Potential impact of accelerating the primary dose of rotavirus vaccine in infants

Abstract

We estimated the potential impact of administering the first dose of rotavirus vaccine at 6 weeks (42 days of life) instead of 2 months of age, which is permissible for all U.S. vaccines recommended at 2 months of age, on rotavirus hospitalization rates. We used published data for hospitalization rates, vaccine coverage, and vaccine efficacy after one dose and assumed a two-week delay in seroconversion after vaccine administration in the United States. Administering the first dose of rotavirus vaccine at 6 weeks instead of 8 weeks of age should have prevented 1110, 1660, and 2210 rotavirus hospitalizations among U.S. infants <3 months of age in 2006 when the vaccine was first introduced. This estimated benefit represents a 2%-4% reduction in rotavirus hospitalizations among children <5 years of age.

Public health impact of accelerated immunization against rotavirus infection among children aged less than 6 months in the United States

“…We believe, therefore, that Halvorson et al may have overestimated the number of hospitalizations and corresponding reductions with accelerated vaccination. 8 To further support our interpretation and use of the reported hospitalization rate, we note that the overall rate from Staat et al (26.9 per 10 000 children aged less than 3 y) roughly corresponds to the overall rate from Payne et al (22.5 per 10 000 children aged less than 3 y), and the latter was used by Payne and colleagues to estimate the total number of hospitalizations in the US on an annual basis. 9 , 10 …”

“…Importantly, for the scenario (accelerated 1st dose only) and the measure (RVGE hospitalizations) that are common between our study and the Halvorson et al study, 8 our model yielded substantially lower reductions (274 vs. 737–2210 [depending on vaccine coverage and efficacy]). While differences between studies in assumed levels of RVGE hospitalizations, vaccine coverage, and vaccine effectiveness may explain some of this discrepancy, we believe the primary reason for the discrepancy is the difference in our (vs. their) interpretation and use of the underlying RVGE hospitalization rate for children aged less than 3 mo (Staat et al).…”

“…We also note, however, as pointed out by Halvorson and colleagues, all of the vaccines that are currently recommended for administration at 8 wk of age could be given as early as 6 wk of age, and an extra healthcare encounter could be avoided by accelerating the 8-wk well-child visit to age 6 wk. 1 , 8 While the administration of subsequent doses of some vaccines could be similarly adjusted, the opportunity cost of shifting the current vaccination schedule must be recognized against the benefit of doing so. Finally, although it is likely—given the current recommended childhood vaccination schedule—that most children receive their 1st dose of RV vaccine at or near age 8 wk in clinical practice, it is undoubtedly the case that some children are vaccinated earlier (as early as 6 wk of age) while others are vaccinated later (as late as ~14 wk of age).…”

“…The impact of accelerating the 1st dose of RV vaccine was evaluated in a recent modeling exercise by Halvorson and colleagues. 8 In their study, Halvorson and colleagues reported a substantial reduction in RV-related hospitalizations by accelerating the administration of the 1st dose of RV vaccine by 2 wk. We sought to expand on these findings by considering alternative strategies for accelerated vaccination and additional measures of disease burden including RV-related emergency department (ED) visits and outpatient visits.…”