Eligible infants not getting rotavirus vaccine

Many infants who could be receiving the rotavirus (RV) vaccine are not, according to a study published in the Journal of Pediatric Infectious Disease Society.

Of all infants who never received RV, 75% had at least one well-child visit during the time in which they were eligible for the first dose, wrote Berhanu G. Gebremeskel, Senior Project Manager for U-M Medical Center, and colleagues in the August 8 issue of the Journal.

“Rotavirus vaccines have substantially reduced disease burden in the U.S. since they were first introduced in 2006, but coverage for RV is somewhat lower during the first six months of life and diverges further from other infant vaccines after seven months of age due to missed opportunities for vaccination as well as the absence of catch-up opportunities,” Gebremeskel wrote. “Interventions, including taking advantage of all well-child visits as opportunities for vaccination, should target the first six months of life, specifically the first three months of age or the time of the first vaccination visit.”

Using data from the Truven Health MarketScan Commercial Claims and Encounters Database, which covers approximately 45 million individuals per year in the U.S. and includes private health sector data from approximately 100 payers, the researchers found that estimated coverage for RV at 19 to 35 months of age lags behind the other vaccines recommended at ages two, four, and six.

For example, in 2012 and 2013, coverage for three or greater doses of diphtheria-tetanus-acellular pertussis vaccine (DTaP) and pneumococcal conjugate vaccine (PCV) each exceeded 90%, whereas coverage for RV was only 69% in 2012 and 72.3% in 2013. “Lower coverage for RV has also been observed in commercial insurance database assessments. Coverage for RV falls short of the Healthy People 2020 objectives of 80%,” Gebremeskel wrote.

While coverage rates for RV, compared with DTaP and PCV, were slightly lower for the first dose, the differences were smaller by the seven-month milestone. Vaccine coverage then diverged thereafter-DTaP and PCV coverage rates increased steadily after seven months of age, whereas RV coverage remained flat.

However, the last dose of RV is not recommended beyond eight months of age in the U.S., whereas DTaP is routinely given up to six years of age and PCV is administered up to five years of age, the researchers reasoned.

Among infants who never received a second or third dose of RV, only 45% had a well-child visit during the time in which they were eligible for those doses. “These results indicate that the reasons for failing to receive a dose of RV may be age-dependent and that there is less opportunity to provide RV due to narrow age windows,” Gebremeskel wrote.

Of those infants who had a missed opportunity for a second or third dose of RV, 72% received DTaP and 70% received PCV during one of those well visits. Out of the 56,167 infants who never received RV but had a well-child visit, 53% received a dose of DTaP, and 45% received a dose of PCV during the well-child visit during the time in which they were eligible to receive the first dose of RV.