Vaccine-derived rotavirus strains in infants in England

Abstract

ObjectiveTo describe infants with acute gastroenteritis symptoms in primary and secondary care who have the Rotarix vaccine-derived G1P[8] rotavirus strain identified in their stools.DesignThis is a prospective national surveillance conducted by Public Health England (PHE). Rotavirus-positive samples from vaccine-eligible children are routinely submitted to PHE for confirmation, and general practitioners are requested to complete a surveillance questionnaire for all cases. The modified Vesikari Score was used to assess severity of gastroenteritis.SettingEngland, July 2013–September 2016.Results2637 rotavirus strains were genotyped and 215 (8%) identified as the Rotarix vaccine-derived G1P[8] strain. There were no Rotarix vaccine-derived G1P[8] strains detected in unimmunised infants. Rotarix vaccine-derived G1P[8] strains clustered around the time of rotavirus vaccination and were responsible for 82% (107 of 130) of rotavirus-positive samples in 2-month-old infants and 68% (36 of 53) in 3-month-old infants. However, 13 samples were obtained more than 7 weeks after the last vaccination date; 10 of these specimens were from six children who were subsequently diagnosed with severe combined immunodeficiency (SCID). Diarrhoea was the single most common presenting symptom (83.0%) in infants with Rotarix vaccine-derived G1P[8] strains, who were less likely to present with fever, vomiting, dehydration or severe gastroenteritis than infants with wild-type rotavirus infection.ConclusionsRotavirus identified in stools of infants around the time of their routine immunisations is most likely the Rotarix vaccine-derived G1P[8] strain. Infants with undiagnosed SCID at the time of rotavirus immunisation may experience prolonged gastroenteritis symptoms. Most infants with vaccine strains in their stools more than 7 weeks after immunisation had SCID.

Severe vaccine‐acquired rotavirus infection in an infant with primary intestinal lymphangiectasia

“…Prolonged shedding of vaccine strain rotavirus is also reported in infants with SCID, who usually require successful immune reconstitution to clear the infection. 2,10,11 The development of severe gastroenteritis after rotavirus vaccination could be the trigger that leads to a diagnosis of their underlying disease in infants with SCID 2 as we have observed in our case. Many of these children will require hospital admission.…”

Group A Rotavirus Detection and Genotype Distribution before and after Introduction of a National Immunisation Programme in Ireland: 2015–2019

“…We detected Rotarix in 10% of patients who were of vaccine-eligible age and, as rotavirus is notifiable in Ireland, this highlights the importance of differentiating between wild-type and vaccine-derived viruses, particularly when screening with a sensitive method, such as RT-PCR. By not excluding vaccine-derived rotavirus from diagnostic tests, there may be an over-estimation of rotavirus disease burden and unnecessary clinical intervention [ 36 , 37 , 38 ]. We identified 180 samples with detectable Rotarix, 20 (11%) of which had another virus detected, the most common being norovirus.…”

Whole Genome Characterization and Evolutionary Analysis of G1P[8] Rotavirus A Strains during the Pre- and Post-Vaccine Periods in Mozambique (2012–2017)

“…Although neighboring countries reported the widespread (Malawi) and sporadic (South Africa) detection of G1P [8] strains that had undergone reassortment with DS-1 like strains [28,37], all Mozambican strains characterized in this study exhibited a typical Wa-like genetic backbone. Despite some reports of vaccine-derived G1P [8] strains detected in Australia and England, none of the strains identified in this study were derived from the Rotarix ® vaccine [38,39].…”