Will Pediatricians Adopt the New Rotavirus Vaccine?

The survey by Kempe et al. based on a questionnaire to US physicians shows that approximately 85% of US pediatricians would recommend vaccination against Rotavirus (1). The major barrier to vaccination were vaccine costs and parental acceptance. Interestingly two major papers describing the trials with the two available vaccines were attached to the questionnaire and presented to the key responders (2,3). We have recently performed a survey to investigate whether pediatricians in the Italian Health Care System would promote or not Rotavirus vaccination and what were the main reasons for their choice. A structured questionnaire was distributed to a sample of pediatricians attending two national conferences held in October and November 2006. We did not provide adjunctive information on Rotavirus diarrhea nor on vaccines. Two hundred forms were distributed and 149 (75%) were returned. The majority of Italian pediatricians (76%) reported that they would promote Rotavirus vaccination. Among them, the most common reasons for recommending Rotavirus vaccination were to prevent hospitalization (76%) and the severe consequences linked to the increased severity of Rotavirus gastroenteritis compared to that induced by other enteric pathogens (52%). Of the 24% who did not recommend vaccination, 63% did so because the vaccine does not protect against gastroenteritis caused by enteric pathogens other than Rotavirus and 48% because of the vaccine cost. However as many as 46% of pediatricians did not consider the gastroenteritis as a problem worth to be prevented. Overall less Italian than American pediatricians endorsed vaccination. In addition, there was a striking difference in the reasons for not promoting it. The vast majority of US pediatricians referred to the high cost of the vaccine and the problem with reimbursement, whereas Italian pediatricians focused on the specific etiologic pattern of protection and, more generally, on the relatively limited severity of diarrhea. These differences are likely to reflect the differences in organization and structure of health system in the two Countries. However they are also a consequence of the methods used in the two studies. Namely, specific information on the Rotavirus burden and the efficacy of vaccines was provided to pediatricians in the US survey, information that have probably “sensitized” key responders on the opportunity to vaccinate children. This was not done in the Italian survey. We know that in the so called industrialised countries, Rotavirus infection is generally a relatively mild disease, but that it is extremely frequent and is associated with a substantial number of hospitalizations. Rotavirus has a major impact on the quality of life of infected infants and children, their parents and families. In addition, the economic burden of Rotavirus is substantial. Despite the significant morbidity and costs associated with Rotavirus in Europe (4) , awareness of the burden and of the risks of the disease is low, and Rotavirus infection is not perceived as a major health problem. As a consequence nor families neither physicians seem ready to acknowledge the importance of active prevention. Payers in turn, regardless they are related to private market (physicians or insurance companies) or public health authorities, are also likely to underscore the importance of vaccination. There is therefore a need to raise awareness among interested parties about Rotavirus-induced gastroenteritis. We believe that the comparative evaluation of the results of the US and Italian surveys strongly suggest that providing information is a key strategy to promote vaccinations against Rotavirus disease.

1- Kempe A, Daley MF, Parashar UD et al. Will pediatricians adopt the new Rotavirus vaccine? Pediatrics 2007;119:1-10

2- Vesikari T, Matson DO, Dennehy P et al. Safety and efficacy of a pentavalent human bovine (WC3) reassortant Rotavirus vaccine. NEJM 2006;354:23-33

3- Ruiz-Palacios GM, Perez-Schael I, Velazquez FR et al. Safety and efficacy of an attenuated vaccine against severe Rotavirus gastroenteritis. NEJM 2006;354:11-22

4- Desselberger U, Wolleswinkel-van den Bosch J, Mrukowicz J et al. Rotavirus types in Europe and their significance for vaccination. Pediatr Infect Dis J 2006;25:S30-41

Conflict of Interest:

None declared