birth and 104 days who received care in intensive care settings. Pentavalent human-bovine reassortant rotavirus vaccine (RV5) was used, per routine clinical care. Stool specimens were collected weekly (February 2013-April 2014) and analyzed for rotavirus strains using real-time reverse transcription-polymerase chain reaction. Demographic and vaccine data were collected. RV5 safety was not assessed.
Results:
Of 385 study infants, 127 were age-eligible for routine vaccinations during hospitalization. At discharge, 32.7% were up-to-date for rotavirus vaccination, compared with 82.7% for other vaccinations. Of rotavirus-unvaccinated infants, 42.6% were discharged at age >104 days and thus vaccination-ineligible. Of 1192 stool specimens collected, rotavirus was detected in 13 (1.1%): 1 wild-type strain from an unvaccinated infant; 12 vaccine-type strains from 9 RV5-vaccinated infants. No vaccine-type rotavirus cases were observed among unvaccinated infants (incidence rate: 0.0 [95% confidence interval: 0.0-1.5] cases per 1000 patient days at risk).
Conclusions:
These data suggest that delaying rotavirus vaccination until discharge from the hospital could lead to missed vaccination opportunities and may be unnecessary in institutions using RV5 with comparable infection control standards.
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