Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study

Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study George Altman, Thomas Spain, Marc Y Henrion, Aidan Flatt, David Singleton, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9295735/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Rotavirus vaccination programmes for infants have significantly reduced the incidence of rotavirus gastroenteritis. Vaccines which decrease disease incidence can reduce antibiotic prescribing and may help combat antimicrobial resistance. A US cohort study found a significant association between rotavirus vaccination and reduced antibiotic prescribing. However, no studies have investigated this association in the UK, where infant rotavirus vaccination was introduced in 2013. Methods: We conducted a retrospective cohort study using the Clinical Practice Research Datalink Aurum, a large representative dataset of UK primary care health records. Between 2010 and 2020, children were assessed for rotavirus vaccination status and followed from six months to seven years of age. The outcome was an antibiotic prescription within seven days following an all-cause acute gastroenteritis (AGE) diagnosis. Recurrent time-to-event modelling was used to estimate adjusted hazard ratios (aHR) accounting for sex, deprivation, urban-rural status, seasonality and health-seeking behaviour. Model estimates were used to predict the prescribing events averted by rotavirus vaccination. Results: Of 429,009 participants eligible for inclusion, 2.4% (10,328 participants) experienced an AGE-linked antibiotic prescribing event. For participants who received one or more rotavirus vaccines, after adjusting for covariates, the aHR was 0.74 (95% CI 0.71–0.77). This finding was robust across several sensitivity analyses, including changing the outcome definition to an antibiotic prescription within 3 days of an acute gastroenteritis diagnosis aHR 0.74 (95% CI 0.71–0.77). We also estimated that in a UK birth cohort born between 2014 and 2019 rotavirus vaccination has averted 12,635 (95%CI 11,363 − 14,109) AGE-linked prescriptions. Conclusions: Rotavirus vaccination was associated with a significantly lower rate of antibiotic prescribing in UK primary care. This is the first UK study to investigate this association, and our findings are consistent with the US cohort study and studies in low and middle-income countries. Our study provides further evidence that rotavirus vaccines are effective against disease in primary care and may contribute to antimicrobial stewardship. Rotavirus vaccine Acute gastroenteritis Antibiotic prescribing Primary care CPRD survival analysis diarrhoea cohort study electronic healthcare data Full Text Additional Declarations Competing interest reported. DH, DS and NF were in receipt of grant support to the institution from Seqirus UK for the evaluation of influenza vaccines in the UK, NF is in receipt of funding to the institution from GSK in relation to malaria vaccines; DH has also received grants from Merck and Co (Kenilworth, NJ) for rotavirus strain surveillance, received honorariums for presentation at a Merck Sharp and Dohme (UK) symposium on vaccines and has consulted on rotavirus strain surveillance; GA, TS, MH have no competing interests to disclose, and no other relationships or activities that could appear to have influenced the submitted work. Supplementary Files RotavirusAbxBMCMedicine20260401Supplementaryv1.0.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers agreed at journal 05 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 02 Apr, 2026 Submission checks completed at journal 02 Apr, 2026 First submitted to journal 01 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9295735","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618879235,"identity":"1759836c-de9a-4e8c-adf3-7cedc63b3b2f","order_by":0,"name":"George Altman","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Altman","suffix":""},{"id":618879236,"identity":"89211282-f862-4af1-b4ed-6a7c1f693f96","order_by":1,"name":"Thomas Spain","email":"","orcid":"","institution":"University of 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DH, DS and NF were in receipt of grant support to the institution from Seqirus UK for the evaluation of influenza vaccines in the UK, NF is in receipt of funding to the institution from GSK in relation to malaria vaccines; DH has also received grants from Merck and Co (Kenilworth, NJ) for rotavirus strain surveillance, received honorariums for presentation at a Merck Sharp and Dohme (UK) symposium on vaccines and has consulted on rotavirus strain surveillance; GA, TS, MH have no competing interests to disclose, and no other relationships or activities that could appear to have influenced the submitted work.","formattedTitle":"Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmed","sideBox":"Learn more about [BMC Medicine](http://bmcmedicine.biomedcentral.com/)","snPcode":"12916","submissionUrl":"https://submission.nature.com/new-submission/12916/3","title":"BMC Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rotavirus vaccine, Acute gastroenteritis, Antibiotic prescribing, Primary care, CPRD, survival analysis, diarrhoea, cohort study, electronic healthcare data","lastPublishedDoi":"10.21203/rs.3.rs-9295735/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9295735/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eRotavirus vaccination programmes for infants have significantly reduced the incidence of rotavirus gastroenteritis. Vaccines which decrease disease incidence can reduce antibiotic prescribing and may help combat antimicrobial resistance. A US cohort study found a significant association between rotavirus vaccination and reduced antibiotic prescribing. However, no studies have investigated this association in the UK, where infant rotavirus vaccination was introduced in 2013.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003e We conducted a retrospective cohort study using the Clinical Practice Research Datalink Aurum, a large representative dataset of UK primary care health records. Between 2010 and 2020, children were assessed for rotavirus vaccination status and followed from six months to seven years of age. The outcome was an antibiotic prescription within seven days following an all-cause acute gastroenteritis (AGE) diagnosis. Recurrent time-to-event modelling was used to estimate adjusted hazard ratios (aHR) accounting for sex, deprivation, urban-rural status, seasonality and health-seeking behaviour. Model estimates were used to predict the prescribing events averted by rotavirus vaccination.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eOf 429,009 participants eligible for inclusion, 2.4% (10,328 participants) experienced an AGE-linked antibiotic prescribing event. For participants who received one or more rotavirus vaccines, after adjusting for covariates, the aHR was 0.74 (95% CI 0.71\u0026ndash;0.77). This finding was robust across several sensitivity analyses, including changing the outcome definition to an antibiotic prescription within 3 days of an acute gastroenteritis diagnosis aHR 0.74 (95% CI 0.71\u0026ndash;0.77). We also estimated that in a UK birth cohort born between 2014 and 2019 rotavirus vaccination has averted 12,635 (95%CI 11,363\u0026thinsp;\u0026minus;\u0026thinsp;14,109) AGE-linked prescriptions.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eRotavirus vaccination was associated with a significantly lower rate of antibiotic prescribing in UK primary care. This is the first UK study to investigate this association, and our findings are consistent with the US cohort study and studies in low and middle-income countries. Our study provides further evidence that rotavirus vaccines are effective against disease in primary care and may contribute to antimicrobial stewardship.\u003c/p\u003e","manuscriptTitle":"Impact of Rotavirus Vaccination on Antibiotic Prescribing in Primary Care: A UK retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-08 21:38:25","doi":"10.21203/rs.3.rs-9295735/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"239867447717292199308607644089019043108","date":"2026-04-07T10:56:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87888505848437482472495941110331044592","date":"2026-04-05T12:22:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207692382779563400445159305155680639495","date":"2026-04-05T07:41:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-03T00:15:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-02T08:44:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-02T08:17:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medicine","date":"2026-04-01T19:58:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmed","sideBox":"Learn more about [BMC Medicine](http://bmcmedicine.biomedcentral.com/)","snPcode":"12916","submissionUrl":"https://submission.nature.com/new-submission/12916/3","title":"BMC Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"321d7b66-76c5-4292-b34d-457461533a5e","owner":[],"postedDate":"April 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-08T21:38:26+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-08 21:38:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9295735","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9295735","identity":"rs-9295735","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}