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Why Aren't We Achieving High Vaccination Rates for Rotavirus Vaccine in the United States?

  • Allison Kempe
    Correspondence
    Address correspondence to Allison Kempe, MD, MPH, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, 13199 E. Montview Blvd, Suite 300, Aurora, CO 80045
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Department of Pediatrics, University of Colorado Anschutz Medical Campus (A Kempe, ST O'Leary, JR Cataldi, and M Brtnikova), Aurora, Colo
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  • Sean T. O'Leary
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Department of Pediatrics, University of Colorado Anschutz Medical Campus (A Kempe, ST O'Leary, JR Cataldi, and M Brtnikova), Aurora, Colo
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  • Margaret M. Cortese
    Affiliations
    National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (MM Cortese, JE Tate, JL St. Pierre, and MC Lindley), Atlanta, Ga
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  • Lori A. Crane
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Department of Community and Behavioral Health, Colorado School of Public Health (LA Crane), Denver, Colo
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  • Jessica R. Cataldi
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Department of Pediatrics, University of Colorado Anschutz Medical Campus (A Kempe, ST O'Leary, JR Cataldi, and M Brtnikova), Aurora, Colo
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  • Michaela Brtnikova
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Department of Pediatrics, University of Colorado Anschutz Medical Campus (A Kempe, ST O'Leary, JR Cataldi, and M Brtnikova), Aurora, Colo
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  • Brenda L. Beaty
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo
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  • Laura P. Hurley
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo

    Division of General Internal Medicine, Denver Health (LP Hurley), Denver, Colo
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  • Carol Gorman
    Affiliations
    Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado (A Kempe, ST O'Leary, LA Crane, JR Cataldi, M Brtnikova, BL Beaty, LP Hurley, and C Gorman), Aurora, Colo
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  • Jacqueline E. Tate
    Affiliations
    National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (MM Cortese, JE Tate, JL St. Pierre, and MC Lindley), Atlanta, Ga
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  • Jeanette L. St. Pierre
    Affiliations
    National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (MM Cortese, JE Tate, JL St. Pierre, and MC Lindley), Atlanta, Ga
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  • Megan C. Lindley
    Affiliations
    National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (MM Cortese, JE Tate, JL St. Pierre, and MC Lindley), Atlanta, Ga
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      Abstract

      Background

      Rotavirus vaccine (RV) coverage levels for US infants are <80%.

      Methods

      We surveyed nationally representative networks of pediatricians by internet/mail from April to June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age.

      Results

      Response rate was 68% (303/448). Ninety-nine percent of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%), and parent concerns about RV safety (6%). The most commonly reported reasons for nonreceipt of RV#1 by 4 to 5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from neonatal intensive care unit/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age.

      Conclusions

      US pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring.

      Keywords

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