BACKGROUND AND OBJECTIVES 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.

中文翻译：

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疫苗株轮状病毒在常规接种疫苗的新生儿重症监护病房中的传播风险。


背景和目标 由于疫苗株水平传播的理论风险，许多新生儿重症监护病房 （NICU） 不给住院患者接种轮状病毒疫苗。我们旨在确定疫苗株传播给常规接种五价轮状病毒疫苗 （RV5） 的 NICU 中未接种疫苗婴儿的发生率和临床意义。方法 这项前瞻性队列研究包括所有入住 100 个床位的 NICU 患者，为期 1 年。每周收集粪便标本;实时定量逆转录聚合酶链反应检测任何 RV5 菌株。假设每个未接种疫苗患者的粪便导致 1 个患者日有传播风险，则计算向未接种疫苗的婴儿传播的发生率。对疑似传播事件进行了调查和地理空间分析。结果 在收治的 1238 名婴儿中，560 名 （45%） 为早产儿，322 名 （26%） 为胃肠道病变。在观察期间，给予了 226 剂 RV5。总体而言，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 份粪便样本。大多数 （681， 99.3%） 未接种疫苗的患者从未对 RV5 毒株检测呈阳性。5 例 （<1%） 检测为 RV5 菌株阳性。未接种疫苗婴儿的估计传播率为 5/2252 次粪便或 2.2/1000 个有风险的患者日 （95% CI： 0.7-5.2）。在收集 RV5 阳性粪便后 7 天内，传播病例未发现胃肠炎症状。在出院日期之前开始 RV5 系列的 126 名患者中，如果只允许在出院时接种疫苗，55% 的患者将不符合开始该系列的年龄条件。结论 RV5 菌株的传播不常见，无临床后果。 通过 NICU 内 RV5 疫苗接种允许疫苗诱导的婴儿轮状病毒病保护的好处似乎超过了疫苗株传播的风险。