In addition to sociodemographic factors, preterm birth and older age were associated with lower rotavirus vaccine coverage in infants when compared with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, according to a study recently published in Pediatrics.

Researchers analyzed data from a large active acute gastroenteritis surveillance system at 7 medical institutions in the United States with large catchment areas to better understand why rotavirus vaccine coverage continues to be lower than that for the DTaP vaccine despite the recommendation to administer both vaccines at the same age-defined healthcare visits.

Data for 10,603 children born after January 1, 2007, were analyzed between December 2014 and June 2016. In 2015, 91% of enrollees in the coverage cohort who were rotavirus-negative initiated rotavirus vaccine, and 97% initiated DTaP vaccine. Roughly 4% of children (341 of 8798) received the first rotavirus vaccine dose at age ≥15 weeks compared with 7.2% (695 of 9641) for the DTaP vaccine (P ≤.001).

Unconditional multivariable logistic regression models revealed that children born between 2013 and 2016 had 5.72 higher odds of rotavirus vaccine initiation and 1.57 higher odds of rotavirus vaccine completion compared with those born between 2007 and 2009 (95% CI, 4.43-7.39 and 1.32-1.88, respectively). Higher maternal education was also associated with higher odds of rotavirus vaccine completion (odds ratio [OR], 1.31; 95% CI, 1.07-1.60).

Researchers found 15% lower odds of rotavirus vaccine initiation with each 1-week increase in infant age at DTaP vaccine initiation (OR, 0.85; 95% CI, 0.80-0.91).

Other factors associated with lower odds of rotavirus vaccine initiation included preterm birth (OR, 0.32; 95% CI, 0.24-0.41), household income between $50,000 and $100,000 (OR, 0.56; 95% CI, 0.40-0.78), and higher maternal education (OR, 0.52; 95% CI, 0.36-0.74).

Factors associated with lower odds of rotavirus vaccine completion included preterm birth (OR, 0.76; 95% CI, 0.62-0.94), African American race (OR, 0.82; 95% CI, 0.70-0.97), and public or no insurance (OR, 0.75; 95% CI, 0.60-0.93).

Findings showed that the rotavirus vaccine age restrictions, which were developed as a result of safety concerns related to intussusception, and vaccination practices in the neonatal intensive care unit contributed to the lower odds of uptake for rotavirus vaccine compared with the DTaP vaccine.

“Whether decreased [rotavirus vaccine] initiation among wealthier parents with higher education is due to vaccine hesitancy, and whether some wealthier families with greater educational attainment (if they do initiate [rotavirus vaccine]) are more likely to complete the series because of greater access to medical care, requires further study,” noted the researchers.

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Because rotavirus vaccine coverage remains lower than DTaP vaccine, timely DTaP administration may help improve coverage. Moreover, “further exploration of preterm children and socioeconomic factors may aid in developing public health efforts to improve [rotavirus vaccine] coverage in the United States,” concluded the authors.

Disclosure: Natasha B. Halasa, MD; Janet A. Englund, MD; David I. Bernstein, MD; and Christopher J. Harrison, MD, disclosed affiliations with pharmaceutical companies. See the reference for complete disclosure information.


Aliabadi N, Wikswo ME, Tate JE, et al. Factors associated with rotavirus vaccine coverage. Pediatrics. 2019;143(2):e20181824.

This article originally appeared on Infectious Disease Advisor