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Published on: January 28, 2019
Rotavirus Vaccine Coverage and Potential Barriers Among US Children Born From 2007 to 2024
Mary C Moran1, Mary E Wikswo1, Leila C Sahni2,3
1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Current rotavirus vaccine (RVV) guidelines may limit infant vaccination. Reconsidering RVV administration in neonatal intensive care units (NICUs) could improve vaccination rates for eligible infants.
Area of Science:
- Pediatrics
- Vaccinology
- Public Health
Background:
- The Advisory Committee on Immunization Practices (ACIP) recommends rotavirus vaccine (RVV) first dose by 14 weeks, 6 days.
- RVV is not recommended until neonatal intensive care unit (NICU) discharge, potentially limiting timely vaccination.
Purpose of the Study:
- To investigate if current RVV guidelines hinder vaccination completion.
- To identify factors associated with missed RVV vaccination opportunities.
Main Methods:
- Analysis of vaccination status in children aged ≥15 weeks from the New Vaccine Surveillance Network (2014-2024).
- Inclusion criteria: rotavirus-negative acute gastroenteritis or healthy controls with known vaccination status.
- Univariate logistic regression used to identify risk factors for non-initiation or completion of RVV series.
Main Results:
- Over 24,755 children were included in the study.
- Strongest risk factors for not initiating RVV: delayed DTaP vaccine, extremely preterm birth, early RVV introduction period, and lack of health insurance.
- Over 50% of extremely preterm infants in NICUs were discharged after 15 weeks of age.
Conclusions:
- Current RVV guidelines may create barriers to timely vaccination.
- Allowing RVV administration in NICUs could improve vaccination coverage.
- Re-evaluation of RVV guidelines is recommended to enhance public health outcomes.
Background/Objectives:
The Advisory Committee on Immunization Practices recommends the first dose of rotavirus vaccine (RVV) be delivered by a maximum age of 14 weeks, 6 days and that the vaccine not be delivered until time of discharge from the neonatal intensive care unit (NICU). We hypothesized that these guidelines limit the number of children who can be vaccinated with RVV.
Methods:
Children born on or after January 1, 2007, enrolled in the New Vaccine Surveillance Network from December 2014 to August 2024 aged at least 15 weeks with rotavirus-negative acute gastroenteritis or as a healthy control, and with known vaccination status were included. We identified factors associated with not initiating or completing the RVV series and missed opportunities for vaccination. Odds ratios (ORs) and 95% CIs were calculated using univariate logistic regression.
Results:
A total of 24 755 children met the inclusion criteria. The risk factors most strongly associated with not initiating RVV were receiving the diphtheria, tetanus, and pertussis vaccine at greater than or equal to age 15 weeks (OR, 30.0; 95% CI, 26.8-33.7), extremely preterm birth (OR, 14.6; 95% CI, 11.2-20.0), being born soon after RVV introduction (2007-2009) (OR, 3.3; 95% CI, 2.9-3.8), and having no health insurance (OR, 2.2; 95% CI, 1.8-2.7). More than 50% of extremely preterm infants in the NICU were not discharged until greater than or equal to age 15 weeks.
Conclusions:
Re-evaluation of the vaccine guidelines to allow RVV administration in the NICU may remove barriers to vaccination and help improve RVV coverage.
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