One of the more common questions that we’re asked at the Vaccine Education Center regards the use of rotavirus vaccines in the hospital setting. The problem is this. Currently, rotavirus vaccination is recommended to begin no later than 104 days of age. Because some children will remain in the hospital beyond that age, they may never receive rotavirus vaccine. However, both the bovine-human reassortant rotavirus vaccine (RotaTeq®) and the attenuated human rotavirus strain (RotaRix®) are live viruses raising the possibility of spread from a vaccinated to an unvaccinated child, which could be a particularly severe problem in a vulnerable population of hospitalized infants, some of whom are severely premature.
Heather Monk and colleagues at The Children’s Hospital of Philadelphia evaluated their hospital’s experience with rotavirus vaccine in the Neonatal Intensive Care Unit (NICU) (Monk HM, Motsney AJ, Wade KC. Safety of Rotavirus Vaccine in the NICU. Pediatrics. 2014 Jun; 133(6):e1555-60.) The authors performed a retrospective review of 96 children vaccinated with RotaTeq® and found that none developed symptoms attributable to vaccination within 15 days. Further, 801 infants who were not vaccinated with rotavirus vaccine, but were located near those who had been vaccinated, were also evaluated; again, none developed symptoms consistent with acquisition of vaccine virus. The authors concluded that, “Inpatient administration ensures that age-eligible infants are vaccinated regardless of hospital duration.”
This paper advances our understanding of the potential risks of live, attenuated rotavirus vaccines in a NICU setting, but will be further supported by vaccine-shedding studies in those who did or did not receive vaccine in that setting.