Research In Practice Blog

Rotavirus
Rotavirus Vaccination: Preventing Missed Opportunities in the NICU
Share  
By Morgan A. Zalot Hammershaimb, MPH

Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates


 
Intro:

Rotavirus is highly contagious and causes severe diarrhea, vomiting, and dehydration in infants and young children. The current pentavalent rotavirus vaccine (RV5) series must be initiated in babies younger than 15 weeks, so vaccination timing is crucial—however, many neonatal intensive care units (NICUs) avoid vaccinating for fear of in-NICU vaccine-strain transmission from vaccinated to unvaccinated infants. Researchers from Children’s Hospital of Philadelphia and the Centers for Disease Control and Prevention conducted a study to examine the risk of transmission of vaccine-strain rotavirus among babies in the NICU.

Study design & findings:

A 1-year prospective investigation was conducted in CHOP’s  100-bed NICU that routinely administers rotavirus vaccine to eligible patients. During the study period, 1238 patients were admitted and 226 RV5 doses were given to 162 patients. Weekly stool specimens were collected from as many patients as possible in the NICU to be tested for presence of vaccine-strain rotavirus. Of the stool samples systematically collected, 2252 were from 686 unvaccinated patients.    

Among vaccinated infants, RV5 was detected in samples collected within the week after patients’ first dose (70%), second dose (48%) and third dose (32%). But despite this observed RV5 shedding in vaccinated patients, more than 99% of non-vaccinated patients’ samples never tested positive for RV5. Vaccine-strain transmission was infrequent and without detectable clinical consequence to the unvaccinated babies in whom vaccine virus was detected.  

Research in Practice Implications:  

Researchers were able to identify possible transmission sources for most of the few cases that comprised the in-NICU transmission events, but because that number was so small, analysis was limited. Thus, evidence from this study supports that the benefits of in-NICU administration of RV5 vaccine to stable, age-eligible infants likely outweigh the risks posed by rotavirus.  

Actionable Insights:  

  • Clinical: Institutions should consider administering rotavirus vaccine to inpatients at the recommended chronologic ages, including while hospitalized in the NICU.  
  • Research: Explore whether collecting stool samples upon NICU admission would affect observed rates of in-NICU transmission; explore impact of alcohol-based sanitizer availability on NICU on transmission.
  • Advocacy/Policy: These findings strengthen the AAP revision which supports RV5 administration.  

Additional Information:

Clinical Futures author(s): 
Morgan A. Zalot Hammershaimb, MPH; Kadedra Wilson; Susan E. Coffin, MD, MPH

Additional study author(s) from Children’s Hospital of Philadelphia: 
Nathan L’Etoile, MD; Anna Davis, MPH; Nicole Wittmeyer, MPH; Carolyn McGann, MD; Salma Sadaf, MBBS; Kathleen A. Gibbs, MD

Citation: 
Morgan A. Zalot, Margaret M. Cortese, Kevin P. O’Callaghan, Mary C. Casey-Moore, Nathan L’Etoile, Sarah Leeann Smart, Michelle J. Honeywood, Slavica Mijatovic-Rustempasic, Jacqueline E. Tate, Anna Davis, Nicole Wittmeyer, Carolyn McGann, Salma Sadaf, Kadedra Wilson, Michael D. Bowen, Rashi Gautam, Umesh D. Parashar, Susan E. Coffin, Kathleen A. Gibbs; Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates. Pediatrics 2024; e2024067621. 10.1542/peds.2024-067621