Safety of Rotavirus Vaccine in the NICU

Abstract

BACKGROUND AND OBJECTIVE: Rotavirus vaccination is discouraged during hospitalization given concerns regarding live attenuated virus transmission, although recommended upon discharge. Infants should have vaccination initiated by 104 days of age or they become age-ineligible. Our institution believed the known risk of severe disease in unvaccinated infants outweighed the theoretical risk of transmission. We routinely administer RotaTeq (RV5) to age-eligible hospitalized infants on enteral feeds. The objective of this study was to determine the safety of RV5 vaccination among vaccinated (VI) and unvaccinated infants (UVI) within the NICU. METHODS: A retrospective review identified VI between 2008 and 2010, and UVI geographically located near VI within 15 days of vaccination. We screened for gastrointestinal symptoms among UVI by using an electronic medical record query (trigger tool) to identify infants with orders for bowel rest, abdominal imaging, and antibiotics. Trigger-positive infants had full chart review. RESULTS: Most VI (76%) were either asymptomatic (25% [24 of 96]) or symptomatic but unchanged from baseline (51% [49 of 96]) postvaccination. Although 24% of VI had clinical status changes postvaccination, none were directly attributed to RV5. Among 801 neighboring UVI, 10 (1.2%) had clinical status changes, none directly attributed to RV5, but mostly bacterial sepsis or preexisting gastrointestinal pathology. Two UVI underwent stool analysis; both negative for rotavirus. CONCLUSIONS: RV5 was well tolerated in hospitalized infants, with most postvaccination symptoms attributed to preexisting symptoms. UVI seemed to have a low risk of symptomatic transmission. Inpatient administration ensures that age-eligible infants are vaccinated regardless of hospital duration. Prospective evaluation of safety and transmissibility is needed.

High Prevalence of Rotavirus G4P[6] Genotypes among Neonates in Two Korean Hospitals

“…Globally, five prevalent genotypes of rotavirus (G1P [8], G2P [4], G3P [8], G4P [8], G9P [8]) were most frequently identified in 2009-2012 [8]. In children, G1P [8] is the most frequently reported rotavirus genotype and G4P [6] is rarely reported [1].…”

“…Rotavirus vaccination program has been successful, however minimum age for the first dose of rotavirus vaccine is 6 weeks, remaining neonates at the risk of rotavirus infection. In addition, infants hospitalized after 6 weeks of age can be vaccinated, protection cannot currently be provided to hospitalized neonates [4,5]. The aim of our study was to evaluate the distribution of rotavirus genotypes in neonates from two hospitals in Korea.…”

Use of rotavirus vaccines in preterm babies on the neonatal unit

“…This was more marked for the extremely low birth weight infants, with the majority (75%) found to be too old for vaccination at discharge. Contrary to the ACIP recommendation, one unit in Philadelphia continued to vaccinate preterm infants in NICU without waiting for discharge; resulting in a third of infants who otherwise would have missed their dose receiving it with no additional safety or transmission concern [20].…”

Premature barn bør tidlig vaksineres mot rotavirus

“…Basert på tilgjengelig evidens fra studier og erfaringer fra andre land anbefales det å vaksinere premature barn mens de ligger på sykehus På en nyfødtintensivavdeling i Philadelphia hvor rotavirusvaksine ble gitt til innlagte barn, fant man ingen vaksinerelaterte symptomer blant 96 vaksinerte barn og 800 naerkontakter (19). I en japansk studie der man vaksinerte barn på nyfødtintensivavdeling og samlet inn avføringsprøver fra uvaksinerte barn som lå i de naermeste sengene, fant man ingen smitteoverføring av vaksinevirus (20).…”