Delaying Rotavirus Vaccination Until Discharge Leads to Missed Opportunities

According to the results of a study published in Pediatrics, rotavirus vaccination was up to date in one-third of infants at the time of discharge from intensive care settings. Vaccine-type rotavirus was detected in stool samples from vaccinated infants but not from unvaccinated infants.

In this prospective cohort study, 385 infants who were hospitalized in intensive care unit settings between age 0 and 104 days were enrolled. Researchers evaluated the eligibility for vaccination and the vaccination status at discharge. The rotavirus vaccine used was pentavalent human-bovine reassortant rotavirus vaccine (RV5). Weekly stool samples were analyzed for the presence of rotavirus strains.

Among the 127 infants who were age eligible for routine vaccinations during hospitalization, the proportions of infants who were up to date for diphtheria-tetanus-acellular pertussis (86.5%; n=45/52), Haemophilus influenzae type b (86.5%; n=45/52), inactivated poliovirus (84.6%; n=44/52), pneumococcal conjugate (84.6%; n=44/52), and hepatitis B vaccine (82.1%; n=23/38) were higher than the proportion of infants up to date for rotavirus vaccine (32.7%; n=17/52). Overall, 33 infants received the first RV5 dose, 10 received the second dose, and 4 received the third dose.

A total of 13 of 1191 stool specimens (1.1%) tested positive for rotavirus. A wild-type rotavirus specimen was found in a stool sample from an unvaccinated child. The remaining 12 specimens were vaccine-type rotavirus and were obtained from 9 vaccinated children. Typically, the vaccine-type strains were reported after the first RV5 dose and within 7 days of vaccination. According to the study authors, the lack of detection of vaccine-type strains in stool samples from unvaccinated children may be attributed to hospital infection control measures.

The safety of the RV5 vaccine was not evaluated in this study.

The authors concluded that, “fewer than half of infants receiving routine childhood immunizations also received rotavirus vaccine before discharge, illustrating the extent of missed opportunities for rotavirus vaccination among infants at high risk for severe rotavirus infection.”

Reference

Hofstetter AM, Lacombe K, Klein EJ, et al. Risk of rotavirus nosocomial spread after inpatient pentavalent rotavirus vaccination [published online December 6, 2017]. Pediatrics. doi: 10.1542/peds.2017-1110