Many of us were taught that you should not give live-virus vaccines in settings with other immunocompromised people, as those who are vaccinated could shed vaccine-strain virus and cause others to be infected. Thus, most neonatal intensive care units (NICUs), while they vaccinate their patients with inactivated vaccines, do not administer the live rotavirus vaccine.
In an article and accompanying video abstract being early released this week in Pediatrics entitled, “Risk of Transmission of Vaccine-Strain Rotavirus in a NICU that Routinely Vaccinates,” Morgan A. Zalot, MPH, Margaret M. Cortese, MD, and colleagues at the Children’s Hospital of Philadelphia and the Centers for Disease Control and Prevention looked at the risk of transmission from the rotavirus vaccine (10.1542/peds.2024-067621).
Over the course of 1 year, the authors gave the rotavirus vaccine to inpatients, usually beginning at 2 months of age and following the Advisory Committee on Immunization Practices (ACIP) guidelines. They used Rotateq, which contains the RV5 strain. They also collected stool samples weekly for RV5 testing from all patients in the NICU. For any samples that were RV5 positive, they then conducted systematic and geospatial investigations to identify patients who might have been the source of infection.
The results are reassuring:
- 226 rotavirus vaccine doses were given to 162 patients.
- RV5 strain was detected in 70% of samples collected in the first week after vaccination and 41% of samples collected in the second week after vaccination.
- Only 5 patients (<1%) who were unvaccinated had stools that tested positive (n=3) or possible positive (n=2) for RV5. Four of these patients shared a health care team member with a recently vaccinated patient.
- None of the patients whose stools tested positive for RV5 had clinical symptoms of gastroenteritis, unexplained fever, or unexplained feeding tolerance in the 2-week period surrounding their first RV5-positive stool.
Dr. Thomas Sandora from Boston Children’s Hospital, in an invited commentary, echoes the authors’ conclusion that, when RV5 vaccine is given to stable, age-eligible NICU patients, although shedding does occur, transmission is rare and has no apparent clinical consequence for these infants (10.1542/peds.2024-068248). He urges us to “turn lost opportunity into action” by updating our policies and recommendations to administer rotavirus vaccines routinely in NICUs. I would add the caveat that this study only used the RV5 vaccine, and there is a RV1-strain vaccine that is commonly used in the US, and we cannot assume that the results will be the same until a similar study is done with this second vaccine.
