title: Variation in rotavirus vaccine coverage by provider location and subsequent disease burden.
abstract: BACKGROUND
  Rotavirus vaccines were introduced in the United States in 2006. Full-series coverage is lower than for other vaccines, and disease continues to occur. We examined variation in vaccine coverage among provider locations and correlated coverage with the detection of rotavirus in children who sought treatment of severe acute gastroenteritis (AGE).
  
  
  METHODS
  Vaccine records of children enrolled in an AGE surveillance program were obtained and children were grouped by the location that administered each child's 2-month vaccines. Cases were children with laboratory-confirmed rotavirus AGE; controls were children with rotavirus-negative AGE or acute respiratory infection. Location-level coverage was calculated using ≥ 1 dose rotavirus vaccine coverage among controls and classified as low (<40%), medium (≥ 40% to <80%), or high (≥ 80%). Rotavirus detection rates among patients with AGE were calculated by vaccine coverage category.
  
  
  RESULTS
  Of controls, 80.4% (n = 1123 of 1396) received ≥ 1 dose of rotavirus vaccine from 68 locations. Four (5.9%) locations, including a NICU, were low coverage, 22 (32.3%) were medium coverage, and 42 (61.8%) were high coverage. In low-coverage locations, 31.4% of patients with AGE were rotavirus-positive compared with 13.1% and 9.6% in medium- and high-coverage locations, respectively. Patients with AGE from low-coverage locations had 3.3 (95% confidence interval 2.4-4.4) times the detection rate of rotavirus than patients with AGE from high vaccine coverage locations.
  
  
  CONCLUSIONS
  We observed the highest detection of rotavirus disease among locations with low rotavirus vaccine coverage, suggesting that ongoing disease transmission is related to failure to vaccinate. Educational efforts focusing on timely rotavirus vaccine administration to age-eligible infants are needed.
authors.affiliation: Immunization Project, Texas Children's Hospital, Houston, Texas; lcsahni@texaschildrens.org.
authors.forename: Leila C
authors.initials: LC
authors.lastname: Sahni
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Payne
authors.affiliation: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: Immunization Project, Texas Children's Hospital, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Boom
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control*; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D008297:Male; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D013223:Statistics as Topic; D013781:Texas
chemical_list: D022243:Rotavirus Vaccines
keywords: rotavirus; rotavirus vaccine; vaccine coverage