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Rotavirus vaccination in NICU may pose little risk


 

FROM PEDIATRICS

Rotavirus vaccine can be safely administered to infants in neonatal intensive care units before discharge without putting nearby unvaccinated infants at risk, a study showed.

Vaccinated infants did not experience any symptoms attributable to the vaccine, and no unvaccinated infants in the same NICU pods as the vaccinated infants contracted rotavirus in the 2 weeks after vaccination, reported Heather Monk and her associates at Children’s Hospital of Philadelphia (CHOP) (Pediatrics 2014 May 19 [doi:10.1542/peds.2013-3504]).

Many infants hospitalized in the NICU are preterm patients who remain there past 104 days, the age by which the first rotavirus vaccine dose should be administered, and are at higher risk for rotavirus after discharge. Yet hospitals may not administer rotavirus vaccines in the NICU because of concerns about shedding from the live virus vaccine causing infection in nearby unvaccinated infants.

CHOP vaccinates age-eligible NICU patients with rotavirus and identified 96 infants who received the vaccine between Sept. 1, 2008, and Sept. 30, 2010. Their records were investigated for fever higher than 38 C, diarrhea or increased stool frequency, vomiting, abdominal distention, hematochezia, feeding intolerance, or intussusception in the week after vaccination. Overall, 25% of the infants had no symptoms after vaccination, 51% had symptoms consistent with those at baseline, and 24% had new symptoms determined to be unrelated to the vaccine.

Meanwhile, 801 unvaccinated infants were in the same NICU "pods" as the vaccinated infants, with beds anywhere from 9 to 32 feet away from the vaccinated infants’ beds. In the 15 days after vaccination – the time during which shedding was documented in rotavirus clinical trials – 6.3% of unvaccinated infants had abdominal imaging, were ordered for bowel rest, or received intravenous antibiotics. However, most (78%) of these were due to preexisting conditions, and the 1.2% who had new symptoms did not have rotavirus; the symptoms in the latter cases were likely due to concomitant medical conditions that developed.

The study did not use external funding. RotaTeq was developed at CHOP, but the vaccine patent has been sold. The authors had no relevant financial conflicts of interest.

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