Coverage and Determinants of Uptake for Privately Funded Rotavirus Vaccine in a Canadian Birth Cohort, 2008-2013

Background: Rotavirus can lead to serious illness or death, even in developed countries. While vaccination can provide protection, many jurisdictions are still grappling with the issue of whether to introduce a universal publicly funded rotavirus vaccination program. This retrospective population-based study assessed rotavirus vaccine coverage, determinants of uptake, and compliance with the recommended schedule in a Canadian jurisdiction with a privately-funded rotavirus vaccination program. Methods: Analysis of pharmaceutical dispensing, vital statistics, and administrative health data determined vaccine coverage and schedule compliance from 2008 to 2013. Multivariable logistic regression was used to assess characteristics of families purchasing vaccine. Results: Vaccine coverage ranged from 1% to 4% between 2008-2013, with 52% of vaccinated children completing the full vaccine series; 7.9% and 3.8% of children received doses before and after the recommended ages, respectively. Children who received >= 1 doses of the vaccine were more likely to have mothers who were married (adjusted odds ratio [aOR] 1.76, 95% CI1.64-1.88), fewer siblings (aOR 3.44, 95% CI 3.01-3.94), be non-First Nations (aOR 2.29, 95% CI 1.78-2.94), and be born prematurely (aOR 1.32, 95% CI 1.23-1.42). Income was a strong influence in urban areas, but not in rural regions, where coverage was lower overall. Conclusions: Vaccine coverage in a privately-funded model was very low and left high risk populations unprotected. Vaccine series completion and compliance with recommended scheduling was also suboptimal.