Background

Rotavirus vaccine (RV) coverage levels for US infants are <80%.

Methods

We surveyed nationally representative networks of pediatricians by internet/mail from April to June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age.

Results

Response rate was 68% (303/448). Ninety-nine percent of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%), and parent concerns about RV safety (6%). The most commonly reported reasons for nonreceipt of RV#1 by 4 to 5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from neonatal intensive care unit/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age.

Conclusions

US pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring.

中文翻译：

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为什么美国轮状病毒疫苗的接种率达不到高水平？

 背景

美国婴儿的轮状病毒疫苗 (RV) 覆盖率为 <80%。

 方法

2019 年 4 月至 6 月，我们通过互联网/邮件对全国有代表性的儿科医生网络进行了调查。多变量回归评估了与最大年龄施用首次 RV 剂量 (RV#1) 困难相关的因素。

 结果

回应率为 68% (303/448)。 99% 的提供商表示强烈推荐 RV。总体而言，RV 交付最常见的障碍（明确/某种程度上是障碍）是：父母对疫苗安全性的整体担忧 (27%)、父母想要推迟 (25%)、父母不认为 RV 是必要的 (12%)，以及家长担心房车安全（6%）。 4 至 5 个月（经常/总是）未收到 RV#1 的最常见原因是父母拒绝接种疫苗 (9%)、医院在出院时不给予 RV (7%)、婴儿出院时超过最大年龄来自新生儿重症监护病房/托儿所 (6%)，以及在就诊最大年龄之前未见过婴儿 (3%) 或见过但未接种疫苗 (4%)。在受访者中，4% 强烈同意，25% 部分同意，他们有时很难在最大年龄之前给予 RV#1。国家儿童健康保险计划/医疗补助保险儿童在实践中所占的比例较高，并报告说 RV 剂量时机的建议过于复杂，这与报告在最大年龄下提供 RV#1 的困难有关。

 结论

美国儿科医生发现了多个可采取行动的问题，这些问题可能导致 RV 免疫率不理想，包括长期住院后离开托儿所之前缺乏疫苗接种、婴儿在最大年龄之前没有接受良好护理就诊、错过就诊机会以及父母拒绝/推迟。