Children with medical complexity or infants born prematurely are at increased risk for severe rotavirus disease; however due to the time constraints of the rotavirus immunization schedule and the theoretical risk of nosocomial transmission of live vaccines, many infants become ineligible to receive the rotavirus vaccine. This prospective cohort study analyzed stool specimens of hospitalized infants vaccinated against rotavirus using the pentavalent vaccine as well as infants who were not immunized to evaluate for viral shedding in both populations. Additionally, the rates of rotavirus vaccination of eligible patients and the percentage of patients who were no longer rotavirus vaccine eligible due to their hospitalization (ie, discharged after 104 days of age) were calculated.  Stool sample analysis revealed that 1% of specimens were positive for rotavirus and that nearly all vaccine-type viral shedding occurred within 7 days of receipt of the first vaccine dose.  No vaccine-type strains were isolated from the stool of unimmunized infants. Of note, about one third of eligible infants were up-to-date on rotavirus vaccination at the time of hospital discharge (compared to 83% up-to-date on all other routine immunizations). Of the infants who were not vaccinated against rotavirus, almost half (42.6%) were not vaccine eligible after discharge.


This article highlights the vulnerability of children with prolonged early-life hospital courses to rotavirus infection given the likelihood of under-immunization and ineligibility for immunization post-discharge. Importantly, while limited in its generalizability, the data presented suggest that rotavirus vaccination may be safe and feasible in the inpatient setting as no vaccine-type strain shedding was noted in the stool of children who did not receive the vaccine. This study provides solid evidence that delayed rotavirus vaccine administration is likely unnecessary and that routine administration could be undertaken in order to optimally protect vulnerable patients from serious infection.

Nicki Brodie, MD

Special Needs Clinic, St. Christopher’s Hospital for Children

Hofstetter AM et al. Risk of Rotavirus Nosocomial Spread After Inpatient Pentavalent Rotavirus Vaccination.  Pediatrics. 2018.