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Missed Opportunities for Rotavirus Vaccination among U.S. Children 19-35 Months of Age

Sederdahl, Bethany Katherine (2017)
Master's Thesis (36 pages)
Committee Chair / Thesis Adviser: Bednarczyk, Robert A
Committee Members: Orenstein, Walter
Research Fields: Public health; Epidemiology
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: rotavirus vaccine; vaccine coverage; pediatrics
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/s1nqq

Abstract

Introduction: Rotavirus remains a common cause of severe gastroenteritis, resulting in hospitalization of about 5 per 10,000 children in the U.S. each year. Available rotavirus vaccines, although effective, are underused compared with other routine childhood vaccines. Receipt of other routine childhood immunizations, such as DTaP or PCV, at 2 and 4 months of age among children unvaccinated for rotavirus indicates a missed opportunity to simultaneously vaccinate for rotavirus. In this study, we analyzed missed opportunities for rotavirus vaccination in children included in the 2014 National Immunization Survey. Methods: All analyses were conducted using data from the 2014 National Immunization Survey (NIS) available from the Centers for Disease Control and Prevention (CDC). We classified missed opportunities for rotavirus vaccination according to the ACIP and WHO rotavirus vaccine recommendations. Doses of DTaP vaccine received from 6 weeks through 7 months and 6 days of age were considered missed opportunities for rotavirus vaccine according to ACIP guidelines. Doses of DTaP or MMR received from 6 weeks to 24 months of age were considered missed opportunities for any dose of rotavirus vaccine according to the World Health Organization recommendation. Results: Seventy-one percent of children in the 2014 NIS were vaccinated for rotavirus. Among the 14% of children unvaccinated for rotavirus, 72% had ≥ 1 ACIP-defined missed opportunity to receive rotavirus vaccine and 63% had ≥2 missed opportunities. Among children unvaccinated for rotavirus, 83% had ≥1 WHO-defined missed opportunity to receive rotavirus vaccine and 75% had ≥2 missed opportunities. We found that complete rotavirus vaccine coverage may be improved from 71% to 81% if all missed opportunities within the ACIP- recommended schedule were used. Additionally, we found that 97% complete coverage would be achievable if rotavirus vaccine were given simultaneously with DTaP or MMR through 24 months of age. Conclusion: Addressing missed opportunities for rotavirus vaccination may be an important step towards achieving 80% rotavirus vaccine coverage, the target outlined by Healthy People 2020. Although expanding the window for rotavirus vaccination through 24 months of age may provide an opportunity to increase coverage, safety concerns may prohibit use of this option in the U.S.

Table of Contents

1. Chapter I: Background/Literature Review 2. Chapter II: Manuscript A. Introduction B. Methods C. Results D. Discussion F. Tables 1-4 G. Figure 1 3. Chapter III: Summary, Public Health Implications, Possible Future Directions 4. References

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