Addressing rotavirus vaccination missed opportunities using the National Immunization Survey Open Access

Abstract

Background: In the United States, rotavirus vaccine (RV) coverage has plateaued below that of other infant vaccines. In 2013, the World Health Organization (WHO) expanded global recommendations for age at RV administration, but the US age restrictions remain unchanged. We assessed missed opportunities for RV series initiation and explored hypothetical increases in RV coverage if current age restrictions were expanded.

Methods: Data from the 2009 and 2012 National Immunization Survey (NIS) were analyzed to assess adherence to ACIP recommendations for 6 infant vaccines. We assessed missed opportunities for RV initiation using diphtheria, tetanus, and acellular pertussis vaccine (DTaP) as a marker of received vaccinations. Additionally, we calculated the hypothetical increase in RV coverage if current RV age restrictions were expanded, accounting for potential missed opportunities outside the current RV administration window.

Results: Of 17,053 children in the 2012 cohort, only 83% received at least 1 dose of RV. Of these children 95% received RV within the ACIP recommended timeframe. Interestingly, of the 17% of children who did not receive RV, nearly 15% received >= 1 dose of DTaP. If RV were administered to all children with missed opportunity for RV administration, an additional 845,894 children would receive >= 1 dose RV, resulting in 97% initiation.

Conclusions: Addressing missed opportunities and expanding the recommendations for RV administration could increase RV initiation to levels seen in other infant vaccines. Increased coverage provides direct benefit to vaccinated children and is important in providing indirect protection to unvaccinated children and adults, decreasing disease incidence.

Table of Contents

Introduction. 1

Methods. 3

Study population. 3

Data Analysis. 3

Ethics. 5

Results. 6

Study population. 6

Adherence to vaccine recommendations for series initiation. 6

Missed Opportunity for Rotavirus Vaccination. 7

Sensitivity analysis of rotavirus vaccine coverage with hypothesized increases in rotavirus vaccine uptake among children with missed opportunity. 8

Discussion. 9

Conclusions. 12

References. 13

Tables and Figures. 18

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	vaccination National Immunization Survey NIS missed opportunity rotavirus vacine rotavirus
Committee Chair / Thesis Advisor	Bednarczyk, Robert A, Emory University
Committee Members	Anderson, Evan, Emory University Orenstein, Walter, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs CDC

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