Rotavirus Vaccine Safety and Effectiveness in Infants With High-Risk Medical Conditions
van Dongen, Josephine A P; Rouers, Elsbeth D M; Schuurman, Rob; Band, Caterina; Watkins, Shannon M; van Houten, Marlies A; Bont, Louis J; Norbruis, Obbe F; Hemels, Marieke A C; van Well, Gijs T J; Vlieger, Arine M; van der Sluijs, Jacqueline; Stas, Helene G; Tramper-Stranders, Gerdien; Kleinlugtenbeld, Elly A; van Kempen, Anne A M W; Wessels, Margreet; van Rossem, Maaike C; Dassel, Carin A C M; Pajkrt, Dasja; Bonten, Marc J M; Bruijning-Verhagen, Patricia C J
(2021) Pediatrics, volume 148, issue 6
(Article)
Abstract
OBJECTIVES: Rotavirus vaccination has 87% to 100% effectiveness against severe rotavirus acute gastroenteritis (AGE) in healthy infants in high-income countries. Little is known whether infants with medical risk conditions (MRCs) are equally protected and if the vaccine is equally well tolerated. We conducted a quasi-experimental prospective multicenter before-after cohort study
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to assess the vaccine effectiveness (VE) and safety profile of the human rotavirus vaccine (HRV) among MRC infants that required prolonged or frequent postnatal care. METHODS: The Netherlands has no national rotavirus immunization program, but HRV was implemented in routine care for MRC infants in 13 Dutch hospitals. Participants in the before and after cohort, HRV unvaccinated and vaccinated, respectively, were followed for occurrence of (rotavirus) AGE. VE of at least 1 dose was estimated by using time-to-event analysis for severe rotavirus AGE. Vaccine-related serious adverse event (AEs) after HRV were retrieved systematically from medical charts. Solicited AEs after vaccinations were prospectively collected and compared between vaccination time points with or without HRV. RESULTS: In total, 1482 high-risk infants with MRC were enrolled, including 631 in the before and 851 in the after cohorts; 1302 infants were premature (88.3%), 447 were small for gestational age (30.2%), and 251 had at least 1 congenital disorder (17.0%). VE against severe rotavirus AGE was 30% (95% confidence interval [CI]: -36% to 65%). Overall, the observed number of rotavirus hospitalizations was low and not significantly different between the cohorts (2 and 2, respectively). The rate of vaccine-related serious AE was 0.24 per 100 vaccine doses. The adjusted risk ratio for any AE after HRV vaccination compared with other routine vaccinations was 1.09 (95% CI: 1.05 to 1.12) for concomitant administration and 0.91 (95% CI: 0.81 to 0.99) for single HRV administration. Gastrointestinal AEs were 10% more frequent after HRV. CONCLUSIONS: In contrast to previous findings among healthy term infants, in routine use, HRV offered limited protection to vulnerable medical risk infants. HRV is generally well tolerated in this group in single administration, but when coadministered with routine vaccines, it is associated with higher risk of (mostly gastrointestinal) AE. Our study highlights the importance of studying vaccine performance in subgroups of medically vulnerable infants.
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Keywords: Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 0031-4005
Publisher: American Academy of Pediatrics
Note: Funding Information: Members of the RIVAR study team include L.M. Zwart, C. Tims-Polder man, G. van Putten, C. Band and, M. van M Beurden, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. We would also like to thank all RIVAR partici pants and their parents or guardi ans and all research nurses of the different study sites for their contri bution to this project. A special rec ognition to Dr van Werkhoven for assisting on the Bayesian analysis. We thank the Dutch Working Group on Clinical Virology from the Dutch Society for Clinical Microbiology and all participating laboratories for providing the virological data from the weekly Sentinel Surveillance system. Funding sources were the Netherlands Organisation for Health Research and Development (grant number: 836021024), Health care Insurers Innovation Foundation, GlaxoSmithKline Biologicals SA (Study ID: 203108), and University Medical Center Utrecht. Publisher Copyright: © 2021 by the American Academy of Pediatrics.
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