Recent changes to US rotavirus vaccine recommendations could lead to a sharp resurgence in severe childhood infections and hospitalizations within just a few years, suggests a new non–peer-reviewed study published recently on the preprint server medRxiv.
For the study, researchers from the Yale School of Public Health projected the potential effects of the Department of Health and Human Services’ January 2026 decision to remove rotavirus vaccination from the routine childhood immunization schedule and to recommend shared clinical decision-making instead.
Burden differs by state
Before rotavirus vaccines became available in 2006, the virus caused more than 400,000 physician visits, 200,000 emergency department (ED) visits, and 55,000 hospitalizations each year among US children. Since then, vaccination has significantly reduced severe illness. Rotavirus vaccine effectiveness has been estimated to be 75% against ED visits and 82% against hospitalization.
The researchers used a previously validated transmission model to estimate what could happen if vaccine uptake falls below current levels. National vaccine coverage currently stands at about 75%, though rates vary widely by state, from nearly 94% in Massachusetts to about 58% in Mississippi.
The team projected that if coverage drops to 60%, rotavirus-related hospitalizations among children would climb from an estimated 36,000 to more than 85,000 over the five-year period from July 2026 through June 2031. If coverage were to fall to 20%, hospitalizations could surge to roughly 204,000. The increase would likely be uneven across the country because the impact of declining rates would look different from state to state.
“It is likely that the burden of the changes to rotavirus vaccine recommendations will fall disproportionately on states such as Texas and Mississippi that already experience higher rates of RVGE [rotavirus-associated gastroenteritis] hospitalizations,” write the authors.
Benefits outweigh risks, authors say
Rotavirus vaccines carry a small risk of intussusception, a rare bowel complication, but the researchers say the benefits of vaccination outweigh the risks. They estimate that if coverage were to drop by 50% across the country, there would be around 22 fewer cases of vaccine-related intussusception but more than 114,000 rotavirus-related hospitalizations.
Overall, the authors write, “Our analysis highlights the considerable increase in the burden of [rotavirus] hospitalization that could result from downgrading the US rotavirus vaccine recommendation to ‘shared clinical decision-making.’”
