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Prevalence and Characterization of Gastroenteritis Viruses among Hospitalized Children during a Pilot Rotavirus
Chu Thi Ngoc Mai1, Le Thi Khanh Ly1, Yen Hai Doan2
1National Institute of Hygiene and Epidemiology, Hanoi 100000, Vietnam.
Insights
The Rotavirus vaccine significantly reduced rotavirus infections in Vietnamese children. However, norovirus and other viral gastroenteritis cases increased, highlighting the need for ongoing surveillance and control strategies.
Area of Science:
- Virology and Epidemiology
- Public Health and Vaccinology
Background:
- Rotavirus (RV), norovirus (NoV), sapovirus (SaV), and human astrovirus (HAstV) are leading causes of pediatric gastroenteritis globally.
- Vietnam introduced the Rotavin-M1 RV vaccine, necessitating an evaluation of its impact on viral gastroenteritis patterns in children.
Purpose of the Study:
- To determine the prevalence of RV, NoV, SaV, and HAstV in hospitalized children under five years old in Vietnam.
- To assess the impact of the Rotavin-M1 RV vaccine introduction on the prevalence of these viral pathogens.
Main Methods:
- A cross-sectional descriptive study was conducted from December 2016 to May 2021 in two Vietnamese provinces.
- Acute diarrheal samples from 2317 children under five were analyzed using ELISA for RV and multiplex real-time RT-PCR for NoV, SaV, and HAstV.
- One year of pre-vaccination surveillance data was compared with post-vaccination data.
Main Results:
- Single RV infection prevalence decreased significantly from 41.6% to 22.7% post-vaccination (p < 0.0001).
- Single NoV infection prevalence more than doubled from 8.8% to 21.8% (p < 0.0001).
- SaV and HAstV prevalences showed slight increases, while viral co-infections decreased, primarily due to reduced RV co-infections.
Conclusions:
- The RV vaccine introduction led to a substantial reduction in rotavirus gastroenteritis in Vietnamese children.
- A concurrent increase in norovirus and other viral gastroenteritis necessitates continued monitoring and potential interventions.
- Shifting etiological patterns of diarrhea require ongoing surveillance to manage the remaining disease burden effectively.
Abstract:
Rotavirus (RV), norovirus (NoV), sapovirus (SaV), and human astrovirus (HAstV) are the most common viral causes of gastroenteritis in children worldwide. From 2016 to 2021, we conducted a cross-sectional descriptive study to determine the prevalence of these viruses in hospitalized children under five years old in Nam Dinh and Thua Thien Hue provinces in Vietnam during the pilot introduction of the RV vaccine, Rotavin-M1 (POLYVAC, Hanoi, Vietnam). We randomly selected 2317/6718 (34%) acute diarrheal samples from children <5 years of age enrolled at seven sentinel hospitals from December 2016 to May 2021; this period included one year surveillance pre-vaccination from December 2016 to November 2017. An ELISA kit (Premier Rotaclone®, Meridian Bioscience, Inc., Cincinnati, OH, USA) was used to detect RV, and two multiplex real-time RT-PCR assays were used for the detection of NoV, SaV and HAstV. The prevalence of RV (single infection) was reduced from 41.6% to 22.7% (p < 0.0001) between pre- and post-vaccination periods, while the single NoV infection prevalence more than doubled from 8.8% to 21.8% (p < 0.0001). The SaV and HAstV prevalences slightly increased from 1.9% to 3.4% (p = 0.03) and 2.1% to 3.3% (p = 0.09), respectively, during the same period. Viral co-infections decreased from 7.2% to 6.0% (p = 0.24), mainly due to a reduction in RV infection. Among the genotypeable samples, NoV GII.4, SaV GI.1, and HAstV-1 were the dominant types, representing 57.3%, 32.1%, and 55.0% among the individual viral groups, respectively. As the prevalence of RV decreases following the national RV vaccine introduction in Vietnam, other viral pathogens account for a larger proportion of the remaining diarrhea burden and require continuing close monitoring.
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