Changing distribution of age, clinical severity, and genotypes of rotavirus gastroenteritis in hospitalized children after the introduction of vaccination: a single center study in Seoul between 2011 and 2014

Abstract

BackgroundThis study aimed to explore changes in clinical epidemiology and genotype distribution and their association among hospitalized children with rotavirus gastroenteritis after the introduction of vaccines.MethodsBetween November 2010 and October 2014, hospitalized children with acute gastroenteritis were enrolled. Rotavirus genotypes were confirmed through reverse transcription-polymerase chain reaction (RT-PCR), semi-nested PCR, and sequencing. Clinical information including vaccination status and the modified Vesikari scores were collected.ResultsAmong 179 children with rotavirus infection, nineteen (10.6 %) were completely vaccinated. During the study period, the number of children between three and 23 months of age decreased significantly compared to the number of children older than 24 months of age (P = 0.010), who showed lower diarrhea severity (duration, P = 0.042; frequency, P = 0.021) but higher vomiting severity (P = 0.007, 0.036) compared to the former. Vaccination status was also significantly associated with lower vomiting severity after adjustment for age (frequency only, P = 0.018). The predominant genotypes were G2P[4] (18.4 %), G1P[8] (14.5 %), and G1P[4]P[8] (12.8 %), and the prevalence of genotypes with uncommon and mixed combinations was more than 50 %. Children infected with G2P[4] strains tended to be older (P = 0.005) and had more severe vomiting (P = 0.018, 0.006) than those with G1P[8].ConclusionsIncrease in age of infected, hospitalized children was accompanied by change in clinical severity during 2011–2014 after the introduction of vaccines in Seoul. Clinical severity was also associated with vaccination status and genotype. Long-term large scale studies are needed to document the significance of the increase in genotypes of uncommon and mixed combinations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1623-y) contains supplementary material, which is available to authorized users.

Clinical Characterisation of Rota Virus Infection Associated with Most Commonly Circulating Genotypes in Children Hospitalised in Children’s University Hospital: A Cross-Sectional Study in Latvia

“…Interestingly, we found a significant association between G8P[8] genotype and dehydration signs, febrile temperature or vomiting episodes. Shim et al (2016) found that G2P [4] was significantly associated with greater vomiting-related severity compared to other genotypes, including G1P [8]. However, the association between G2P[4] and clinical severity itself is mostly consistent with the results of several studies from the pre-vaccine era (Bern et al, 1992;Cascio et al, 2001).…”

Epidemiology and economic losses of rotavirus infection associated with hospitalization of Armenian children

“…The study results documented that most of the hospitalizations (72%) occurred among children < 3 years of age, which coincided with the international data [13][14][15][16]. The fact that no statistically significant differences in age between patients admitted to Intensive Care Unit and patients admitted to general divisions were detected may suggest that there were other factors influencing the severity of the disease.…”

Epidemiology and Factors Related to Clinical Severity of Acute Gastroenteritis in Hospitalized Children after the Introduction of Rotavirus Vaccination

“…Additionally, we found that rotavirus infection (in mostly unvaccinated children in this study) was the primary pathogenic cause of severe clinical gastroenteritis. Because this study was performed between 2012 and 2013, which corresponds to 5–6 years after the introduction of the rotavirus vaccine in Korea (the rate of rotavirus vaccination more than 2 times was reported to be 65.6% in Seoul, and nationwide rate 52.4% in 2013 by Korean National Immunization Survey; http://www.cdc.go.kr ), the age of children vulnerable to rotavirus infection seems to have transiently increased over the study period ( 8 ).…”

“…Viral double stranded RNA and DNA were extracted from the supernatant using the QIAamp MiniElute Virus Spin Kit (Qiagen, Hilden, Germany). PCR was performed to detect adenovirus ( 15 ) and reverse transcription PCR (RT-PCR) was performed to detect rotavirus ( 8 ), norovirus ( 16 ), and astrovirus ( 17 ) as described previously ( 18 ). Multiplex PCR using a Seeplex Diarrhea-V ACE detection kit (Seegene Inc., Seoul, Korea) was also performed to detect astrovirus, group A rotavirus, enteric adenovirus, and norovirus, according to the manufacturer's instructions ( 19 ).…”

“…However, previous studies on the severity of viral gastroenteritis were conducted mostly before the introduction of rotavirus vaccination; hence, rotavirus infection was most prevalent and mostly occurred in those less than 24 months of age. The clinical epidemiology of viral gastroenteritis, including prevalence and vulnerable age, has been changing since the introduction of rotavirus vaccination ( 1 2 8 ). This might affect both clinical severity and the factors related to clinical severity of viral gastroenteritis.…”