1920. Rotavirus Vaccine Uptake, Shedding, and Lack of Nosocomial Spread in Infants Hospitalized in the NICU
Session: Poster Abstract Session: Vaccines: Rotavirus
Saturday, October 10, 2015
Room: Poster Hall
Background: Preterm infants or infants with underlying high-risk medical conditions are at increased risk of severe rotavirus (RV) disease or RV-associated complications. RV vaccination as a 2- or 3-dose series is recommended for these infants at or after discharge from the neonatal intensive care unit (NICU) because of concern about transmission and nosocomial spread. Initiation of RV vaccination must occur between 42-104 days of age (D) when many of these infants remain hospitalized; limited data suggest few receive RV vaccine before discharge.

Methods: As part of the CDC-funded New Vaccine Surveillance Network, we evaluated infants who were admitted to Seattle Children’s Hospital between 0-105 D and received care in the NICU. Stool specimens were collected weekly and geo-temporal location was recorded. Specimens were analyzed for RV using qRT-PCR. RV positives were genotyped. Demographic and vaccine data were abstracted from the electronic medical record. 

Results: In total, 385 infants were followed for a mean hospital stay of 49 days (SD 68 days). Infants were predominantly male (57%), non-Hispanic (78%), white (58%), and publicly insured (56%). Mean age at enrollment was 26 D (SD 27 D). Of those admitted before 42 D and hospitalized beyond 60 D (n=126), 82-87% were up-to-date for other routine vaccinations (DTaP, Hib, IPV, PCV, hepatitis B) at the time of discharge, whereas only 33% were up-to-date for RV vaccination. Of those eligible for, but unvaccinated against RV during the hospitalization (n=93), 33 (35%) were discharged after 104 D and thus no longer eligible for RV vaccine. 

We collected 976 serial stool specimens; 671 (69%) have been analyzed to date, detecting no (0%) wild-type RV. Four infants had RV vaccine-type strains detected in their stool following RV vaccination (all RotaTeq): 3 shed after the 1st dose (day 1, day 4), 1 shed after both the 1st dose (day 12) and 2nddose (day 2). No unvaccinated infant, including contacts of vaccinated infants with shedding, had RV vaccine strain detected.

Conclusion: This study demonstrated lower uptake of RV vaccine compared to other routine vaccines in the NICU. Although vaccine-type RV shedding did occur, no cases of nosocomial spread were observed during nearly one year of study. Further evaluation of RV vaccination in the NICU setting is warranted.

Annika M. Hofstetter, MD, PhD, MPH1, Kirsten Lacombe, RN, MSN2, Eileen J. Klein, MD, MPH1, Charla Jones, MPH2, Bonnie Strelitz, MPH2, Elizabeth Jacobson, MD1, Daksha Ranade, MPH, MBA2, Mary E. Wikswo, MPH3, Michael D. Bowen, PhD3, Umesh D. Parashar, MBBS, MPH3, Daniel Payne, PhD, MSPH3 and Janet Englund, MD, FIDSA1, (1)Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA, (2)Seattle Children's Hospital, Seattle, WA, (3)Centers for Disease Control and Prevention, Atlanta, GA


A. M. Hofstetter, Merck Investigator Studies Program: Grant Investigator , Research grant
Pfizer Medical Education Group: Grant Investigator , Research grant

K. Lacombe, None

E. J. Klein, None

C. Jones, None

B. Strelitz, None

E. Jacobson, None

D. Ranade, None

M. E. Wikswo, None

M. D. Bowen, None

U. D. Parashar, None

D. Payne, None

J. Englund, GlaxoSmithKline: Consultant and Grant Investigator , Research support

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