Catching-up with pentavalent vaccine: Exploring reasons behind lower rotavirus vaccine coverage in El Salvador

Abstract

Rotavirus vaccine was introduced in El Salvador in 2006 and is recommended to be given concomitantly with DTP–HepB–Haemophilus influenzae type b (pentavalent) vaccine at ages 2 months (upper age limit 15 weeks) and 4 months (upper age limit 8 months) of age. However, rotavirus vaccination coverage continues to lag behind that of pentavalent vaccine, even in years when national rotavirus vaccine stockouts have not occurred. We analyzed factors associated with receipt of oral rotavirus vaccine among children who received at least 2 doses of pentavalent vaccine in a stratified cluster survey of children aged 24–59 months conducted in El Salvador in 2011. Vaccine doses included were documented on vaccination cards (94.4%) or in health facility records (5.6%). Logistic regression and survival analysis were used to assess factors associated with vaccination status and age at vaccination. Receipt of pentavalent vaccine by age 15 weeks was associated with rotavirus vaccination (OR: 5.1; 95% CI 2.7, 9.4), and receipt of the second pentavalent dose by age 32 weeks was associated with receipt of two rotavirus vaccine doses (OR: 5.0; 95% CI 2.1–12.3). Timely coverage with the first pentavalent vaccine dose was 88.2% in the 2007 cohort and 91.1% in the 2008 cohort (p = 0.04). Children born in 2009, when a four-month national rotavirus vaccine stock-out occurred, had an older median age of receipt of rotavirus vaccine and were less likely to receive rotavirus on the same date as the same dose of pentavalent vaccine than children born in 2007 and 2008. Upper age limit recommendations for rotavirus vaccine administration contributed to suboptimal vaccination coverage. Survey data suggest that late rotavirus vaccination and co-administration with later doses of pentavalent vaccine among children born in 2009 helped increase rotavirus vaccine coverage following shortages.

Impact of Rotavirus Vaccine Introduction and Postintroduction Etiology of Diarrhea Requiring Hospital Admission in Haydom, Tanzania, a Rural African Setting

“…The vaccine effectiveness point estimates were high in this study. Other studies from East Africa have ranged from 57% to 75% [ 6 , 8 , 37 ]. While the precision in all of these studies is relatively low, there are several potential reasons for the high point estimates noted here.…”

Avaliação de coberturas vacinais de crianças em uma cidade de médio porte (Brasil) utilizando registro informatizado de imunização

“…Essa observação é importante porque quatro esquemas básicos são completados aos seis meses (DTP, Hib, hepatite B e poliomielite). O limite máximo de idade para aplicação da vacina VORH restringiu o aumento das coberturas do esquema completo, como já observado em outros trabalhos 16,21,22 . Em contrapartida, a introdução da vacina pode contribuir para o aumento da oportunidade de vacinas aplicadas na mesma idade 16,22,23,24 , porém esse resultado não foi encontrado no Brasil 21 nem neste estudo, pois a oportunidade da vacina VORH foi menor do que de outras vacinas aplicadas na mesma idade, as quais já apresentavam maiores coberturas anteriormente.…”

Facilitators and barriers for use of rotavirus vaccine amongst various stakeholders and its implications for Indian context – A systematic review

“…Timely coverage of routine immunisation is an important correlate of uptake of rotavirus vaccine given the criteria for age restriction. 22,21 A modelling study by Patel et al, showed that the additional lives saved by removing age restrictions for rotavirus vaccination would in fact outnumber the potential excess vaccine-associated intussusception deaths. 37 Due to further evidence in this regard, the age restriction 35 Delayed childhood vaccination is a known challenge in India.…”

“…In two observational study conducted in US and El Salvador, coverage of rotavirus vaccine was found to be associated with coverage of routine vaccination. 21,15 In Indian study, increased coverage of pneumococcal vaccine was found to be associated with increased uptake of rotavirus vaccine (RR D 13.2). 14 In a retrospective study based on vaccination data in US, children who received DTaP immunization within 24 to 32 weeks of age were 17.8 times more likely to receive vaccination with rotavirus vaccine as compared to children who received it after this age limit.…”