Rotavirus vaccine coverage and disease burden vary by provider location

Last Updated: 2015-01-12

By Reuters Staff

NEW YORK (Reuters Health) - Rotavirus disease rates are higher in provider locations with lower rotavirus vaccine coverage, prompting researchers to call for more diligence in administering the vaccine to every age-eligible child.

Hospitalizations of children under age five for rotavirus infection have declined by 60% to 89% since introduction in 2006 of rotavirus vaccines, though vaccine uptake rates are only about 67% (compared with 93% to 95% for other childhood vaccines recommended at 2, 4, and 6 months of age).

The U.S. Advisory Committee on Immunization Practices (ACIP) recommends doses of either of the two available rotavirus vaccines be administered at two and four months of age (but as early as six weeks of age and no later than 14 weeks 6 days for the first dose), with the third dose of RotaTeq administered at six months of age.

The researchers - Leila C. Sahni from Texas Children's Hospital's Immunization Project, Houston, Texas, and colleagues - had discovered that a high proportion of rotavirus-positive cases of severe acute gastroenteritis (AGE) was occurring among patients from a small number of individual provider locations.

For the new study, they examined vaccine records of children enrolled in their routine AGE and acute respiratory infection (ARI) surveillance initiative, to evaluate variation in rotavirus disease by vaccine coverage at each location.

Four locations (including a neonatal ICU), or 5.9% of the total, were classified as low-coverage (i.e., <40% of eligible children receiving at least one dose of vaccine), 22 (32.3%) as medium coverage (40% to 80% of children receiving at least one dose of vaccine), and 42 (61.8%) as high coverage (80% or more children receiving at least one dose of vaccine).

In the low-coverage locations, rotavirus was detected in 31.4% of children with AGE, compared with 13.1% in medium-coverage locations and 9.6% in high-coverage locations, according to the January 12 Pediatrics online report.

At the sole low-coverage NICU, more than half the infants were age-eligible to have received rotavirus vaccine. "Infants discharged from a NICU are frequently underimmunized for all two-month vaccinations," the authors explain. "Specific to rotavirus vaccine, we believe that this underimmunization may be exacerbated by the logistical challenges of vaccine administration at the time of NICU discharge and not during hospitalization."

"If rotavirus vaccine is not given during NICU hospitalization or at discharge, pediatricians in the community may fail to realize this, may presume that the vaccine had been omitted for a specific reason, or may have doubts about administering vaccine to a fragile, medically complex infant," they say.

Results were consistent across rotavirus seasons, the researchers note.

"Collectively, these findings indicate that failure to vaccinate is contributing, at least in part, to the lower but persistent burden of rotavirus AGE in the post-rotavirus vaccine era," they conclude. "As a detailed characterization of the provider locations and the vaccine attitudes of parents treated at these locations was not an objective of this study, the reason for the low rotavirus vaccine coverage among some sites is unclear."

"Educational efforts targeting vaccine providers, including NICU physicians and nurses, should focus on the importance of administration of rotavirus to every age-eligible child," the investigators advise. "Furthermore, local and state health departments should use their immunization information systems to identify provider locations where additional education about the importance of rotavirus administration may be needed."

Sahni did not respond to a request for comments.

The authors reported no disclosures.

SOURCE: http://bit.ly/1wRnplf

Pediatrics 2015.