Rotavirus vaccination in the neonatal intensive care units: where are we? A rapid review of recent evidence.

PURPOSE OF REVIEW: Rotavirus is a leading cause of viral acute gastroenteritis in infants. Neonates hospitalized in neonatal intensive care units (NICUs) are at risk of rotavirus infections with severe outcomes. The administration of rotavirus vaccines is only recommended, in the United States and Canada, upon discharge from the NICU despite rotavirus vaccines being proven well tolerated and effective in these populations, because of risks of live-attenuated vaccine administration in immunocompromised patients and theoretical risks of rotavirus vaccine strains shedding and transmission.We aimed to summarize recent evidence regarding rotavirus vaccine administration in the NICU setting and safety of rotavirus vaccines in preterm infants. METHODS: We conducted a rapid review of the literature from the past 10 years, searching Medline and Embase, including all study types except reviews, reporting on rotavirus vaccines 1 and 5; NICU setting; shedding or transmission; safety in preterm. One reviewer performed data extraction and quality assessment. RECENT FINDINGS: Thirty-one articles were analyzed. Vaccine-derived virus shedding following rotavirus vaccines existed for nearly all infants, mostly during the first week after dose 1, but with rare transmission only described in the household setting. No case of transmission in the NICU was reported. Adverse events were mild to moderate, occurring in 10-60% of vaccinated infants. Extreme premature infants or those with underlying gastrointestinal failure requiring surgery presented with more severe adverse events. SUMMARY: Recommendations regarding rotavirus vaccine administration in the NICU should be reassessed in light of the relative safety and absence of transmission of rotavirus vaccine strains in the NICU.

Nontyphoidal Salmonella Osteomyelitis in Immunocompetent Children Without Hemoglobinopathies: A Case Series and Systematic Review of the Literature.

Salmonella osteomyelitis is well-described in children with hemoglobinopathies, particularly infection with Salmonella typhi. To characterize nontyphoidal osteomyelitis in otherwise healthy children without hemoglobinopathies, we performed a retrospective review of children discharged from our institution with this condition, supplemented with a systematic literature review. Among the 46 subjects identified, common risk factors for Salmonella infection were frequently absent and complications were common.

Management and outcome of a varicella exposure in a neonatal intensive care unit: lessons for the vaccine era.

BACKGROUND: Varicella exposure in health care settings poses a threat to susceptible, immunocompromised hosts. We describe the management and outcome of a varicella exposure in a neonatal intensive care unit. METHODS: We reviewed the history of the index case, determination of the exposed cohort, medical management of exposed neonates, and assignment of health care workers based on exposure and immune status. We present the results of serologic testing of health care workers related to their history of varicella disease. RESULTS: Of 427 health care workers assessed at the time of the exposure, 13.1% were seronegative for varicella. Among 180 employees recorded as having a previous history of varicella, 9 were seronegative. A total of 34 infants received prophylaxis with intravenous immune globulin; acyclovir prophylaxis was added for those born at <28 weeks gestational age. The exposed cohort was isolated. No secondary cases of varicella occurred among patients or health care workers. CONCLUSION: Nosocomial varicella exposures require rapid assessment and response, which can be guided by a checklist of actions. Varicella immunity in health care workers cannot be assumed even among those born before 1980; institutional policies should adhere to the 2007 Centers for Disease Control and Prevention's definition of immunity to varicella for health care workers.