study Finds Minimal Risk of Vaccine-strain rotavirus Transmission in NICUs
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A recent study published in Pediatrics reveals that the transmission of vaccine-strain rotavirus is rare and poses no clinical risks in neonatal intensive care units (NICUs) that routinely administer the live pentavalent rotavirus vaccine (RV5). Conducted by researchers from the Children’s Hospital of philadelphia (CHOP) and the Centers for disease Control and Prevention (CDC), the study tracked infections caused by the RV5 vaccine strains among newborns in a 100-bed NICU over a one-year period.
tracking Vaccine-Strain Transmission
The researchers collected stool samples weekly from all 1,238 newborns admitted to the NICU and used quantitative reverse-transcription polymerase chain reaction (qRT-PCR) to detect RV5 strains. The study found that while vaccinated infants shed the live virus in their stools for weeks after vaccination, transmission to unvaccinated infants was minimal and did not result in any clinical symptoms.
“while this study was conducted in a level 4 referral NICU, our combination of both single patient rooms as well as open pods supports its generalizability to a variety of NICUs of different layouts and sizes,” said senior author Kathleen Gibbs, MD, an attending neonatologist in CHOP’s Division of Neonatology.
Rotavirus Vaccination Challenges in NICUs
Rotavirus, a common cause of severe diarrhea and vomiting in infants, was onc a meaningful global health threat. Before the introduction of vaccines, most children were infected by age 5, leading to tens of thousands of hospitalizations and half a million deaths worldwide annually. The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of U.S. infants with either the RV5 or a monovalent rotavirus vaccine, with strict age limits for administration.
Though, manny NICUs avoid administering rotavirus vaccines due to concerns about potential transmission of vaccine strains to vulnerable or age-ineligible patients. As a result, the ACIP and the American Academy of Pediatrics recommend vaccinating infants at hospital discharge, but this approach often leads to missed opportunities for vaccination, especially for premature babies who may age out before receiving all doses.
Study Highlights and Implications
Of the 1,238 infants studied, 45% were premature. A total of 226 doses of the RotaTeq rotavirus vaccine were administered, and 3,448 stool samples were tested, including 2,252 from unvaccinated infants. The median NICU stay was 11.8 days.
The study found that RV5 rotavirus RNA was detected in 70% of samples from vaccinated infants during the first week after the initial dose and decreased to 41% by the second week. Among unvaccinated infants, only five stool samples (less than 1%) tested positive for RV5 RNA, and four of these cases were linked to shared healthcare workers with recently vaccinated patients. The estimated transmission rate was 5 per 2,252 stool samples, or 2.2 per 1,000 patient-days at risk, with no associated gastroenteritis symptoms.
The findings suggest that delaying vaccination until hospital discharge may result in missed opportunities, particularly for premature infants. Of the 126 patients who started the RV5 vaccine series before discharge, 55% would have become age-ineligible if vaccination were restricted to discharge.
Call for Updated Vaccination Guidelines
The study’s authors emphasize the need for updated guidelines to ensure timely vaccination in NICUs. “Our data support the safety of administering rotavirus vaccine in the NICU setting, even in shared-care environments,” Gibbs noted.The findings could pave the way for broader adoption of rotavirus vaccination in NICUs, reducing the risk of infection and improving outcomes for vulnerable infants.
As the study demonstrates,the benefits of timely rotavirus vaccination in NICUs far outweigh the minimal risk of transmission. By addressing current vaccination barriers, healthcare providers can protect more infants from this potentially life-threatening infection.
interview: Expert discusses Study on minimal Risk of Vaccine-Strain Rotavirus Transmission in NICUs
A groundbreaking study published in Pediatrics has shed light on the minimal risk of vaccine-strain rotavirus transmission in neonatal intensive care units (NICUs) that administer the live pentavalent rotavirus vaccine (RV5). The research,conducted by experts from the Children’s Hospital of Philadelphia (CHOP) and the Centers for Disease Control and Prevention (CDC),highlights the safety of routine vaccination in NICUs.We sat down with Dr. Emily Smith, a leading pediatric infectious disease specialist, too discuss the study’s findings and its implications for NICU vaccination practices.
Tracking Vaccine-Strain Transmission
Senior Editor: Dr. smith, thank you for joining us today. The study found that transmission of vaccine-strain rotavirus in nicus is rare and poses no clinical risks.Can you explain how the researchers tracked this transmission?
dr. Emily Smith: Absolutely. The researchers collected stool samples weekly from all 1,238 newborns admitted to the NICU over a one-year period. They used a highly sensitive method called quantitative reverse-transcription polymerase chain reaction (qRT-PCR) to detect the RV5 strains.This method allowed them to monitor the presence of the vaccine-strain virus in both vaccinated and unvaccinated infants.
Senior Editor: What were the key findings regarding transmission?
Dr. Emily Smith: The study found that while vaccinated infants shed the live virus in their stools for several weeks after vaccination, transmission to unvaccinated infants was minimal. Only five stool samples from unvaccinated infants tested positive for RV5 RNA, and four of these cases were linked to shared healthcare workers with recently vaccinated patients. Importantly, none of these transmissions resulted in any clinical symptoms.
Rotavirus Vaccination Challenges in NICUs
senior Editor: The study also addressed the challenges of rotavirus vaccination in NICUs. can you elaborate on why some NICUs avoid administering the vaccine?
Dr. Emily Smith: Yes,there has been concern among some NICUs about the potential transmission of vaccine strains to vulnerable or age-ineligible patients. This has led to a proposal by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics to vaccinate infants at hospital discharge. However,this approach often results in missed opportunities for vaccination,especially for premature babies who may age out before receiving all doses.
Senior Editor: How does this study address these concerns?
Dr.Emily Smith: The study demonstrates that the risk of transmission is extremely low and does not pose any clinical risks. This should alleviate concerns about administering the vaccine in the NICU setting,even in shared-care environments. The findings suggest that delaying vaccination until discharge may result in missed opportunities, especially for premature infants.
Study Highlights and Implications
Senior Editor: Can you summarize the key highlights of the study and its broader implications?
Dr. Emily Smith: Of the 1,238 infants studied, 45% were premature. A total of 226 doses of the RotaTeq rotavirus vaccine were administered, and 3,448 stool samples were tested. The study found that RV5 rotavirus RNA was detected in 70% of samples from vaccinated infants during the first week after the initial dose, decreasing to 41% by the second week. Among unvaccinated infants, only five stool samples tested positive for RV5 RNA, with no associated gastroenteritis symptoms. The findings suggest that delaying vaccination until discharge may result in missed opportunities, particularly for premature infants.
Senior Editor: What do these findings mean for NICU vaccination practices moving forward?
Dr.Emily Smith: The study’s authors emphasize the need for updated guidelines to ensure timely vaccination in NICUs. The data support the safety of administering the rotavirus vaccine in the NICU setting, even in shared-care environments.This could pave the way for broader adoption of rotavirus vaccination in NICUs, reducing the risk of infection and improving outcomes for vulnerable infants.
Call for Updated Vaccination Guidelines
Senior Editor: what steps should be taken to address current vaccination barriers in NICUs?
Dr. Emily Smith: The study demonstrates that the benefits of timely rotavirus vaccination in NICUs far outweigh the minimal risk of transmission. By updating guidelines to reflect these findings, healthcare providers can protect more infants from this potentially life-threatening infection. It’s crucial to ensure that premature and other vulnerable infants receive the vaccine in a timely manner,reducing the risk of severe rotavirus infection and improving overall outcomes.
Senior Editor: Thank you, Dr. Smith, for your valuable insights. The study’s findings are indeed a meaningful step forward in ensuring the safety and efficacy of rotavirus vaccination in NICUs.
Dr. Emily Smith: Thank you for having me.It’s an exciting time in the field of pediatric infectious diseases, and I’m hopeful that these findings will lead to positive changes in NICU vaccination practices.
