Philadelphia, December 9, 2024 - Researchers from Children's Hospital of Philadelphia (CHOP) found that transmission of rotavirus vaccine strains in a neonatal intensive care unit (NICU) is rare and without clinical consequences. This strongly suggests that giving the rotavirus vaccine to eligible infants during their hospitalization provides immune benefits that outweigh any risks. The findings, published today in the journal Pediatrics, could serve as the basis for a change in clinical practice.
Rotavirus is a virus that infects the lining of the intestines and is typically characterized by symptoms such as high fever, persistent and severe vomiting and diarrhea. Before rotavirus vaccines were available, most children were infected before age 5, contributing to roughly half a million child deaths worldwide and tens of thousands of hospitalizations of young children in the U.S., each year. Rotavirus remains the most common cause of diarrhea in infants and young children.
The first dose of a rotavirus vaccine is usually given to newborns at two months old. Historically, many NICUs do not give rotavirus vaccines to inpatients due to a theoretical risk of horizontal transmission of vaccine strains. Some vaccinated infants shed live attenuated vaccine-strain rotavirus in their stool for weeks after administration. Holding vaccination until patients are discharged often leaves infants with long hospitalizations vulnerable to severe disease due to underlying health conditions.
"As an infectious disease doctor who has worked on Infection Control in NICUs for many years, I was struck by how rarely vaccine virus was transmitted and how it did not cause clinical symptoms," said co-senior study author Susan E. Coffin, MD , an attending physician for the Division of Infectious Diseases at CHOP.
Bringing together expertise from across CHOP, including various divisions such as Infectious Diseases and Neonatology, this study included all patients admitted to CHOP's 100-bed N/IICU for one year. Stool specimens were collected weekly and tested for rotavirus vaccine strains.
Among the 1238 infants admitted, 226 doses of the RotaTeq vaccine were administered. A total of 3448 stool samples were analyzed; among these samples from unvaccinated patients (686), only five tested positive for a rotavirus vaccine strain with no gastroenteritis symptoms identified.
"While this study was conducted in a level 4 referral NICU, our combination supports its generalizability to different layouts and sizes," said Kathleen A. Gibbs, MD , an attending neonatologist at CHOP.
This study was supported by the Centers for Disease Control and Prevention grant 00HCVGEE-2020-43693.
About Children's Hospital of Philadelphia:
A non-profit organization founded in 1855 as America's first pediatric hospital; CHOP has pioneered major research initiatives benefiting children worldwide through its extensive care network across Pennsylvania and New Jersey.