Peer-reviewed article
Role of Vaccine Age Restrictions on Rotavirus Vaccine Coverage, Vaccine Safety Datalink 2018-2024.
Jordan E Cates, Jacob Haapala, Julia M Baker, Gabriela Vazquez-Benitez, Matthew F Daley et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how age restrictions on rotavirus vaccines affect vaccination coverage in US children. Among nearly 392,000 children, 3.2% did not receive the rotavirus vaccine, with over 60% of these having delayed initial vaccination that made them ineligible by age cutoffs. Children whose vaccination timing coincided with the early COVID-19 pandemic, those with fewer primary care visits, and Medicaid recipients were at highest risk of missing the vaccine.
Key points
- Age restrictions contributed to 3.2% of children not initiating rotavirus vaccination
- 61.5% of children who missed rotavirus vaccination had delayed DTaP initiation that made them age-ineligible
- Children who became vaccination-eligible during March-May 2020 (early COVID-19 period) had 2.2 times higher risk of delayed vaccination and non-initiation
- Children with fewer than 5 primary care visits in their first year had 4 times higher risk of missing rotavirus vaccination
- Medicaid recipients had 2.3 times higher risk of not receiving rotavirus vaccination
Limitations
The study describes associations observed in health systems data but cannot establish causation. It does not evaluate specific interventions to overcome age-restriction barriers or measure health outcomes from missed vaccinations.
Abstract
BACKGROUND: Rotavirus vaccines (RVs) are coadministered in the United States with diphtheria-tetanus-acellular pertussis (DTaP) vaccines but have age restrictions for the first and last doses. We examined how delays in preventive care visits for vaccination affected RV initiation and series completion. METHODS: We compared the timeliness of DTaP vaccination relative to RV in children born January 1, 2018 to June 30, 2023 across 8 US health systems. Adjusted risk ratios (aRRs) were estimated using modified Poisson regression to identify risk factors for delayed DTaP vaccination and no RV vaccination. RESULTS: Among 391 892 children who initiated DTaP, 12 546 (3.2%) did not initiate RV. Of these, 7721 (61.5%) children had delayed DTaP initiation and were age-ineligible for RV at the time of DTaP initiation. Children who became eligible for RV during the early stage of the COVID-19 pandemic (March to May 2020) had a higher risk of delayed DTaP and no RV initiation (aRR = 2.20; 95% CI, 1.98-2.45), as did children with fewer than 5 primary care visits within the first year of life (aRR = 4.03; 95% CI, 3.81-4.26), and Medicaid recipients (aRR = 2.34; 95% CI, 2.23-2.45). Similar factors were associated with failure to complete the RV series due to age restrictions. CONCLUSIONS: Age restrictions may have contributed to lack of RV initiation and series completion in this cohort. Public health strategies tailored to populations at risk for delayed vaccination may be needed to promote timely administration of RV.