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Published on: January 28, 2019
Severe rotavirus gastroenteritis in children older than 5 years after vaccine introduction
Kiyoshi Kyo1, Chika Takano2, Yuki Kasuga1
1Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
Insights
Rotavirus (RV) gastroenteritis remains a concern, with increasing hospitalizations in children over 5 years old. Vaccination appears to reduce symptom severity in this age group, highlighting the need for continued monitoring.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Rotavirus (RV) is a primary cause of acute gastroenteritis in infants.
- While RV vaccines have reduced severe infections, a notable burden persists, even in developed nations like Japan.
- Understanding RV epidemiology and vaccine effectiveness is crucial for public health strategies.
Purpose of the Study:
- To analyze trends in severe rotavirus gastroenteritis hospitalizations in Japan.
- To evaluate the efficacy of the rotavirus vaccine in children older than 5 years.
- To identify prevalent rotavirus genotypes circulating in Japan.
Main Methods:
- Retrospective survey of 380 hospitalized acute gastroenteritis patients (2015-2019).
- Detailed clinical data collected for 21 RV gastroenteritis patients in 2019.
- Fecal sample analysis to determine RV genotypes (G9P[8]I1 identified).
Main Results:
- An increasing trend in hospitalizations for severe RV gastroenteritis was observed in children over 5 years old.
- Vaccinated patients aged ≥5 years showed significantly less severe gastrointestinal symptoms compared to unvaccinated patients (p=0.014).
- The predominant RV genotype identified in 2019 was G9P[8]I1.
Conclusions:
- Children over 5 years old are susceptible to severe rotavirus infections, necessitating prompt intervention strategies.
- Continuous monitoring of clinical characteristics and RV epidemiology is essential following the inclusion of RV vaccines in Japan's national immunization program.
- Vaccine effectiveness in older age groups warrants further investigation and surveillance.
Introduction:
Rotavirus (RV) is the major pathogen responsible for acute gastroenteritis in infants. Since RV vaccines were introduced, a substantial decline in the incidence of severe RV infection has been reported. However, some burden still exists, even in developed countries, including Japan.
Methods:
We retrospectively surveyed 380 patients hospitalized for acute gastroenteritis from 2015 to 2019. In 2019, additional detailed clinical information of 21 patients with RV gastroenteritis was obtained to evaluate the efficacy of the RV vaccine. Nine fecal samples from those patients were collected to detect the RV genotypes.
Results:
Our data showed an increasing trend in hospitalizations for severe RV gastroenteritis in children older than 5 years. According to the Vesikari clinical severity scores in the older group (≥5 years), the gastrointestinal symptoms in vaccinated patients were less severe than those in unvaccinated patients (p = 0.014). The genotype analysis revealed that G9P[8]I1 was the major genotype in the recruited patients in 2019.
Conclusions:
This report warns that children older than 5 years could be affected by severe RV infection and suggests prompt intervention for this age group, similar to that in infants. In the new period in which the RV vaccine is included in Japanese national immunization programs beginning October 2020, continuous monitoring of patient clinical characteristics and RV epidemiology is required to determine the role of vaccines.
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