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Published on: January 28, 2019
Secular variation in United States rotavirus disease rates and serotypes: implications for assessing the rotavirus
Daniel C Payne1, Peter G Szilagyi, Mary Allen Staat
1Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. DVP6@cdc.gov
Insights
Rotavirus disease rates and strains varied significantly across three US counties between 2006-2007, even with limited rotavirus vaccine use. This natural variability is crucial for evaluating vaccine impact.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Population-based surveillance for rotavirus disease in children was established in 2006 across three US counties: Monroe County, NY; Hamilton County, OH; and Davidson County, TN.
- Surveillance focused on children under 3 years old admitted to hospitals or emergency departments (EDs) for diarrhea and/or vomiting.
Purpose of the Study:
- To monitor and compare population-based rates of rotavirus disease and circulating strains in three distinct geographic locations.
- To understand the natural variability of rotavirus disease and serotypes before widespread vaccine implementation.
Main Methods:
- Clinical data and stool specimens were collected from hospitalized children (<3 years) during the 2006 and 2007 rotavirus seasons.
- Specimens were tested for rotavirus, genotyped, and hospitalization/ED visit rates were calculated.
- Rotavirus vaccination coverage was assessed in June 2007.
Main Results:
- Aggregate rotavirus hospitalization rates were similar across sites in 2006-2007, but individual county rates varied significantly.
- Rochester saw a 3-fold increase in rotavirus hospitalizations, while Cincinnati and Nashville experienced decreases.
- The predominant rotavirus strain shifted in Rochester to P[8],G12 in 2007, while P[8],G1 remained dominant elsewhere. Rotavirus vaccine coverage reached 15% by June 2007.
Conclusions:
- Significant variability in rotavirus disease rates and serotypes was observed across the three sites during 2006-2007, despite limited vaccine use.
- This natural temporal and geographic variability in rotavirus disease must be considered when assessing the impact of rotavirus vaccination programs.
- Understanding baseline disease patterns is essential for accurate vaccine effectiveness studies.
Background:
Since 2006, we have conducted population-based surveillance for rotavirus disease in children seen in hospitals and emergency departments (EDs) in Monroe County, NY (Rochester), Hamilton County, OH (Cincinnati), and Davidson County, TN (Nashville).
Methods:
During the 2006 and 2007 rotavirus seasons, clinical information and stool specimens were obtained from county children who were <3 years presenting with diarrhea and/or vomiting to the hospital or ED of the only children's hospital in each county. Specimens were tested for rotavirus and genotyped, and rates of hospitalization and ED visits were calculated.
Results:
While aggregate rotavirus hospitalization rates for the 3 sites were similar in 2006 and 2007 (22.5/10,000 and 26.8/10,000, respectively), individual rates for the 3 counties differed considerably. The rotavirus hospitalization rate in Rochester between 2006 and 2007 increased 3-fold, but decreased by 33% in Cincinnati and 41% in Nashville over the 2 study years. G1 strains accounted for >80% of strains at all 3 sites in 2006. However, in 2007, the uncommon P[8], G12 strain was detected in 69% of Rochester specimens, while the P[8], G1 strain remained predominant in the other 2 sites. No subjects received rotavirus vaccine in 2006 and coverage with 2 to 3 vaccine doses reached 15% in all 3 communities by June 2007.
Conclusions:
During the 2006 and 2007 rotavirus seasons, with only limited vaccine use, remarkable variability was observed in the population-based rates of severe rotavirus and in the rotavirus serotypes across the 3 sites. This natural secular variability in rotavirus disease must be considered in the assessment of the impact of vaccine on disease rates and rotavirus serotypes.
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