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Published on: January 28, 2019
Why Aren't We Achieving High Vaccination Rates for Rotavirus Vaccine in the United States?
Allison Kempe1, Sean T O'Leary1, Margaret M Cortese2
1Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo; Department of Pediatrics, University of Colorado Anschutz Medical Campus (A Kempe, ST O'Leary, JR Cataldi, and M Brtnikova), Aurora, Colo.
Insights
Pediatricians face challenges in achieving rotavirus vaccine (RV) coverage, with parental concerns and missed opportunities being key barriers. Addressing these issues is crucial for improving infant immunization rates.
Area of Science:
- Pediatric Infectious Diseases
- Public Health and Epidemiology
- Vaccinology
Background:
- Rotavirus vaccine (RV) coverage in the United States remains below the target of 80% for infants.
- Suboptimal immunization rates highlight a need to understand barriers to RV administration.
Purpose of the Study:
- To identify factors associated with difficulties in administering the first rotavirus vaccine (RV#1) dose by the recommended maximum age.
- To assess pediatrician-identified barriers to timely rotavirus vaccination.
Main Methods:
- A national survey of pediatricians was conducted using internet and mail methods from April to June 2019.
- Multivariable regression analysis was employed to determine factors linked to delayed RV#1 administration.
Main Results:
- Parental concerns regarding vaccine safety (27%) and deferral (25%) were the most cited barriers to RV delivery.
- Reasons for not receiving RV#1 by 4-5 months included parental refusal (9%) and missed opportunities in healthcare settings (7-11%).
- Difficulty administering RV#1 by the maximum age was associated with a higher proportion of Medicaid/CHIP-insured children and complex vaccination schedule recommendations.
Conclusions:
- Pediatricians report actionable issues contributing to low rotavirus vaccine coverage.
- Key barriers include missed vaccination opportunities in nurseries, infants exceeding the age limit before well-child visits, and parental vaccine hesitancy.
- Strategies to improve RV immunization rates should address these identified challenges.
Background:
Rotavirus vaccine (RV) coverage levels for US infants are <80%.
Methods:
We surveyed nationally representative networks of pediatricians by internet/mail from April to June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age.
Results:
Response rate was 68% (303/448). Ninety-nine percent of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%), and parent concerns about RV safety (6%). The most commonly reported reasons for nonreceipt of RV#1 by 4 to 5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from neonatal intensive care unit/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age.
Conclusions:
US pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring.
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