Rotavirus vaccination for infants with medical risk conditions

In the RIVAR study the full safety-effectiveness-implementation spectrum of rotavirus vaccination for infants with MRC was evaluated. Therefore, for this specific patient population, guided recommendations can be made. Non-specific effects of rotavirus vaccination are ignored in this recommendation, because these could not be confirmed in our study but we acknowledge that further research is required. Considering the combined (cost-) effectiveness, safety and feasibility results I would advise a universal rotavirus vaccination strategy excluding premature infants below 32 weeks of gestation and premature infants with comorbidities. At high vaccination coverage, this strategy could yield sufficient indirect effectiveness (herd effect), and reduction in nosocomial infections for the extreme vulnerable medical risk infants, as well as substantial reductions in rotavirus disease in the total infant population, resulting in cost and healthcare benefit. The existing national immunization program infrastructure can be used, guaranteeing quality of parent counseling and high uptake in the population. Because the most extremely vulnerable infants with MRC are excluded, administration within age restrictions of rotavirus vaccination will generally be feasible at well-baby clinics. Rotavirus vaccine effectiveness in healthy premature and term infants with congenital (gastrointestinal) pathology has been studied satisfactory, even though newer studies in the current epidemiology landscape are needed.

Summarizing conclusion
Rotavirus vaccine (cost-) effectiveness and its safety profile among infants with medical risk conditions (MRC) and the implementation of a targeted rotavirus vaccination program have been studied and evaluated in this thesis. This population of infants with MRC should be prioritized for prevention since their disease burden is highest and substantial, even in a well-developed country like the Netherlands. However, a hospital-based vaccination program targeted exclusively towards these medical risk infants showed limited protection and efficiency. Vaccine performance is subject to host characteristics and changing epidemiological conditions, which warrants population specific research and continued surveillance of vaccine effectiveness. The limited protection from current oral rotavirus vaccines among infants with MRC emphasize the need for alternative and optimized preventive strategies for rotavirus disease.