Article

Monovalent Rotavirus Vaccine Provides Protection Against an Emerging Fully Heterotypic G9P[4] Rotavirus Strain in Mexico

Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 09/2011; 204(5):783-6. DOI: 10.1093/infdis/jir390
Source: PubMed

ABSTRACT After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006-2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%-100%) against G9P[4] rotavirus-related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure.

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    • "G3P[8] G4P[8] G9P[8] G2P[4] G9P[4] G9P[6] US High Hospital or ED AGE, rota neg, Hospital or ED; healthy matched 89 (70–96) 94 (78–98) Cortese et al. (2013) US High Hospital or ED AGE, rota neg, hospital or ED 74 (40–89) Payne et al. (2013) Belgium High Hospital Acute non-gastrointestinal illness, hospital 95 (78–99) 87 (<0–98) 90 (19–99) 85 (64–94) Matthijnssens et al. (2014) Australia (aborigenes) Middle Hospital Healthy, birth registry matched 85 (23–97) Snelling et al. (2009) Australia (aborigenes) Middle Hospital Healthy, birth registry matched 19 (<0–70) Snelling et al. (2011) Mexico Middle Hospital Community 94 (16–100) Yen et al. (2011) Brazil Middle Hospital or ED, & intravenous hydration AGE, rota neg, Hospital or ED; ARI, hospital 41 (<0–67) Correia et al. (2010) Brazil Middle Hospital Acute non-gastrointestinal illness, hospital 89 (78–95) 75 (64–84) Ichihara et al. (2014) Brazil Middle Hospital & intravenous hydration Acute non-gastroenteritis, non-vaccine preventable illness, hospital; community 41 (26–52) Justino et al. (2011) Brazil Middle Hospital AGE, rota neg, hospital 71 (5–91) Gurgel et al. (2007) Brazil Middle Hospital AGE, rota neg, hospital or ED; household cluster survey 10 (<0–52) Gurgel et al. (2009) El Salvador Middle Hospital Community 59 (36–73) de Palma et al. (2010) Bolivia Middle Hospital AGE, rota neg, hospital or ED; acute nongastroenteritis non-vaccine preventable illness, hospital or ED 69 (36–85) 73 (55–84) 43 (À13 to 72) 84 (53–94) Patel et al. (2013) Abbreviations: RV1: Rotarix Ò ; AGE, Acute gastroenteritis; ED, Emergency department; ARI, acute respiratory infection. a Vaccine effectiveness was assessed in infants who received full 2-dose series RV1 as described in the text. "
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    Infection Genetics and Evolution 10/2014; DOI:10.1016/j.meegid.2014.10.008 · 3.26 Impact Factor
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    • "www.thelancet.com/infection Published online July 29, 2014 http://dx.doi.org/10.1016/S1473-3099(14)70832-1 5 Homotypic Braeckman, 2012 22 Cortese, 2013 23 Subtotal Partly heterotypic Payne, 2013 24 Subtotal Fully heterotypic Braeckman, 2013 22 Cortese, 2013 23 Subtotal 11/41 20/84 12/44 12/44 46/80 8/36 54/116 Cases (V/N) 49/53 150/193 87/155 87/155 93/103 64/90 157/193 Controls (V/N) 97% (90 to 99) 90% (77 to 96) 9/43 101/140 94% (80 to 98) 71% (39 to 86) 71% (39 to 86) 85% (68 to 93) 88% (71 to 95) 87% (76 to 93) Vaccine effectiveness (95% CI) Homotypic Cortese, 2013 23 Payne, 2013 24 Payne, 2013 24 Subtotal Single-antigen vaccine type Staat, 2011 26 Staat, 2011 26 Staat, 2011 26 Subtotal Partly heterotypic Cortese, 2013 23 Payne, 2013 24 Payne, 2013 24 Subtotal Single-antigen non-vaccine type Staat, 2011 26 Staat, 2011 26 Subtotal 3/37 4/15 76/196 83/248 5/39 4/27 12/44 21/110 1/29 14/36 35/82 50/147 3/21 8/24 11/45 34/73 1411/1811 1411/1811 2856/3695 127/268 88/170 194/299 409/737 24/50 1411/1811 1411/1811 2846/3672 42/114 85/124 127/238 90% (64 to 97) 90% (67 to 97) 82% (76 to 87) 83% (78 to 87) 84% (57 to 94) 84% (51 to 95) 80% (59 to 90) 82% (70 to 89) 96% (69 to 99) 82% (64 to 91) 79% (67 to 87) 82% (70 to 89) 71% (–3 to 92) 77% (42 to 91) 75% (47 to 88) Homotypic de Palma, 2010 28 Subtotal Partly heterotypic Patel, 2013 32 Patel, 2013 32 Snelling, 2009 21 Subtotal Fully heterotypic Correia, 2010 27 Gurgel, 2007 12,29 Gurgel, 2009 30 Justino, 2011 31 Patel, 2013 32 Patel, 2013 32 Snelling, 2011 20 Yen, 2011 33 Subtotal 128/171 128/171 30/42 52/77 3/21 85/140 43/61 4/17 16/49 289/538 45/56 7/14 17/36 3/21 424/792 489/557 489/557 636/716 743/839 32/83 1411/1638 637/795 44/85 148/424 564/853 673/766 541/629 54/94 14/29 2675/3675 59% (36 to 73) 59% (36 to 73) 69% (36 to 85) 73% (55 to 84) 73% (3 to 93) 72% (58 to 81) 41% (–6 to 67) 71% (5 to 91) 10% (–70 to 52) 41% (26 to 52) 43% (–13 to 72) 84% (53 to 94) 34% (–43 to 69) 82% (26 to 96) 47% (28 to 61) Single-antigen vaccine type Mast, 2011 34 Mast, 2011 34 Mast, 2011 34 Mast, 2011 34 Mast, 2011 34 Mast, 2011 34 Subtotal Partly heterotypic Patel, 2009 35 Subtotal Single-antigen non-vaccine type Mast, 2011 34 Mast, 2011 34 Mast, 2011 34 Subtotal 127/141 57/86 18/19 3/7 10/13 138/154 353/420 158/209 158/209 5/7 61/93 1/4 67/104 693/721 444/505 107/108 40/43 71/75 740/773 2095/2225 868/1044 868/1044 20/21 483/552 23/24 526/597 63% (28 to 81) 73% (55 to 84) 83% (–100 to 99) 94% (62 to 99) 81% (3 to 96) 62% (28 to 79) 70% (58 to 78) 37% (10 to 56) 37% (10 to 56) 88% (–67 to 99) 73% (55 to 83) 99% (70 to 99) 87% (38 to 97) 1 0·01 0·1 2 Odds ratio G1P[8] "
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    ABSTRACT: Background Concerns exist about whether monovalent (RV1) and pentavalent (RV5) rotavirus vaccines provide adequate protection against diverse strains and whether vaccine introduction will lead to selective pressure. We aimed to investigate the distribution of rotavirus strains and strain-specific rotavirus vaccine effectiveness after vaccine introduction. Methods We did a systematic review of published work to assess the strain-specific effectiveness of RV1 and RV5 rotavirus vaccines. We classified strains as homotypic, partly heterotypic, and fully heterotypic based on the amount of antigen-matching between strain and vaccine. When studies reported vaccine effectiveness against single antigens (G-type or P-type), we categorised them as either single-antigen vaccine type or single-antigen non-vaccine type. Our primary outcome was strain-specific vaccine effectiveness, comparing effectiveness of homotypic strains with fully or partly heterotypic strains. A secondary outcome was the prevalence of rotavirus strains after vaccine introduction. We estimated pooled odds ratios using random-effect regression models, stratified by country income level and vaccine type, and tested for differences in strain-specific vaccine effectiveness. We assessed strain distribution trends from surveillance reports. Findings In high-income countries, RV1 pooled vaccine effectiveness was 94% (95% CI 80–98) against homotypic strains, 71% (39–86) against partly heterotypic strains, and 87% (76–93) against fully heterotypic strains. In middle-income settings, respective pooled data were 59% (36–73), 72% (58–81), and 47% (28–61). In high-income countries, RV5 vaccine effectiveness was 83% (78–87) against homotypic strains, 82% (70–89) against single-antigen vaccine type strains, 82% (70–89) against partly heterotypic strains, and 75% (47–88) against single-antigen non-vaccine type strains. In middle-income settings, RV5 vaccine effectiveness was 70% (58–78) against single-antigen vaccine type strains, 37% (10–56) against partly heterotypic strains, and 87% (38–97) against single-antigen non-vaccine type strains. No difference was noted in vaccine effectiveness for either RV1 or RV5 in any setting (all p>0·05). Prevalent strains in countries using RV1 were G2P[4] (2198 of 4428, 50%) and G1P[8] (953, 22%), and those in countries using RV5 were G1P[8] (1280 of 3875, 33%) and G2P[4] (1169, 30%). Sustained predominance of a single strain was not recorded. Interpretation RV1 and RV5 exert similar effectiveness against homotypic and heterotypic rotavirus strains. Persistence of specific strains was not recorded, suggesting vaccine-induced selective pressure did not occur. Expansion of rotavirus surveillance efforts to low-income countries and ongoing surveillance are crucial to identify emergence of new strains and to assess strain-specific vaccine effectiveness in various settings. Funding None.
    The Lancet Infectious Diseases 09/2014; DOI:10.1016/S1473-3099(14)70832-1 · 19.45 Impact Factor
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    • "strains. In addition to Bangladesh, G9P[4] RVA strains have been recently described as emerging in a few Latin American countries such as Brazil, Mexico, Guatemala and Honduras [5] [6] [7]. "
    Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 10/2013; 58(4). DOI:10.1016/j.jcv.2013.09.024 · 3.47 Impact Factor
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