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Published on: January 28, 2019
Vaccine-derived rotavirus strains in infants in England
Charlotte Mary Gower1, Jake Dunning2,3, Sameena Nawaz3
1Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK.
Insights
Rotavirus G1P[8] strains detected in infants are often from the Rotarix vaccine, especially around vaccination times. Infants with severe combined immunodeficiency (SCID) may have prolonged symptoms after rotavirus immunization.
Area of Science:
- Virology
- Pediatrics
- Immunology
Background:
- Rotavirus is a common cause of gastroenteritis in infants.
- Rotavirus vaccines are administered to prevent severe disease.
- Surveillance is crucial to monitor vaccine efficacy and identify circulating strains.
Purpose of the Study:
- To describe infants with acute gastroenteritis and Rotarix vaccine-derived G1P[8] rotavirus strain in stools.
- To investigate the association between vaccine-derived strains and infant age and vaccination status.
- To identify potential risk factors for prolonged symptoms in infants with vaccine-derived rotavirus strains.
Main Methods:
- Prospective national surveillance by Public Health England (PHE) from July 2013 to September 2016.
- Genotyping of 2637 rotavirus strains from vaccine-eligible children.
- Clinical data collection via surveillance questionnaires and assessment of gastroenteritis severity using the modified Vesikari Score.
Main Results:
- 215 (8%) of rotavirus strains were identified as the Rotarix vaccine-derived G1P[8] strain.
- No vaccine-derived strains were detected in unimmunized infants.
- Vaccine-derived strains were prevalent in 2-month-olds (82%) and 3-month-olds (68%) around vaccination periods.
- 10 of 13 infants with vaccine strains >7 weeks post-vaccination had undiagnosed severe combined immunodeficiency (SCID).
- Diarrhea was the most common symptom; infants with vaccine strains were less likely to have fever, vomiting, dehydration, or severe gastroenteritis compared to wild-type infections.
Conclusions:
- Rotavirus strains identified in infants around routine immunization are likely the Rotarix vaccine-derived G1P[8] strain.
- Infants with undiagnosed SCID may present with prolonged gastroenteritis symptoms post-rotavirus immunization.
- SCID should be considered in infants with persistent gastroenteritis symptoms and vaccine-derived rotavirus strains detected more than 7 weeks after immunization.
Objective:
To describe infants with acute gastroenteritis symptoms in primary and secondary care who have the Rotarix vaccine-derived G1P[8] rotavirus strain identified in their stools.
Design:
This is a prospective national surveillance conducted by Public Health England (PHE). Rotavirus-positive samples from vaccine-eligible children are routinely submitted to PHE for confirmation, and general practitioners are requested to complete a surveillance questionnaire for all cases. The modified Vesikari Score was used to assess severity of gastroenteritis.
Setting:
England, July 2013-September 2016.
Results:
2637 rotavirus strains were genotyped and 215 (8%) identified as the Rotarix vaccine-derived G1P[8] strain. There were no Rotarix vaccine-derived G1P[8] strains detected in unimmunised infants. Rotarix vaccine-derived G1P[8] strains clustered around the time of rotavirus vaccination and were responsible for 82% (107 of 130) of rotavirus-positive samples in 2-month-old infants and 68% (36 of 53) in 3-month-old infants. However, 13 samples were obtained more than 7 weeks after the last vaccination date; 10 of these specimens were from six children who were subsequently diagnosed with severe combined immunodeficiency (SCID). Diarrhoea was the single most common presenting symptom (83.0%) in infants with Rotarix vaccine-derived G1P[8] strains, who were less likely to present with fever, vomiting, dehydration or severe gastroenteritis than infants with wild-type rotavirus infection.
Conclusions:
Rotavirus identified in stools of infants around the time of their routine immunisations is most likely the Rotarix vaccine-derived G1P[8] strain. Infants with undiagnosed SCID at the time of rotavirus immunisation may experience prolonged gastroenteritis symptoms. Most infants with vaccine strains in their stools more than 7 weeks after immunisation had SCID.
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