Oral antibiotics do not interfere with rotavirus vaccine immunogenicity

Evan J. Anderson

Oral antibiotics did not affect the immunogenicity of the rotavirus vaccine in infants, according to findings published in the Journal of the Pediatric Infectious Diseases Society.

“Antibiotics are frequently administered to children around the time that they receive rotavirus immunizations,” Evan J. Anderson, MD, associate professor in the department of pediatrics at Emory University, explained to Infectious Diseases in Children. “Health care providers and parents don’t need to worry that if antibiotics are needed for the treatment of a bacterial infection around the time of rotavirus vaccination, serologic responses will be adversely affected.”

Earlier studies have suggested that antibiotic treatment can affect fecal shedding of rotavirus and the immune response to the vaccine, but these latest findings support health care providers’ decision to administer rotavirus immunization to children on time, Anderson added.

Anderson and colleagues analyzed data from a randomized, multicenter rotavirus vaccine study that examined the noninferiority and safety of mixed schedules of RotaTeq (RV5, Merck) and Rotarix (RV1, GlaxoSmithKline) vaccines. A total of 1,174 infants were enrolled in the primary rotavirus study between March 2011 and September 2013 and randomly assigned to one of five groups based on administration of the two vaccines. Researchers found that mixed schedules of RV5 and RV1 were safe and induced comparable immune responses compared with the vaccines given alone.

The latest analysis focused on 114 (10%) of the infants who received antibiotics 14 days before to 7 days after rotavirus vaccination. There were no differences in age, sex, ethnicity or race at enrollment between those with or without antibiotic exposure, they wrote. The group that received the two-dose vaccine schedule of RV1-RV1 had less antibiotic exposure than infants in the other four groups (5.2% vs. 9.7%-12.1%, respectively; P = .050), which received three doses. The researchers said this finding was "expected.”

According to the Anderson and colleagues, the rotavirus immunoglobulin A seroresponse rates and geometric mean titers (GMTs) against at least one vaccine antigen 1 month after the last vaccination were similar between antibiotic unexposed vs. antibiotic exposed participants in all study groups. A multivariable logistic regression model found that the only difference was lower IgA responses in the group that received two vaccine doses, which is similar to findings from the primary study (P < .0001).

Prespecified secondary analyses revealed that antibiotic exposure did not affect GMTs or neutralizing antibody responses against the most common types of rotavirus. The GMTs and IgA responses showed no difference according to the vaccine dose around which the antibiotic was administered, the timing of antibiotic exposure or the antibiotic class, they wrote. However, they also noted that the numbers of participants included in these subanalyses were small. Other limitations included potential residual unmeasured confounders, and the immunologic responses the researchers measured were limited to humoral IgA and neutralizing antibody responses in serum, they said.

“Despite these important limitations, it is reassuring that we did not identify any effect of antibiotic administration on serologic responses observed after the completion of a rotavirus vaccination schedule,” Anderson and colleagues concluded. – by Joe Gramigna

References:

Anderson EJ, et al. J Pediatric Infect Dis Soc. 2019;doi:10.1093/jpids/piz044.

Libster R, et al. Pediatrics. 2016;doi:10.1542/peds.2015-2603.

Disclosures: Anderson reports personal consulting fees from AbbVie and Pfizer, and Emory University receives research funds from MedImmune, Regeneron, PaxVax, Pfizer, GlaxoSmithKline, Merck, Novavax, Sanofi Pasteur and Micron. All other authors report no relevant financial disclosures.