CDC on Rotavirus Vaccine: Too Many 'Missed Opportunities'

Before the rotavirus vaccine was available, highly contagious rotavirus infection precipitated 200,000 emergency room visits, 55,000 hospitalizations, and 60 to 65 deaths each year in the United States.

Young children are disproportionately affected by rotavirus, and it is a more severe disease for them. Rotavirus spreads quickly, most often in hospitals and day cares, causing fever, nausea, vomiting, abdominal cramps, and frequent, watery diarrhea for up to 8 days.

Although a vaccine has been available since 2006, rotavirus vaccine uptake among American children is not as robust as coverage for other routine childhood vaccines.

Researchers from the CDC in Atlanta, GA—concerned about the less-than-optimal uptake—have published a study in the journal Vaccine. They compared rotavirus vaccine (RV) uptake over time with other routine vaccinations. Results indicate that fewer infants are starting the RV series by 5 months of age than they did in 2012.

These researchers used data from 6 Immunization Information System (IIS) Sentinel Sites. These sites cover roughly 10% of the US pediatric population. They compared uptake of RV to that of diphtheria, tetanus, and acellular pertussis (DTaP) and pneumococcal conjugate vaccine (PCV). These are vaccines that are given at the same time that RV could be given.

Data from 2012 and before noted that coverage with the first dose of RV reached 78% in 2010 and remained at 79% to 81% through 2013. The difference between first-dose DTaP coverage and RV coverage fluctuated by 6% to 8% from mid-2012 to December 2013. Most immunizers maintained the ACIP's recommended schedule during that time.

One factor that influences immunization with RV is the requirement that the RV series must be started before age 14 weeks 6 days; failure to meet the requirement accounted for approximately one-third of the difference in coverage between first dose of DTaP.

The researchers attributed the remaining difference to "missed opportunities." In these cases, infants were seen and received another routine immunization when age-eligible for the first RV dose, but somehow, they did not receive RV.

RV's labeling includes statements on the risk of intussusception, which is estimated to occur in one in 20,000 infants, and some parents may refuse the vaccine based on this risk.

Each year, RV prevents 40,000 to 50,000 hospitalizations among American infants and young children. Older children and adults that are not vaccinated have reaped the benefit by virtue of lower exposure. The researchers recommend educating immunizers about barriers to RV uptake. Immunizers need to take the opportunity to provide RV and encourage parents to consider it at every opportunity.

Reference

Pringle K, Cardemil CV, Pabst LJ, Parashar UD, Cortese MM. Uptake of rotavirus vaccine among US infants at Immunization Information System Sentinel Sites. Vaccine. 2016; 7;34(50):6396-6401.