NICU Restrictions Linked to Lower Rotavirus Vaccination Rates in Extremely Preterm Infants: Study
USA: A U.S. study has found that children born extremely preterm after the introduction of rotavirus vaccines had 14.6 times higher odds of remaining unvaccinated compared with other children.
The findings suggest that current recommendations discouraging rotavirus vaccine administration in the neonatal intensive care unit (NICU), along with strict upper age limits for vaccination, create significant barriers to immunization in this high-risk population. Researchers noted that these policy-related obstacles may leave many vulnerable infants unprotected against severe rotavirus infection, highlighting the need to reassess vaccination strategies to improve coverage among preterm infants.
The findings were published in Pediatrics by Mary C. Moran of the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues.
Rotavirus is a major cause of severe gastroenteritis in infants and young children. Current U.S. recommendations require the first rotavirus vaccine dose to be given by 14 weeks and 6 days of age and advise against vaccination during NICU hospitalization. Researchers investigated whether these guidelines may limit vaccine uptake, particularly among preterm infants with prolonged NICU stays.
Using data from the New Vaccine Surveillance Network, the investigators analyzed children born on or after January 1, 2007, who were enrolled between December 2014 and August 2024. The study included children aged at least 15 weeks with documented vaccination status who either had rotavirus-negative acute gastroenteritis or were healthy controls.
A total of 24,755 children were included in the analysis. The researchers evaluated factors associated with failure to initiate or complete the rotavirus vaccine series and assessed missed vaccination opportunities.
The researchers reported the following findings:
- Receiving the diphtheria, tetanus, and pertussis vaccine at 15 weeks of age or later was the strongest predictor of not initiating rotavirus vaccination, increasing the odds of remaining unvaccinated by 30-fold.
- Extremely preterm infants had 14.6 times higher odds of not receiving the rotavirus vaccine compared with other children.
- Children born during the early years after the introduction of the rotavirus vaccine (2007–2009) were more than three times as likely to remain unvaccinated as those born in later years.
- Lack of health insurance was associated with more than double the odds of not initiating rotavirus vaccination.
- More than 50% of extremely preterm infants in the NICU were not discharged until they were at least 15 weeks old.
- Many extremely preterm infants exceeded the recommended maximum age for receiving the first rotavirus vaccine dose before becoming eligible for vaccination under current guidelines.
The authors concluded that current vaccination recommendations may inadvertently limit rotavirus vaccine coverage among extremely preterm infants. They suggested that permitting rotavirus vaccination in the NICU could remove a key barrier to immunization, improve vaccine uptake, and enhance protection against severe rotavirus disease in this vulnerable population.
Reference:
Moran MC, et al "Rotavirus vaccine coverage and potential barriers among US children born from 2007 to 2024" Pediatrics 2026; DOI: 10.1542/peds.2025-074382.
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