Unexpectedly high burden of rotavirus gastroenteritis in very young infants

Abstract

Background: The highest incidence of rotavirus gastroenteritis has generally been reported in children 6-24 months of age. Young infants are thought to be partially protected by maternal antibodies acquired transplacentally or via breast milk. The purpose of our study was to assess the age distribution of children with confirmed community-acquired rotavirus gastroenteritis presenting to an urban referral hospital. Methods: Children presenting to The Children's Hospital of Philadelphia with acute gastroenteritis have been monitored for the presence of rotavirus antigen in the stool by ELISA (followed by genotyping if ELISA-positive) since the 1994-95 epidemic season. Results: Over the last 12 rotavirus seasons prior to the introduction of the pentavalent rotavirus vaccine in 2006, stool specimens from 1646 patients tested positive for community-acquired rotavirus infection. Gender or age was not recorded in 6 and 5 cases, respectively. Overall, 58% of the cases occurred in boys. G1 was the predominant VP7 serotype, accounting for 72% of cases. The median (IQR) age was 11 (5-21) months. A total of 790 (48%) cases occurred in children outside the commonly quoted peak age range, with 27% in infants <6 months of age and 21% in children >24 months of age. A total of 220 (13%) cases occurred during the first 3 months of life, and the highest number of episodes per month of age [97 (6%)] was observed during the second month of life. Conclusions:The incidence of community-acquired rotavirus gastroenteritis monitored over 12 seasons in the prevaccine era at a major university hospital was nearly constant for each month of age during the first year of life, revealing an unexpectedly high incidence of symptomatic rotavirus disease in infants <3 months old. A sizeable fraction of cases occurred in children too young to have been vaccinated according to current recommendations.

Distribution of rotavirus genotypes causing nosocomial and community-acquired acute gastroenteritis at The Children's Hospital of Philadelphia in the new rotavirus vaccine era

“…5 Initial attacks of rotavirus gastroenteritis before the age of 2 y are often debilitating enough to warrant doctor visits or hospitalizations, but deaths are infrequent in the US. [6][7][8] In Philadelphia, rotavirus epidemics have historically commenced in January with the incidence typically peaking in March or April and then quickly subsiding by early June. 6 The surface VP7 and VP4 antigens can be used to classify rotavirus into G and P serotypes, respectively.…”

Vaccine-derived Human-bovine Double Reassortant Rotavirus in Infants With Acute Gastroenteritis

“…In this case it is possible that the first dose of RotaTeq® had not taken, perhaps due to presence of maternally acquired antibodies, and the second dose was effectively the first successful vaccination for this infant. 18,19 Our studies of viral culture showed that G1P [8] double reassortant appears stable in vitro. In the US, sibling transmission of vaccine-derived G1P [8] virus between an immunocompetent vaccinated sibling and a healthy immunocompetent unvaccinated sibling has already been reported.…”

Rotaviral diarrhoea – why it is worth preventing

“…życia (prawie 80%), a niemal 90% zakażeń RV ma miejsce pomiędzy 3. a 36. mies. życia [4,25,26]. Niemniej jednak do 27% zakażeń występuje przez 6.…”

“…(ze szczytem w 2. mies. u dzieci w pierwszym półroczu życia) [25]. Większą zapadalność obserwuje się w krajach o wysokim standardzie życia oraz w środowisku miejskim [27].…”