1380 - Current status of the legal landscape regarding Rotavirus Vaccination in the United States

Background: In the US, the Advisory Committee on Immunization Practices recommended routine rotavirus vaccination for all infants in 2006. Since then, rotavirus (RV) vaccination coverage (VC) has increased; however, RV VC is still below that of other routine childhood vaccines. All states require children to be vaccinated against certain communicable diseases as a condition for childcare attendance; other states require that children with diarrhea are excluded from childcare. Given the potential impact of these policies on VC, we sought to understand the legal landscape affecting rotavirus (RV) vaccination.

Methods: Legal epidemiological methods using Westlaw NEXT database were used to complete a systematic assessment of RV vaccination requirements for childcare entry and evaluate the ease at which non-medical exemptions are attained.  These methods were also used to evaluate state diarrhea childcare exclusion policies.

Results: Six states require RV vaccination for childcare attendance: Wyoming (2018); Ohio and Rhode Island (2015); Idaho (2011); North Dakota (2008); and Pennsylvania (2002) (Figure 1). All 6 states permit non-medical exemption that allow children to be exempt from vaccination. Ohio, North Dakota, and Pennsylvania are the most lenient, only requiring parental signature to withdraw from vaccination; while Wyoming is the least lenient, requiring a signed notarized official document. Childcare diarrhea exclusion policies were found in 28 states.Rotavirus Vaccination Requirements for Childcare Entry by State as of 2019.


Conclusion: To date, a minority of states have implemented RV vaccination policies while more states have diarrhea exclusion policies. However, vaccination policies may play a role in increasing VC and consequently lower acute gastroenteritis and diarrhea burden. In 2017, the VC for the full series of RV vaccination was 73.2%. Four of the states that have RV state vaccination policies had higher state-wide vaccination coverages than the national average. Given the concern in reducing diarrhea transmission, as evidenced by the large number of diarrhea exclusion policies, and the potential impact of policies on higher VC which may result in greater protection and reduction in RV disease, considerations should be given to implementing such policies in more states.