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Timely immunisation of premature infants against rotavirus in the neonatal intensive care unit
  1. Shamez N Ladhani1,2,
  2. Mary E Ramsay1
  1. 1Immunisation Department, Public Health England, London, UK
  2. 2Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
  1. Correspondence to Dr Shamez Ladhani, Immunisation Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK; shamez.ladhani{at}

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The UK introduced a live-attenuated rotavirus vaccine (Rotarix) into the national infant immunisation programme in July 2013. The vaccine is given orally at 2 months and 3 months of age alongside the routine vaccinations. Although rotavirus gastroenteritis is not associated with long-term complications or death in the UK, it is responsible for 14 000 hospitalisations, 30 000 Accident and Emergency (A&E) attendances, 37 000 National Health Service (NHS) Direct calls (a 24-hour helpline service), 91 000–133 000 general practice visits annually in children aged under 5 years in England and Wales, costing the NHS an estimated £14 million annually.1 In addition to reducing distress to young children and their families, immunisation against rotavirus is expected to significantly reduce disease burden, hospitalisation rates and health utilisation costs.2

Compared with term infants, those born prematurely are less likely to be protected against rotavirus infection because of poor passive maternal antibody transfer before birth and reduced opportunities for breastfeeding after birth.3 Premature infants with rotavirus infection are more likely to suffer from acute dehydration requiring hospitalisation,4–6 and bloody mucoid stools, intestinal dilatation, abdominal distension and necrotising enterocolitis.5–9 Moreover, prolonged outbreaks of rotavirus gastroenteritis have been reported in neonatal units, where the smaller, sicker babies who stay in hospital longer have the highest risk of infection.6 ,10 In this context, too, premature infants develop more severe symptoms than term infants.11

The UK currently recommends that premature infants should receive the oral rotavirus vaccine along with their routine immunisations at their chronological age and, like Australia but unlike the USA, the oral rotavirus vaccine should be given even if the infant is hospitalised at the time. A strong basis for this recommendation is the strict age restriction recommended internationally for oral rotavirus vaccines, whereby the first dose should be given by 15 weeks of age …

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  • Contributors Both authors contributed equally to the writing of the editorial and have agreed on the final wording.

  • Competing interests SNL performs contract research for vaccine manufacturers on behalf of St George’s University of London, but receives no personal remuneration. MER is the coeditor of the Green Book on Immunisation Against Infectious Diseases that summarises national recommendations for the UK.

  • Provenance and peer review Commissioned; internally peer-reviewed.

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