Rotavirus vaccines were implemented in 2006 in the United States. The 2014 estimate for complete rotavirus vaccination (RVV) coverage in US children is 72.6%, lower than the 94.1% coverage for 3 doses of DTaP, which shares the same schedule as RVV at 2/4/6 months of age.
Methods: We analyzed children aged 8 months-5 years in active surveillance at 7 US medical institutions from 12/2014-11/2015 to assess predictors of RVV initiation (any dose) and completion. These include sex, race, ethnicity, insurance status, household income, mother’s age and education level, and where the child normally sought medical care when ill. We report odds ratios (OR, 95%CI) from adjusted multivariate logistic regression models, controlling for age.
Results: Of 4226 enrolled children, 3798 (90%) had initiated RVV and 3245 (77%) had completed the series, versus 4139 (98%) and 3896 (92%) for DTaP, respectively. 146 (4%) children had completed the DTaP series, but had not initiated RVV. In multivariate analysis, children who usually received medical care in an emergency department (ED) when ill had lower odds of RVV initiation compared with those receiving medical care in a doctor’s office (0.6 (95%CI 0.5, 0.8). Hispanic ethnicity, household income >$150 000, and initiation of DTaP were associated with higher ORs (1.7 (1.2, 2.3), (2.9 (1.2, 6.8) and 96.0 (45.4, 202.7)) for RVV initiation, respectively. Children who normally received medical care in an ED versus the doctor’s office and whose mothers had attained any degree/diploma compared to none were less likely to have completed the full RVV series (0.6 (0.4–0.9) and (0.4 (0.2, 0.8)), respectively, whereas those who received 3 DTaP doses were more likely to have completed RVV series (278.3 (116.0, 667.2)).
Conclusion: In this US cohort, we identified children that missed opportunities to initiate RVV, despite having received DTaP within the dosing schedule for RVV. Children who predominantly relied on the ED for care when ill were less likely to have initiated or completed RVV, suggesting that access to a more stable health care environment, allows for routine immunization services. Mothers with higher education were less likely to have children who completed RVV, reasons for this hesitancy require further exploration.
J. Tate, None
U. D. Parashar, None
D. Payne, None