Date of Award

Fall 12-18-2013

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Lisa Casanova, PhD

Second Advisor

Lilly Immergluck, MD

Abstract

Background: Rotavirus is one of the most common diarrheal diseases in children less than 5 years of age. Rotavirus vaccines have greatly reduced this burden in the United States. An examination was conducted to determine possible disparities in RV vaccination rates compared to DTaP.

Methods: Children were actively enrolled during two rotavirus seasons from January-June of 2010 and 2011 in the Emergency Departments (ED) and inpatient floors from all Children's Healthcare of Atlanta (CHOA) sites (Scottish Rite, Egleston, and Hughes Spalding) with acute gastroenteritis (AGE). Data and a stool sample were collected from enrolled children and samples were tested for presence of rotavirus using an enzyme immunoassay (EIA) kit (Rotaclone). Vaccination records were abstracted from the state immunization registry and primary healthcare providers to examine complete and incomplete vaccination status. This cohort of children with vaccination records were used for this analysis. Cases were identified as children receiving a complete RV dose series and controls were identified as children with incomplete RV doses. A logistic regression model was used to determine disparities seen amongst children with incomplete vaccination status.

Results: Of the 660 patients that were approached for this study, 414 participants were included in this retrospective cohort analysis. 46.9% had incomplete rotavirus vaccination status and were more likely to be positive for rotavirus AGE (OR 1.76, 95% CI 1.46-2.13). Black infants had a higher rate of incomplete RV compared to whites (p-value 0.0006). When controlling for covariates, racial differences were no longer significant (OR 1.37 95% CI 0.77-2.57); however household size (p-value 0.0343), age at onset of illness (p-value 0.0061), and DTaP vaccination status (p-value < 0.0001) were all significant in determining vaccination status for children.

Conclusions: Racial disparities and socioeconomic differences are not evident in determining rotavirus vaccination rates; however, household size, a possible social determinant, has an effect on RV status. In addition, timely vaccinations are important in preventing incomplete RV vaccination status, due to RV vaccine age restrictions.

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