Genetic diversity of group A rotavirus in acute gastroenteritis outpatients in Shanghai from 2017 to 2018

Abstract

Background: Group A Rotavirus (RVA), despite being an important pathogen in hospitalized children, is less studied in pediatric outpatients, and even rarely investigated in adults. This study aims to understand the genetic diversity of RVA in outpatients across all age groups in Shanghai, and thus providing a molecular basis for vaccine implementation and evaluation. Methods: Stool samples were first screened by Real-time Reverse Transcription Polymerase Chain Reaction (rRT-PCR). RVA genotyping was performed through the amplification of partial VP7 and VP4 gene. Strains of interest were further sequenced and analyzed using MEGA 6.0. Results: Four thousand nine hundred one samples were collected, from which 7.61% (373 cases) were screened positive for RVA. RVA prevalence was higher in children (9.30%) than in adults (7.21%) (χ 2 = 4.72, P < 0.05). 9.38% RVA positive cases had taken antibiotics before hospital visit while 49.60% had been prescribed antibiotics afterwards. RVA displayed a strong seasonality in both adults and children with a shared commonality in genotype repertoire, where G9P[8] was the most prevalent strain (67.96%) followed by G3P[8] (15.49%) and G1P[8] (12.32%). Meanwhile the first local case of fecal shedding of the G10P[15] vaccine strain was also discovered. Conclusions: While the prevalence of rotavirus is highest during cold seasons, it is revealed for the first time that G9P[8] is the predominant genotype in both adults and pediatric outpatients. Clinically, higher occurrence of nausea or vomiting was observed in RVA positive cases. Antibiotic overuse was implicated in both non-clinical and clinical settings. The finding emphasizes the importance of RVA genotyping in surveillance as it provides the basis for new vaccine application as well as a baseline for future vaccine efficacy evaluation.

Effect of rotavirus genetic diversity on vaccine impact

“…Human G genotypes (G1, G2, G3, G4, G9) along with the most common human P genotypes P [4], P [6], and P [8], are the most prevalent rotavirus genotypes identified worldwide in humans. 45 The most prevalent genotypes in combination found in human populations are G1P [8], G2P [4], G3P [8], G4P [8], G9P [8] and to a lesser extent G12P [8]. 46 Strains with unusual genotypes like G1P [4], G2P [8], G9P [4], G12P [4], G8P [6], G8P [8] and G12P [6] are also responsible for majority of RVA infections.…”

“…45 The most prevalent genotypes in combination found in human populations are G1P [8], G2P [4], G3P [8], G4P [8], G9P [8] and to a lesser extent G12P [8]. 46 Strains with unusual genotypes like G1P [4], G2P [8], G9P [4], G12P [4], G8P [6], G8P [8] and G12P [6] are also responsible for majority of RVA infections. These rare strains often show a large variation from one area to the other, and can migrate to become prevalent strains worldwide.…”

“…50 It is, however, hard to predict which strains will be able to spread globally. A recent example concerns the G9P [8] strain, which was first considered uncommon, but today holds a dominant role among worldwide circulating strains. Several studies show increased detection of the genotype of G12, implying that this is likely to be the next strain to be widely dominant.…”

“…In addition, people with a non-functional FUT3 gene express neither LeA nor LeB (LeA-B-). 86 The most common antigen recognised by both P [4] and P [8] strains is Leb as the H-type 1 antigen, while the P [6] rotavirus only recognises the H-type 1 antigen.…”

“…To optimise responses to these three types of P, which make up the majority of cases of serious rotavirus disease worldwide, a trivalent formulation of the vaccine, containing VP8 subunits from the P [4], P [6] and P [8] strains, was developed. 106 In general, the trivalent P2-VP8 rotavirus vaccine was well tolerated at all dose levels tested in adults, infants, with minor harmful effects.…”