Rotavirus Vaccination Coverage Remains Inconsistent

Lara C. Pullen, PhD

January 12, 2015

Continued rotavirus disease transmission appears to be associated with a failure to vaccinate. In particular, a new study has detected the highest levels of rotavirus disease among locations with low rotavirus vaccine coverage.

Leila C. Sahni, MPH, from Texas Children's Hospital, Houston, and colleagues present the result of their vaccine record review in an article published online January 12 in Pediatrics. They tracked down the vaccination records of patients who used the Texas Children's Hospital emergency department during the 2-year study period.

Children were assigned to a provider location on the basis of their vaccine record. Location level coverage was calculated according to the percentage of children in that location who had one or more dose of rotavirus vaccine: less than 40% coverage was defined as low coverage, from 40% to less than 80% coverage was defined as medium coverage, and 80% coverage or more was defined as high coverage.

The investigators found that 80.4% of control children (children with rotavirus-negative acute gastroenteritis or acute respiratory infection) received one or more dose of rotavirus vaccine from 68 locations. They identified four locations (5.9%), including neonatal intensive care units, that had low coverage.

Patients with acute gastroenteritis from low-coverage locations were 3.3 times more likely to have laboratory-confirmed rotavirus infection than patients with acute gastroenteritis from locations with high vaccine coverage (95% confidence interval, 2.4 - 4.4). The investigators also found that unvaccinated children tended to be older than children who had received one or more dose of rotavirus vaccine (22.5 vs 12.9 months; P < .001).

The rotavirus vaccine was introduced in 2006. Although uptake has increased steadily over the years, full coverage remains lower than for other vaccines. As a consequence, rotavirus disease continues to occur.

The study was not designed to determine the reason behind the low rotavirus vaccine coverage among some sites. Instead, it described the effect of such a lapse.

"[P]roviders who do not offer rotavirus vaccine to age-eligible children may create pockets of susceptible children that serve as reservoirs of ongoing disease transmission," the authors write. They conclude by suggesting that education efforts focus on the administration of rotavirus vaccine to eligible infants.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online January 12, 2015.

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