Risk of Transmission of Vaccine-Strain Rotavirus in a Neonatal Intensive Care Unit That Routinely Vaccinates.

IF 6.2 2区医学 Q1 PEDIATRICS Pediatrics Pub Date : 2025-01-01 DOI:10.1542/peds.2024-067621

Morgan A Zalot, Margaret M Cortese, Kevin P O'Callaghan, Mary C Casey-Moore, Nathan L'Etoile, Sarah Leeann Smart, Michelle J Honeywood, Slavica Mijatovic-Rustempasic, Jacqueline E Tate, Anna Davis, Nicole Wittmeyer, Carolyn McGann, Salma Sadaf, Kadedra Wilson, Michael D Bowen, Rashi Gautam, Umesh D Parashar, Susan E Coffin, Kathleen A Gibbs

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Abstract

Background and objectives: Many neonatal intensive care units (NICUs) do not give rotavirus vaccines to inpatients due to a theoretical risk of horizontal transmission of vaccine strains. We aimed to determine incidence and clinical significance of vaccine-strain transmission to unvaccinated infants in a NICU that routinely administers pentavalent rotavirus vaccine (RV5).

Methods: This prospective cohort study included all patients admitted to a 100-bed NICU for 1 year. Stool specimens were collected weekly; real-time quantitative reverse-transcription polymerase chain reaction was used to detect any RV5 strain. Incidence of transmission to unvaccinated infants was calculated assuming each unvaccinated patient's stool contributed 1 patient-day at risk for transmission. Investigations and geospatial analyses were conducted for suspected transmission events.

Results: Of 1238 infants admitted, 560 (45%) were premature and 322 (26%) had gastrointestinal pathology. During observation, 226 RV5 doses were administered. Overall, 3448 stool samples were tested, including 2252 from 686 unvaccinated patients. Most (681, 99.3%) unvaccinated patients never tested positive for RV5 strain. Five (<1%) tested RV5 strain positive. The estimated rate of transmission to unvaccinated infants was 5/2252 stools or 2.2/1000 patient-days at risk (95% CI: 0.7-5.2). No gastroenteritis symptoms were identified in transmission cases within 7 days of collection of RV5-positive stool. Of 126 patients for whom the RV5 series was initiated before the discharge date, 55% would have become age-ineligible to start the series if vaccination was allowed only at discharge.

Conclusions: Transmission of RV5 strain was infrequent and without clinical consequences. Benefits of allowing vaccine-induced protection against rotavirus disease in infants through in-NICU RV5 vaccination appear to have outweighed risks from vaccine-strain transmission.

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常规接种疫苗的新生儿重症监护病房中疫苗株轮状病毒传播的风险

背景和目的：许多新生儿重症监护病房（NICUs）不给住院患者接种轮状病毒疫苗，因为理论上存在疫苗株水平传播的风险。我们的目的是确定在常规接种五价轮状病毒疫苗（RV5）的NICU中未接种疫苗的婴儿中疫苗株传播的发生率和临床意义。方法：本前瞻性队列研究纳入所有在100张床位的NICU住院1年的患者。每周采集粪便标本；实时定量反转录聚合酶链反应检测RV5菌株。假定每个未接种疫苗的患者的粪便有1个患者日的传播风险，计算未接种疫苗婴儿的传播发生率。对疑似传播事件进行了调查和地理空间分析。结果：1238例患儿中，560例早产儿（45%），322例患儿（26%）有胃肠道病理。在观察期间，共给药226剂RV5。总共检测了3448份粪便样本，其中包括来自686名未接种疫苗的患者的2252份。大多数（681,99.3%）未接种疫苗的患者从未检测出RV5毒株阳性。结论：RV5毒株传播罕见，无临床后果。通过在新生儿重症监护病房内接种RV5疫苗，使婴儿免受轮状病毒疾病的疫苗诱导保护的益处似乎超过了疫苗株传播的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatrics 医学-小儿科

CiteScore

12.80

自引率

5.00%

发文量

791

审稿时长

2-3 weeks

期刊介绍： The Pediatrics® journal is the official flagship journal of the American Academy of Pediatrics (AAP). It is widely cited in the field of pediatric medicine and is recognized as the leading journal in the field. The journal publishes original research and evidence-based articles, which provide authoritative information to help readers stay up-to-date with the latest developments in pediatric medicine. The content is peer-reviewed and undergoes rigorous evaluation to ensure its quality and reliability. Pediatrics also serves as a valuable resource for conducting new research studies and supporting education and training activities in the field of pediatrics. It aims to enhance the quality of pediatric outpatient and inpatient care by disseminating valuable knowledge and insights. As of 2023, Pediatrics has an impressive Journal Impact Factor (IF) Score of 8.0. The IF is a measure of a journal's influence and importance in the scientific community, with higher scores indicating a greater impact. This score reflects the significance and reach of the research published in Pediatrics, further establishing its prominence in the field of pediatric medicine.