Variation in rotavirus vaccine coverage by provider location and subsequent disease burden

Incidence, Clinical Characteristics, and Genotype Distribution of Rotavirus in a Neonatal Intensive Care Unit 5 Years After Introducing Rotavirus Vaccine

BACKGROUND

Rotavirus (RV) is a common cause of viral gastroenteritis in children worldwide. We aimed to investigate the incidence, symptoms, and genotype of RV infection in a neonatal intensive care unit (NICU) in South Korea 5 years after the introduction of RV vaccination to evaluate its effect on newborn infants.

METHODS

A total of 431 fecal specimens were collected from patients admitted to NICU between April 20, 2012 and September 10, 2013. Enzyme-linked immunoassays were used to detect RV antigen. Nested multiplex polymerase chain reaction was used for genotyping.

RESULTS

The overall incidence of RV infection was 43.9% and was significantly higher in preterm infants, infants born in the study hospital, low birth weight infants, and cesarean births (P < 0.05). Symptoms of diarrhea, poor feeding, abdominal distension, and apnea were significantly higher in infants with RV infection than those without infection. RV infection gradually increased depending on infant care at home, postpartum clinic, or hospital (26.0, 45.1, and 60.2%, respectively; P = 0.000). The dominant RV genotype in the NICU was G4P[6] at 95.4%.

CONCLUSION

Current RV vaccines did not affect the incidence of RV infection in newborn and preterm infants in the NICU. Most RV-positive patients in the NICU had symptoms, and the incidence of RV infection was relatively higher in hospitals and postpartum clinics with group life than home. The dominant RV genotype was G4P[6] across study groups.

Assessment of the epidemiological effects of using of the pentavalent rotavirus vaccine at a low level of vaccination coverage of the target cohort

Background: Assessment of the informativeness of using various parameters characterizing the epidemic process during rotavirus infection to analyze the effects of the RotaTeq (MSD, USA) pentavalent rotavirus vaccine’s using at low (<20%) level of vaccination coverage of the target cohort. Materials and methods: Were analyzed the correlation links between the vaccination coverage rates and the number of reported cases of rotavirus infection, incidence rates, the number of rotavirus-positive laboratory tests and their shares among the examined children for the territories of Moscow and the Moscow Region in 2014-2018, using the database of the laboratory information system and data of the Federal statistical monitoring, Results: The presence of a strong reliable inverse correlation between the coverage of vaccination and the only of the analyzed indicators – the share of positive results of laboratory studies in the age group of children 6-24 months was revealed. There was a one and a half to two-fold decrease in the share of positive laboratory tests for rotavirus infection in the years of reaching 18–20% vaccination coverage. Conclusion: The obtained data indicate the high informative value of laboratory information system data and the perspective of their use for a comprehensive assessment of the activity of the epidemic process.

Missed Opportunities for Rotavirus Vaccination

BACKGROUND

Rotavirus remains an important cause of gastroenteritis and has been associated with the hospitalization of 34 to 53 per 10 000 children <5 years of age in the United States annually from 2008 to 2012. Rotavirus vaccines are underused compared with other routine vaccines. We describe rotavirus vaccine coverage and missed opportunities for rotavirus vaccination.

METHODS

The National Immunization Survey is a random-digit-dial, population-based survey including US children 19 to 35 months of age. Children fully vaccinated for rotavirus were those who received 3 doses of the pentavalent rotavirus vaccine, 2 doses of the monovalent rotavirus vaccine, or ≥3 doses of either vaccine type. Doses of the diphtheria-tetanus-acellular pertussis vaccine received from 6 weeks through 8 months and 0 days of age when the rotavirus vaccine was not received were considered missed opportunities for rotavirus vaccination according to Advisory Committee on Immunization Practices (ACIP) guidelines, and doses of the diphtheria-tetanus-acellular pertussis vaccine or measles-mumps-rubella vaccine from 6 weeks through 24 months and 0 days of age were considered missed opportunities according to World Health Organization recommendations.

RESULTS

Of the 14 571 children included in the 2014 National Immunization Survey, 71% were fully vaccinated for rotavirus. Lower socioeconomic status increased the likelihood of being unvaccinated for rotavirus. Among the 14% of children who received no doses of the rotavirus vaccine, 72% had ≥1 ACIP-defined missed opportunities, and 83% had ≥1 World Health Organization-defined missed opportunities. Higher socioeconomic status increased the likelihood of having missed opportunities. Complete rotavirus vaccine coverage could be improved to 81% if all missed opportunities within the ACIP-recommended schedule were addressed.

CONCLUSIONS

Addressing missed opportunities for rotavirus vaccination is essential to achieving the 80% rotavirus vaccine coverage target outlined by Healthy People 2020.

Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada

BACKGROUND

In August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix™ vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario.

METHODS

We assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program's introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression.

RESULTS

A total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61-2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24-1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05-2.04), and having no siblings (aOR = 1.62; 95%CI,1.30-2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39-2.10) and third year (aOR = 2.02; 95% CI 1.56-2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88-0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91-0.97, per 100 patients rostered). Additional associations were identified for series completion.

CONCLUSIONS

Family physician delivery achieved moderately high coverage in the program's first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports.

Coverage and Determinants of Uptake for Privately Funded Rotavirus Vaccine in a Canadian Birth Cohort, 2008-2013

BACKGROUND

Rotavirus can lead to serious illness or death, even in developed countries. While vaccination can provide protection, many jurisdictions are still grappling with the issue of whether to introduce a universal publicly funded rotavirus vaccination program. This retrospective population-based study assessed rotavirus vaccine coverage, determinants of uptake, and compliance with the recommended schedule in a Canadian jurisdiction with a privately-funded rotavirus vaccination program.

METHODS

Analysis of pharmaceutical dispensing, vital statistics, and administrative health data determined vaccine coverage and schedule compliance from 2008 to 2013. Multivariable logistic regression was used to assess characteristics of families purchasing vaccine.

RESULTS

Vaccine coverage ranged from 1% to 4% between 2008-2013, with 52% of vaccinated children completing the full vaccine series; 7.9% and 3.8% of children received doses before and after the recommended ages, respectively. Children who received ≥1 doses of the vaccine were more likely to have mothers who were married (adjusted odds ratio [aOR] 1.76, 95% CI1.64-1.88), fewer siblings (aOR 3.44, 95%CI 3.01-3.94), be non-First Nations (aOR 2.29, 95%CI 1.78-2.94), and be born prematurely (aOR 1.32, 95%CI 1.23-1.42). Income was a strong influence in urban areas, but not in rural regions, where coverage was lower overall.

CONCLUSIONS

Vaccine coverage in a privately-funded model was very low and left high risk populations unprotected. Vaccine series completion and compliance with recommended scheduling was also suboptimal.

Potential safety issues and other factors that may affect the introduction and uptake of rotavirus vaccines

Rotavirus vaccines have demonstrated significant impact in reducing the burden of morbidity and mortality from childhood diarrhoea in countries that have implemented routine vaccination to date. Despite this success, in many countries, rotavirus vaccine coverage remains lower than that of other routine childhood vaccines. Several issues may potentially affect vaccine uptake, namely safety concerns related to intussusception with consequent age restrictions on rotavirus vaccination, contamination with porcine circovirus, vaccine-derived reassortant strains and hospitalization in newborn nurseries at time of administration of live oral rotavirus vaccine. In addition to these safety concerns, other factors may also affect uptake, including lower vaccine efficacy in the developing world, potential emergence of strains escaping from vaccine protection resulting in lower overall impact of a vaccination programme and sustainable vaccine financing. Although further work is needed to address some of these concerns, global policy bodies have reaffirmed that the benefits of rotavirus vaccination outweigh the risks, and vaccine use is recommended globally.

Rotavirus Infection: A Disease of the Past?

Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide. Vaccination is the only control measure likely to have a significant impact on the incidence of severe disease. Rotavirus vaccines have reduced the burden of disease in the United States and Europe and vaccine programs are being introduced in Asia and Africa where it is hoped that vaccine will have significant impact on severe infection. Long-term monitoring and strain surveillance are needed to assess the effects of rotavirus immunization programs and to determine whether changes in strain ecology will affect rotavirus vaccine effectiveness.