Rotavirus Vaccination Can Be Performed Without Viral Dissemination in the Neonatal Intensive Care Unit

Hiramatsu, Hiroyuki; Suzuki, Ryota; Nagatani, Arisa; Boda, Hiroko; Miyata, Masafumi; Hattori, Fumihiko; Miura, Hiroki; Sugata, Ken; Yamada, Shigeki; Komoto, Satoshi; Taniguchi, Koki; Ihira, Masaru; Nishimura, Naoko; Ozaki, Takao; Yoshikawa, Tetsushi

doi:10.1093/infdis/jix590

Cited by 32 publications

(17 citation statements)

References 36 publications

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“…Another important finding in our study was the lack of Rotarix vaccine-derived G1P[8] strains in the stools of unimmunised, symptomatic children during the first 3 years of the national immunisation programme. Recent studies in neonatal intensive care units also did not identify any transmission of Rotarix vaccine-derived G1P[8] strains from immunised to unimmunised infants 23–25. Transmission of the vaccine strain to unimmunised children has been reported, although infrequently, and is not associated with any symptoms in the recipients, which is reassuring 26–28.…”

Section: Discussionmentioning

confidence: 99%

Vaccine-derived rotavirus strains in infants in England

et al. 2019

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ObjectiveTo describe infants with acute gastroenteritis symptoms in primary and secondary care who have the Rotarix vaccine-derived G1P[8] rotavirus strain identified in their stools.DesignThis is a prospective national surveillance conducted by Public Health England (PHE). Rotavirus-positive samples from vaccine-eligible children are routinely submitted to PHE for confirmation, and general practitioners are requested to complete a surveillance questionnaire for all cases. The modified Vesikari Score was used to assess severity of gastroenteritis.SettingEngland, July 2013–September 2016.Results2637 rotavirus strains were genotyped and 215 (8%) identified as the Rotarix vaccine-derived G1P[8] strain. There were no Rotarix vaccine-derived G1P[8] strains detected in unimmunised infants. Rotarix vaccine-derived G1P[8] strains clustered around the time of rotavirus vaccination and were responsible for 82% (107 of 130) of rotavirus-positive samples in 2-month-old infants and 68% (36 of 53) in 3-month-old infants. However, 13 samples were obtained more than 7 weeks after the last vaccination date; 10 of these specimens were from six children who were subsequently diagnosed with severe combined immunodeficiency (SCID). Diarrhoea was the single most common presenting symptom (83.0%) in infants with Rotarix vaccine-derived G1P[8] strains, who were less likely to present with fever, vomiting, dehydration or severe gastroenteritis than infants with wild-type rotavirus infection.ConclusionsRotavirus identified in stools of infants around the time of their routine immunisations is most likely the Rotarix vaccine-derived G1P[8] strain. Infants with undiagnosed SCID at the time of rotavirus immunisation may experience prolonged gastroenteritis symptoms. Most infants with vaccine strains in their stools more than 7 weeks after immunisation had SCID.

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Section: Discussionmentioning

confidence: 99%

Vaccine-derived rotavirus strains in infants in England

et al. 2019

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“…25 The shedding of RVV strains has been raised as a potential concern in these settings, but realworld NICU observations have not revealed vaccine-type rotavirus to be detected in infants who are unvaccinated, including those whose NICU stays overlapped by time and location with those of patients who were vaccinated. 25,26 Children born in the years shortly after introduction of RVV had a higher risk of missed RVV initiation. Many reasons may have played a role in this finding, including variations in insurance adoption and reimbursement rates, 27 caregiver lack of knowledge regarding rotavirus disease, 28 or hesitancy regarding RVV safety given that the first licensed RVV (RotaShield; Wyeth Laboratories, Marietta, PA) was withdrawn because of concerns regarding intussusception.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Rotavirus Vaccine Coverage

et al. 2019

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BACKGROUND: Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014-2016. METHODS: We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models. RESULTS: We enrolled 10 603 children. In 2015, $1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age $15 weeks versus 4% for RVV (P # .001). Recent birth years (2013-2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43-7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24-0.41), older age at DTaP initiation

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“…In both studies, no vaccine-type strains were detected in stool specimens of unvaccinated infants with potential exposure to vaccinated infants. 25,37 Based on these precepts, several groups have reported results of immunization in preterm infants, including in-NICU vaccination (►Table 1). Based on these studies, at least 280 infants have received rotavirus vaccination while admitted to the NICU without report of nosocomial transmission, providing insight into the safety of this practice.…”

Section: Issues With Current Vaccine Guidelinesmentioning

confidence: 99%

Rationale for In-Neonatal Intensive Care Unit Administration of Live, Attenuated Rotavirus Vaccination

Briggs-Steinberg

Shah

2018

Amer J Perinatol

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Rotavirus is the most common nonseasonal vaccine preventable illness. Despite increased severity of rotaviral illness in early infancy, most neonatal intensive care units (NICU) do not administer rotavirus vaccination either during the NICU stay at age of eligibility or at discharge as the Advisory Committee on Immunization Practices recommends. In this commentary, we review the rationale for the administration of rotavirus vaccination to premature infants. Further, we outline data supporting vaccine administration at chronologic age while still admitted to the NICU.

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Rotavirus Vaccination Can Be Performed Without Viral Dissemination in the Neonatal Intensive Care Unit

Abstract: This study is direct evidence of no transmission of rotavirus vaccine strains between vaccinated infants and unvaccinated infants in close proximity within a NICU.

Cited by 32 publications

References 36 publications

Vaccine-derived rotavirus strains in infants in England

Vaccine-derived rotavirus strains in infants in England

Factors Associated With Rotavirus Vaccine Coverage

Rationale for In-Neonatal Intensive Care Unit Administration of Live, Attenuated Rotavirus Vaccination

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