Rotavirus recommendations leave NICU population vulnerable, study finds
The CDC’s Advisory Committee on Immunization Practices cautions against administering the rotavirus vaccine to infants in a NICU or nursery because of the potential for horizontal transmission of the live vaccine-strain virus. It also recommends age restrictions on the timing of the rotavirus vaccine, with the first dose to be given before 15 weeks of age. These intersecting recommendations create a vulnerable population of infants who require a prolonged intensive care stay and might age out of vaccine eligibility, according to a study published in the Journal of the Pediatric Infectious Diseases Society.
“In this paper, we describe a rotavirus outbreak that affected nearly all resident patients at a subacute care facility,” Rachel M. Burke, an epidemiologist in the CDC’s Viral Gastroenteritis Branch, told Infectious Diseases in Children. “Most children were unvaccinated against rotavirus; a number of these had aged out of eligibility due to prolonged stays in intensive care — where live vaccines are discouraged — while others missed the opportunity to be vaccinated while they were still age-eligible.”
The outbreak resulted in one fatality and serves as an example of the “potential consequences of low rotavirus vaccine coverage among medically fragile children,” Burke added.
Burke and colleagues reviewed the clinical history, vaccination history and signs and symptoms of 26 patients (median age, 2.9 years) in the facility during the outbreak. They defined case-patients as those who experienced three or more loose stools within 24 hours, with onset between April 2017 and May 2017. They used reverse-transcription PCR to test patient stool samples for rotavirus.
A total of 22 (85%) of the patients met the case definition, 15 were unvaccinated, three were partially vaccinated, two were fully vaccinated and 11 tested positive for rotavirus.
“Vaccination is the best means of preventing severe rotavirus-associated outcomes,” Burke said. “Clinicians should be vigilant in pursuing rotavirus vaccination in a timely manner for all eligible infants, with special focus on infants who may otherwise miss the opportunity to be vaccinated — such as infants approaching the age-eligibility window or age-eligible infants being discharged from intensive care units.”
In a related editorial, Infectious Diseases in Children Andi L. Shane, MD, MPH, MSc, associate professor of pediatrics at Emory University School of Medicine and Children's Healthcare in Atlanta, and Geoffrey A. Weinberg, MD, professor of pediatrics and clinical director of the Pediatric Infectious Diseases & Pediatric HIV Program at the University of Rochester School of Medicine & Dentistry and Golisano Children’s Hospital, argued that stringent age-restricting recommendations for rotavirus vaccine are unwarranted.
“We encourage the [ACIP] to adopt a strategy to relax age limitations on the administration of rotavirus vaccine similar to that of the World Health Organization, which permits rotavirus vaccine doses to be administered to children between 6 weeks and 24 months of age,” they wrote. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.