NICU Babies More Likely to Miss Rotavirus Vax

For U.S. kids born after the rotavirus vaccine was introduced, recommendations against administration in the neonatal intensive care unit (NICU) appeared to be a strong barrier to getting immunized, researchers reported.

Children most likely to not receive a first rotavirus vaccine dose included those with extremely preterm birth (OR 14.6, 95% CI 11.2-20.0), birth soon after introduction of the vaccine (OR 3.3, 95% CI 2.9-3.8), and lack of health insurance (OR 2.2, 95% CI 1.8-2.7), noted Mary Moran, PhD, MPH, of the CDC, and colleagues, in Pediatrics.

The CDC’s Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) have recommended a maximum age for a first rotavirus vaccine dose of 14 weeks and 6 days and full series completion by 8 months of age, the research team noted.

However, ACIP guidelines have recommended NICU patients who are age-eligible not receive the shot until discharge due to a theoretic risk of vaccine virus transmission within the NICU, although AAP guidelines note that hospitals may consider giving the shot to otherwise eligible infants in the NICU, Moran and colleagues continued. “These guidelines may inhibit high-risk infants, such as those born prematurely, from being vaccinated,” they wrote.

In an examination of NICU details for 230 extremely preterm infants who received diphtheria, tetanus, and pertussis (DTaP) vaccination, more than half were not discharged until at least 15 weeks. Of these infants, 80% did not receive the rotavirus shot.

Overall, kids who received a first dose of the DTaP vaccine — another pediatric vaccine on the same schedule — at 15 weeks of age or older had greater odds of not receiving a first rotavirus vaccine dose (OR 30.0, 95% CI 26.8-33.7) or not finishing the series (OR 6.6, 95% CI 5.7-7.8) compared with those who received the DTaP vaccine before 15 weeks.

Among kids 8 months of age or older, risk factors associated with the greatest odds of not completing the rotavirus vaccine series were receipt of first dose at 15 weeks or older (OR 18.8, 95% CI 15.9-22.3), extremely preterm birth (OR 4.9, 95% CI 2.6-5.2), lack of health insurance (OR 3.2, 95% CI 2.5-4.1) or public insurance (OR 2.2, 95% CI 1.9-2.4), and a household income of $25,000 or less (OR 2.3, 95% CI 2.0-2.6).

“[Rotavirus vaccine] series completion is consistently lower than other pediatric vaccines on the same schedule,” Moran and colleagues wrote. And potential reasons for lower rotavirus vaccine coverage “have not been fully assessed.”

While the study period extended only to 2024, another potential barrier to rotavirus vaccination has surfaced more recently, according to an editorial accompanying the study in Pediatrics. Earlier this year, the CDC drastically reduced the number of universally recommended childhood vaccines from 17 to 11, with rotavirus vaccination downgraded to shared clinical decision-making.

“Despite suboptimal vaccination coverage, the progress that has been made in rotavirus vaccination has led to dramatic decreases in rotavirus hospitalizations in the United States,” wrote editorialists Jessica Cataldi, MD, and Sean O’Leary, MD, MPH, both of the University of Colorado School of Medicine in Aurora.

Before widespread rotavirus vaccine use, each year saw 55,000 to 70,000 infant hospitalizations and 50 to 100 deaths related to rotavirus, they noted. In recent years, hospitalizations have dropped by about 80%, and deaths have been rare. Furthermore, there have been population-level benefits and greatly reduced costs from rotavirus hospitalization.

“Given these benefits, the recent move by HHS to remove a routine recommendation for rotavirus vaccination is incredibly misguided,” Cataldi and O’Leary continued. “As of this writing, in response to a federal lawsuit by AAP and other medical organizations, a judge has ruled that the changes made by the HHS cannot be implemented for now as the case makes its way through the courts.”

“Regardless of the ultimate outcome, though, significant damage has been done to trust in vaccinations by the anti-vaccine agenda of current HHS leadership, with resultant dramatic increases in vaccine-preventable diseases, such as measles and pertussis,” they wrote. “Rotavirus may not be far behind.”

Moran and colleagues used New Vaccine Surveillance Network data from December 2014 to August 2024 to study children born after Jan. 1, 2007, who were age-eligible for rotavirus vaccination, had rotavirus-negative acute gastroenteritis or were a healthy control, and had known vaccination status.

Among 24,775 kids at least 15 weeks of age, first-dose rotavirus vaccine coverage increased over time. After a slight decrease in the middle of the COVID-19 pandemic, coverage returned to its stable level of 91%. Meanwhile, first-dose DTaP vaccine coverage decreased from 98% during the stable RVV coverage period to 96% in the middle of the COVID pandemic and did not rebound to its pre-pandemic level.

Limitations included that the research team only counted vaccine doses delivered on the day of or before enrollment, with some kids potentially vaccinated after enrollment, and that analyses were restricted to kids enrolled at 15 weeks or older, or 8 months of age or older, Moran and colleagues noted. Also, although data came from eight geographically diverse, urban pediatric medical institutions, they may not be representative of the entire U.S. pediatric population.