The rotavirus vaccine in a medicaid population: series completion and health care utilization

Abstract

Coverage estimates for the complete rotavirus vaccine series are considerably lower than the Healthy People 2020 target, as well as for other vaccinations routinely recommended in early childhood. Regardless, routine rotavirus vaccination in infants has been extremely effective in reducing rotavirus-associated illness in the United States. There are racial and socioeconomic disparities in rotavirus vaccine coverage, as well as lower rates of coverage among rural children. Furthermore, there is evidence of disproportionate disease burden among Medicaid-enrolled children. Further reductions in rotavirus disease burden are possible with improvements in coverage rates, although coverage may not reflect the full of the impact of rotavirus vaccination. Both the receipt of the complete rotavirus vaccine series, as well as receipt of a partial series, have been shown effective in the prevention of severe illness. Therefore, the present study was conducted within a Medicaid-enrolled population to 1) Examine the association between rural residence and rotavirus vaccination 2) Examine demographic and provider characteristics as potential predictors of rotavirus vaccine series initiation and completion, and 3) Examine differences in rotavirus-associated health care utilization by the status of rotavirus vaccine series completion. The study population included 293,458 children enrolled in Medicaid between 2010-2017. Nearly 77% of infants received at least one rotavirus vaccine dose; however, only 56% completed the full series. Infants who resided in rural areas were more likely to initiate the vaccine series, but rurality of residence had mixed impact on series completion. The receipt of ≥1 dose of the diphtheria, tetanus, and pertussis (DTaP) vaccine was strongly associated with rotavirus vaccine series initiation. The strongest predictors of series completion were the receipt of all age appropriate doses of DTaP and receipt of the Rotarix® (RV1) (GlaxoSmithKline Biologicals) vaccine. Analysis of health care utilization found that receipt of any dose of rotavirus vaccine was effective in the prevention of severe illness; however, completion of the series maximized protection against severe cases of rotavirus-associated illness.