Zalot Morgan A, Cortese Margaret M, O'Callaghan Kevin P, Casey-Moore Mary C, L'Etoile Nathan, Smart Sarah Leeann, Honeywood Michelle J, Mijatovic-Rustempasic Slavica, Tate Jacqueline E, Davis Anna, Wittmeyer Nicole, McGann Carolyn, Sadaf Salma, Wilson Kadedra, Bowen Michael D, Gautam Rashi, Parashar Umesh D, Coffin Susan E, Gibbs Kathleen A
Department of Pediatrics, Children's Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania.
Viral Gastroenteritis Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatrics. 2025 Jan 1;155(1). doi: 10.1542/peds.2024-067621.
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).
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.
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.
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.
由于疫苗株存在理论上的水平传播风险，许多新生儿重症监护病房（NICU）不对住院患儿接种轮状病毒疫苗。我们旨在确定在常规接种五价轮状病毒疫苗（RV5）的NICU中，疫苗株传播给未接种疫苗婴儿的发生率及临床意义。
这项前瞻性队列研究纳入了一家拥有100张床位的NICU在1年内收治的所有患者。每周收集粪便标本；采用实时定量逆转录聚合酶链反应检测是否存在任何RV5株。假设每位未接种疫苗患者的粪便构成1个有传播风险的患者日，计算传播给未接种疫苗婴儿的发生率。对疑似传播事件进行调查和地理空间分析。
在1238名入院婴儿中，560名（45%）为早产儿，322名（26%）有胃肠道病变。在观察期间，共接种了226剂RV5。总体而言，共检测了3448份粪便样本，其中包括来自686名未接种疫苗患者的2252份样本。大多数（681名，99.3%）未接种疫苗患者的RV5株检测从未呈阳性。5名（<1%）检测RV5株呈阳性。估计传播给未接种疫苗婴儿的发生率为5/2252份粪便，或2.2/1000个有风险的患者日（95%置信区间：0.7 - 5.2）。在收集到RV5阳性粪便的7天内，传播病例中未发现胃肠炎症状。在出院日期前开始RV5系列接种的126名患者中，如果仅允许在出院时接种疫苗，55%的患者将因年龄原因无法开始该系列接种。
RV5株的传播很少见，且无临床后果。通过在NICU内接种RV5疫苗使婴儿获得轮状病毒疾病疫苗诱导保护的益处似乎超过了疫苗株传播的风险。
