Vaccine-derived rotavirus strains in infants in England

Journal article

Objective:
To 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.

Design:
This 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.

Setting:
England, July 2013–September 2016.

Results :
2637 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.

Conclusions:
Rotavirus 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.

Authors: Gower, CM; Dunning, J; Nawaz, S; Allen, D; Ramsay, ME

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ
• Journal: Archives of Disease in Childhood
• Volume: 105
• Issue: 6
• Pages: 553-557
• Place of publication: England
• Publication date: 2019-12-23
• Acceptance date: 2019-12-03
• DOI: 10.1136/archdischild-2019-317428
• EISSN: 1468-2044
• ISSN: 0003-9888
• Pmid: 31871043
• Language: English
• Keywords: fever; gastroenteritis; reverse transcriptase polymerase chain reaction; feces; population surveillance; vaccines, attenuated; infant; rotavirus infections; genotype; severe combined immunodeficiency; England; rotavirus vaccines; diarrhea; rotavirus; prospective studies; vomiting