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Diversity of rotavirus strains circulating in children under five years of age who presented with acute gastroenteritis before and after rotavirus vaccine introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015.
Vaccine. 2018 11 12; 36(47):7243-7247.V

Abstract

BACKGROUND

Following the introduction of rotavirus vaccine into the routine immunization schedule, the burden of rotavirus disease has significantly reduced in Zambia. Although rotavirus vaccines appear to confer good cross-protection against both vaccine and non-vaccine strains, concerns about strain replacement following vaccine implementation remain. We describe the diversity of the circulating rotavirus strains before and after the Rotarix® vaccine was introduced in Lusaka from January 2012.

METHODS

Under five children were enrolled through active surveillance at University Teaching Hospital using a standardized WHO case investigation form. Stool samples were collected from children who presented with ≥3 loose stool in 24 h and were admitted to the hospital for acute gastroenteritis as a primary illness. Samples were tested for group A rotavirus antigen enzyme-linked immunosorbent assay. Randomly selected rotavirus positive samples were analysed by reverse transcription polymerase chain reaction for G and P genotyping and and Nucleotide sequencing was used to confirm some mixed infections.

RESULTS

A total of 4150 cases were enrolled and stool samples were collected from 4066 (98%) children between 2008 and 2011, before the vaccine was introduced. Rotavirus antigen was detected in 1561/4066 (38%). After vaccine introduction (2012 to 2015), 3168 cases were enrolled, 3092 (98%) samples were collected, and 977/3092 (32%) were positive for rotavirus. The most common G and P genotype combinations before vaccine introduction were G1P[8] (49%) in 2008; G12P[6] (24%) and G9P[8] (22%) in 2009; mixed rotavirus infections (32%) and G9P[8] (20%) in 2010, and G1P[6] (46%), G9P[6] (16%) and mixed infections (20%) in 2011. The predominant strains after vaccine introduction were G1P[8] (25%), G2P[4] (28%) and G2P[6] (23%) in 2012; G2P[4] (36%) and G2P[6] (44%) in 2013; G1P[8] (43%), G2P[4] (9%), and G2P[6] (24%) in 2014, while G2P[4] (54%) and G2P[6] (20%) continued to circulate in 2015.

CONCLUSION

These continual changes in the predominant strains suggest natural secular variation in circulating rotavirus strains post-vaccine introduction. These findings highlight the need for ongoing surveillance to continue monitoring how vaccine use affects strain evolution over a longer period of time and assess any normal seasonal fluctuations of the rotavirus strains.

Authors+Show Affiliations

University Teaching Hospital, Department of Pathology & Microbiology, Virology Laboratory, Lusaka, Zambia. Electronic address: juliachibumbya@gmail.com.University Teaching Hospital, Department of Pediatrics' and Child Health, Lusaka, Zambia.Sefako Makgatho Health Sciences University, South African Medical Research Council Diarrhoeal Pathogens Research Unit and WHO AFRO Rotavirus Regional Reference Laboratory, Department of Virology, Medunsa, Pretoria, South Africa.Sefako Makgatho Health Sciences University, South African Medical Research Council Diarrhoeal Pathogens Research Unit and WHO AFRO Rotavirus Regional Reference Laboratory, Department of Virology, Medunsa, Pretoria, South Africa.University Teaching Hospital, Department of Pathology & Microbiology, Virology Laboratory, Lusaka, Zambia.WHO Country Office, Lusaka, Zambia.Centres for Disease Control and Prevention, Atlanta, GA, USA.WHO Country Office, Lusaka, Zambia.Sefako Makgatho Health Sciences University, South African Medical Research Council Diarrhoeal Pathogens Research Unit and WHO AFRO Rotavirus Regional Reference Laboratory, Department of Virology, Medunsa, Pretoria, South Africa.Centres for Disease Control and Prevention, Atlanta, GA, USA.World Health Organization Regional office for Africa (WHO/AFRO), Brazzaville, Congo.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

29907481

Citation

Simwaka, J C., et al. "Diversity of Rotavirus Strains Circulating in Children Under Five Years of Age Who Presented With Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015." Vaccine, vol. 36, no. 47, 2018, pp. 7243-7247.
Simwaka JC, Mpabalwani EM, Seheri M, et al. Diversity of rotavirus strains circulating in children under five years of age who presented with acute gastroenteritis before and after rotavirus vaccine introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015. Vaccine. 2018;36(47):7243-7247.
Simwaka, J. C., Mpabalwani, E. M., Seheri, M., Peenze, I., Monze, M., Matapo, B., Parashar, U. D., Mufunda, J., Mphahlele, J. M., Tate, J. E., & Mwenda, J. M. (2018). Diversity of rotavirus strains circulating in children under five years of age who presented with acute gastroenteritis before and after rotavirus vaccine introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015. Vaccine, 36(47), 7243-7247. https://doi.org/10.1016/j.vaccine.2018.03.035
Simwaka JC, et al. Diversity of Rotavirus Strains Circulating in Children Under Five Years of Age Who Presented With Acute Gastroenteritis Before and After Rotavirus Vaccine Introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015. Vaccine. 2018 11 12;36(47):7243-7247. PubMed PMID: 29907481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diversity of rotavirus strains circulating in children under five years of age who presented with acute gastroenteritis before and after rotavirus vaccine introduction, University Teaching Hospital, Lusaka, Zambia, 2008-2015. AU - Simwaka,J C, AU - Mpabalwani,Evans M, AU - Seheri,Mapaseka, AU - Peenze,Ina, AU - Monze,Mwaka, AU - Matapo,Belem, AU - Parashar,Umesh D, AU - Mufunda,Jacob, AU - Mphahlele,Jeffrey M, AU - Tate,Jacqueline E, AU - Mwenda,Jason M, Y1 - 2018/06/12/ PY - 2017/07/19/received PY - 2017/12/16/revised PY - 2018/03/14/accepted PY - 2018/6/17/pubmed PY - 2019/2/15/medline PY - 2018/6/17/entrez SP - 7243 EP - 7247 JF - Vaccine JO - Vaccine VL - 36 IS - 47 N2 - BACKGROUND: Following the introduction of rotavirus vaccine into the routine immunization schedule, the burden of rotavirus disease has significantly reduced in Zambia. Although rotavirus vaccines appear to confer good cross-protection against both vaccine and non-vaccine strains, concerns about strain replacement following vaccine implementation remain. We describe the diversity of the circulating rotavirus strains before and after the Rotarix® vaccine was introduced in Lusaka from January 2012. METHODS: Under five children were enrolled through active surveillance at University Teaching Hospital using a standardized WHO case investigation form. Stool samples were collected from children who presented with ≥3 loose stool in 24 h and were admitted to the hospital for acute gastroenteritis as a primary illness. Samples were tested for group A rotavirus antigen enzyme-linked immunosorbent assay. Randomly selected rotavirus positive samples were analysed by reverse transcription polymerase chain reaction for G and P genotyping and and Nucleotide sequencing was used to confirm some mixed infections. RESULTS: A total of 4150 cases were enrolled and stool samples were collected from 4066 (98%) children between 2008 and 2011, before the vaccine was introduced. Rotavirus antigen was detected in 1561/4066 (38%). After vaccine introduction (2012 to 2015), 3168 cases were enrolled, 3092 (98%) samples were collected, and 977/3092 (32%) were positive for rotavirus. The most common G and P genotype combinations before vaccine introduction were G1P[8] (49%) in 2008; G12P[6] (24%) and G9P[8] (22%) in 2009; mixed rotavirus infections (32%) and G9P[8] (20%) in 2010, and G1P[6] (46%), G9P[6] (16%) and mixed infections (20%) in 2011. The predominant strains after vaccine introduction were G1P[8] (25%), G2P[4] (28%) and G2P[6] (23%) in 2012; G2P[4] (36%) and G2P[6] (44%) in 2013; G1P[8] (43%), G2P[4] (9%), and G2P[6] (24%) in 2014, while G2P[4] (54%) and G2P[6] (20%) continued to circulate in 2015. CONCLUSION: These continual changes in the predominant strains suggest natural secular variation in circulating rotavirus strains post-vaccine introduction. These findings highlight the need for ongoing surveillance to continue monitoring how vaccine use affects strain evolution over a longer period of time and assess any normal seasonal fluctuations of the rotavirus strains. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/29907481/Diversity_of_rotavirus_strains_circulating_in_children_under_five_years_of_age_who_presented_with_acute_gastroenteritis_before_and_after_rotavirus_vaccine_introduction_University_Teaching_Hospital_Lusaka_Zambia_2008_2015_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(18)30380-3 DB - PRIME DP - Unbound Medicine ER -