Before the introduction of the rotavirus vaccine, many children under 5 years old experienced a week-long bout of diarrhea thanks to the infection. Rotavirus often sent them to the emergency department (ED) and sometimes could require a hospital stay, costing an estimated $1 billion every year. 

Rotavirus vaccination slashed the number of trips to pediatric hospitals and associated costs. Yet in January, the US Centers for Disease Control and Prevention (CDC) recommended changing rotavirus vaccination from routine to shared clinical decision making (SCDM). If this change occurs, experts worry it would reduce the number of children protected from the virus. 

A modeling study published this week in JAMA Network Open finds that, if rotavirus vaccine SCDM is adopted, it could cost an additional $34.5 to $103.5 million in associated healthcare costs by the time US children reach 2 years of age.

“Even modest reductions in vaccination uptake may result in increased morbidity and increased clinical and economic burdens,” wrote the authors, led by researchers at the Washington University School of Medicine. “Revisions from routine to SCDM rotavirus vaccination recommendations warrant full consideration of the potential negative effects on public health and health care expenditures.” 

When vaccination dips, ED visits, hospitalizations rise

Currently, 71% of infants are fully vaccinated with two doses of rotavirus vaccine, 15% are partially vaccinated, and 14% are unvaccinated. The paper’s authors estimated 2025 costs, including direct medical and indirect expenses, at $19,675 for gastrointestinal-related hospitalizations and $1,206 for ED visits.

Using decision analytical modeling, the researchers examined three possible outcomes if the rotavirus vaccine recommendation switched to shared clinical decision making—a 10%, 20%, and 30% reduction in vaccination. 

Even modest reductions in vaccination uptake may result in increased morbidity and increased clinical and economic burdens.

At current vaccine coverage rates, children face more than 20,200 gastrointestinal-related hospitalizations and 126,800 ED trips by the time they turn 2 years old. A decline in vaccination of 10% to 30% represents an additional 1,500 to 4,500 hospital stays and 4,400 to 13,200 ED visits. This adds an extra $34.5 to $103.5 million in healthcare costs. 

‘We already had clear recommendations in place’

The US Department of Health and Human Services’ efforts to change some vaccine recommendations to shared decision making is creating confusion for families. 

“To say, for example, to someone, ‘I think you should go have a decision-making conversation about it,’ implies that you don’t really think that they need to have the vaccine,” Margot Savoy, MD, MPH, chief medical officer of the American Academy of Family Physicians, told CIDRAP News. 

“That’s not necessarily aligned with the evidence in the case of vaccines—where we already had clear recommendations in place,” she added. 

The turmoil at HHS and CDC means that many parents feel unsure of what to do about vaccines. 

“The chaos in communication, it’s been very difficult for families, parents, and also somewhat now for providers to understand why there seems to be such controversy when there wasn’t before,” James Campbell, MD, chair of the American Academy of Pediatrics Committee on Infectious Diseases, previously told CIDRAP News. “There’s no new data to lead to the controversy. There’s just people sowing chaos.”