Transmission to unvaccinated babies ‘incredibly rare’ when rotavirus vaccines used in NICU
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Key takeaways:
- CHOP has vaccinated its eligible NICU patients for rotavirus for a decade.
- Less than 1% of all neonates tested positive.
TORONTO — Rotavirus vaccination is not associated with significant outbreaks of the disease in NICUs, according to a study presented at the Pediatric Academic Societies Meeting.
The prospective, 1-year cohort study was conducted by researchers at The Children’s Hospital of Philadelphia (CHOP) and CDC to determine how frequently vaccine-strain rotavirus is transmitted from vaccinated to unvaccinated infants in the NICU, and whether it causes significant clinical disease.
“I came to CHOP in 2017, having been a neonatologist for 10 years, and had never vaccinated a single patient against rotavirus because it wasn’t ‘safe,’ and I just accepted that as OK,” Kathleen A. Gibbs, MD, an attending neonatologist at CHOP and medical director for quality improvement and patient safety in the hospital’s NICU, told Healio.
Vaccination of rotavirus in the NICU at CHOP is now a longtime standard, and as such, the CDC recognized an opportunity to inform practice by examining any potential risks — such as with illness transmission — that could stem from vaccination, according to Gibbs.
From January 2021 to January 2022, the researchers collected weekly stool samples from NICU patients and sent them to the CDC, which performed testing for rotavirus and whether it was vaccine-derived in a phased approach.
“When we had our results, we went through and asked, Did we have any patients who were not vaccinated at all and who were positive for this vaccine strain of rotavirus?” Morgan A. Zalot, MPH, a clinical research study lead at CHOP, told Healio. “Then we dug through their charts to figure out [if they were] in a bed near a patient who was vaccinated recently, or was someone else in the NICU who was vaccinated cared for by the same care team, because we know that sometimes rotavirus can live on hands.”
Gibbs said the 100-bed NICU at CHOP is a mix of two formations common across the country.
“Our NICU is large for the vulnerable patient population, but also mixed design in terms of NICUs across the country,” with some single patient rooms and many beds in an open pod formation, Gibbs said.
Over the course of the surveillance period, 226 doses of rotavirus vaccine were administered in the NICU, and the researchers collected 3,448 stool samples, including 2,252 from unvaccinated patients.
Researchers found that 99.3% of stools from unvaccinated patients tested negative for rotavirus, with only five unvaccinated patients testing positive, and no patients had rotavirus-associated symptoms. The estimated rate of transmission of was 2.2 events per 1,000 patient-days at risk (95% CI, 0.7-5.2).
“One of the most surprising things is just how incredibly rare events were,” Susan E. Coffin, MD, MPH, attending physician in the division of infectious diseases at CHOP, told Healio. “We found only five times that there was even the littlest bit of detectable rotavirus with the incredibly sensitive assays in this PCR.”
Coffin called the transmission events “silent.”
“We never would have known unless we were using this sort of heightened surveillance,” Coffin said. “It reaffirms the decisions that we have been operating under for a decade, that [vaccinating] is the right thing to do, and so many kids would have been discharged from the NICU without any protection against rotavirus if we hadn’t used the vaccine.”
Coffin is interested in how the practice affects health outcomes outside the NICU.
“I think what we see is, probably at the population level, that fewer babies discharged from a NICU like ours that gives the vaccine would have to have a readmission or a follow up ER visit for diarrhea and dehydration,” Coffin said.
Reference:
Study: Rotavirus vaccinations in NICU pose minimal risk. https://www.eurekalert.org/news-releases/1043209. Published May 3, 2024. Accessed May 6, 2024.
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Zalot MA, et al. Investigation of potential vaccine-strain rotavirus transmission in a 100-bed NICU that routinely vaccinates: 1-year surveillance results. Presented at: Pediatric Academic Societies Meeting; May 2-6, 2024; Toronto.
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