Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates

Area of Science:

• Neonatalogy
• Infectious Diseases
• Vaccinology

Background:

• Neonatal intensive care units (NICUs) often withhold rotavirus vaccines due to theoretical horizontal transmission risks.
• This study addresses the safety and transmission of the pentavalent rotavirus vaccine (RV5) in a NICU setting.

Purpose of the Study:

• To determine the incidence of rotavirus vaccine (RV5) strain transmission to unvaccinated infants within a NICU.
• To assess the clinical significance of any observed vaccine-strain transmission.

Main Methods:

• Prospective cohort study in a 100-bed NICU over one year.
• Weekly stool specimen collection and real-time quantitative reverse-transcription polymerase chain reaction (RT-qPCR) for RV5 detection.
• Incidence calculated based on patient-days at risk; geospatial analyses for transmission events.

Main Results:

• RV5 was administered to 226 infants; 3448 stool samples were tested.
• Only 5 (<1%) of 686 unvaccinated infants tested positive for RV5 strain.
• Estimated transmission rate was 2.2/1000 patient-days at risk, with no associated gastroenteritis symptoms.

Conclusions:

• Rotavirus vaccine (RV5) strain transmission in the NICU setting is infrequent.
• Observed transmission had no clinical consequences, supporting in-NICU vaccination.
• Benefits of early rotavirus protection outweigh risks of vaccine-strain transmission.