Rotavirus vaccination in the US: a systematic review of vaccination coverage and completion

Figures & data

Table 1. Dosing schedules of RV vaccines licensed and recommended in the US

	RV1 (two-dose series)		RV5 (three-dose series)
	PI schedule^Citation9	ACIP	PI schedule^Citation10	ACIP
Recommended ages for doses	-	At 2, 4 months	-	At 2, 4 and 6 months
Minimum age for first dose	6 weeks	6 weeks	6–12 weeks	6 weeks
Maximum age for first dose	-	14 weeks and 6 days	-	14 weeks and 6 days
Interval between doses	≥ 4 weeks before maximum age	≥ 4 weeks	4–10-week intervals before maximum age	≥ 4 weeks
Maximum age for last dose	24 weeks	8 months and 0 days	32 weeks	8 months and 0 days

ACIP: Advisory Committee on Immunization Practices; PI, prescribing information; RV, rotavirus; RV1: Rotarix, GSK, Belgium; RV5: RotaTeq, Merck & Co., Inc., USA

Figure 1. Systematic review flow diagram

^aHill et al⁷

Table 2. Summary of included studies assessing RV vaccine series completion/compliance with schedules in the US

Author; Publication Year	Data Source; Study Period	Sample Size	RV Vaccine Completion Rate	RV Vaccine Compliance Rate	Factors impacting series completion/compliance
Calnan M. et al^Citation19	Medicaid administrative claims data from four states; May 2008 – April 2013	Cohort 1: 658,219 met PI criteria Cohort 2: 675,963 met ACIP criteria	Cohort 1: 55% (RV1) vs. 44% (RV5), p < .0001 Cohort 2: 60% (RV1) vs. 47% (RV5), p < .0001	Cohort 1: 55% (RV1) vs. 25% (RV5), p < .0001 Cohort 2: 57% (RV1) vs. 46% (RV5), p < .0001	Increased likelihood: use of RV1 (vs. RV5); DTaP vaccination completion, Fee-for-service insurance (vs. other/unknown) Decreased likelihood: attending non-pediatric specialties (vs. pediatric specialty)
Eisenberg D. et al^Citation20	Administrative claims data from 14 commercial health plans (HealthCore); August 2008 – January 2011	Cohort 1: 162,614 met PI criteria Cohort 2: 164,596 met ACIP criteria	Cohort 1: 85% (RV1) vs. 76% (RV5), p < .05 Cohort 2: 85% (RV1) vs. 78% (RV5), p < .05	Cohort 1: 69% (RV1) vs. 54% (RV5), p < .05 Cohort 2: 81% (RV1) vs. 66% (RV5), p < .05	-
Hill A. et al^Citation7	Survey data from the National Immunization Survey-Child; 2016	14,988	74%^a	-	Decreased likelihood: Black and Hispanic (vs. White), living below federal poverty level, Medicaid or uninsured (vs. private insurance)
Krishnarajah G. et al^Citation21	Administrative claims data of managed care enrollees (OptumInsight); January 2009 – March 2010	55,584	91% (RV1) vs. 83% (RV5), p < .001	75% (RV1) vs. 60% (RV5) compliant to PI; p < .001 83% (RV1) vs. 76% (RV5) compliant to ACIP criteria	Increased likelihood: use of RV1 (vs. RV5), pediatrician as provider type (vs. family physician), month of series initiation March-June (vs. January), geographic region Midwest, South, West (vs. Northeast)
Krishnarajah G. et al^Citation22	Medicaid administrative claims data from 10–13 states (MarketScan); May 2008 – June 2012	Cohort 1: 673,956 met PI criteria Cohort 2: 695,612 met ACIP criteria	Cohort 1: 65% (RV1) vs. 46% (RV5), p < .0001 Cohort 2: 74% (RV1) vs. 49% (RV5), p < .0001	Cohort 1: 65% (RV1) vs. 31% (RV5), p < .0001 Cohort 2: 69% (RV1) vs. 46% (RV5), p < .0001	Increased likelihood: Receipt of DTaP vaccine, use of RV1 Decreased likelihood: Black or Hispanic race (vs. White)
Kurosky S. et al^Citation23	Survey data from the National Immunization Survey; 2012	11,710	90% (RV1)^b; 81% (RV5)^b	77% (RV1); 70% (RV5)	-
Lanes S. et al^Citation24	Administrative claims data from commercial health plans (HealthCore); February 2006 – November 2012	272,142	78% (RV5, enrolled at birth through 1^st birthday); 77% (RV5, enrolled by 6 weeks of age and no minimum follow-up)	-	-
Panozzo C. et al^Citation25	Administrative claims data, commercial insurance (MarketScan); January 2006 – September 2010	594,117	87% (RV1) vs. 79% (RV5), p < .001	83% (RV1); 78% (RV5)	Increased likelihood: Receipt of DTaP vaccine, pediatrician provider type (vs. family physician) Decreased likelihood: mother’s age <25 years, having siblings <10 years old (vs. no siblings), residing in rural and small urban areas
Varan A. et al^Citation26	Survey data from the National Immunization Survey; 2010–2012	52,441	65%^a	-	Increased likelihood: non-Hispanic Asian or non-Hispanic other, child’s age ≥24 months, maternal education ≥12 years, income-to-poverty ration ≥400%, region of residence in Midwest or South Decreased likelihood: Foreign-born (vs. US-born), lacking health insurance, not being first-born, having 2 healthcare providers

ACIP: Advisory Committee Immunization Practices; DTaP: Diphtheria-Tetanus-acellular Pertussis; PI: prescribing information, RV1: Rotarix, GSK, Belgium; RV5: RotaTeq, Merck & Co., Inc., USA

^aIncludes RV1 or RV5

^bCompletion rate at 24 months of age

United States (US) Food and Drug Administration. Highlights of Prescribing Information - Rotarix. [accessed 2018 Nov 20]. https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm133539.pdf.

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