Rotavirus vaccine (RVV) coverage in the U.S. has plateaued at ~72% since its introduction in 2006. Healthy People 2020 has set a target of 80% RVV coverage by 2020. The Advisory Committee on Immunization Practices (ACIP) recommends administration of the first dose of RVV between 6 weeks (W) and 14W and 6 days. The World Health Organization (WHO) recommended RVV initiation up to 24 months (M), citing increased benefits of rotavirus prevention relative to a small risk of intussusception. We consider missed opportunities for RVV within the ACIP and WHO-recommended RVV schedules.
We analyzed provider-verified data from the 2013 National Immunization Survey for 19-35M children to assess missed opportunities for RVV. Weighted values were used when estimating percentages. ACIP missed opportunities were defined as receipt of DTaP within the ACIP-recommended RVV schedule without doses of RVV. WHO missed opportunities for RVV were defined as receipt of either DTaP or measles, mumps, and rubella (MMR) vaccine before 24M. Children were considered fully vaccinated if they received 3 doses of RV5 or 2 doses of RV1. Partially vaccinated children were those who received ≥1 dose of RVV, but were not fully vaccinated.
Only 73% of children were fully vaccinated against rotavirus. An additional 12% were partially vaccinated. Of children unvaccinated with RVV (15%), 66% had ≥1 dose of DTaP within the ACIP schedule, and 81% had ≥1 dose of DTaP or MMR by 24M. Among partially vaccinated children, 10% had ≥1 missed opportunity within the ACIP schedule, and 92% had ≥1 missed opportunity within the WHO schedule. Among children with no ACIP missed opportunities, 32% of rotavirus unvaccinated children and 82% of partially vaccinated children had ≥1 WHO missed opportunity. We estimated that 84% RVV coverage (≥1 dose) is possible by improving uptake within the ACIP schedule, and 96% if expanded to the WHO schedule.
Healthy People 2020 goals of 80% RVV vaccine coverage may be achieved by improving linkage between DTaP administration and RVV. Reaching DTaP3 coverage levels with RVV (~95%) would not be possible without expanding the age for initiation of RVV up to 24M consistent with WHO recommendations.
W. A. Orenstein, None
E. J. Anderson, AbbVie: Consultant , Consulting fee
MedImmune: Grant Investigator , Editorial support and Research support
R. Bednarczyk, None