Rotavirus shedding in premature infants following first immunization
ABSTRACT There is limited data regarding rotavirus vaccine shedding in premature infants. We describe the natural history of rotavirus shedding in premature infants in the 2-week period following first immunization with RotaTeq(®), the pentavalent rotavirus vaccine (RV5), and the risk for symptomatic transmission to household contacts (HHC).
A prospective pilot study of 15 premature infants of gestational ages 26-34 weeks immunized with RV5 between 6 and 14 weeks chronological age on discharge from the NICU was conducted. Stool samples collected in the following 2 weeks and analyzed for rotavirus antigen by enzyme immunoassay (EIA), cell culture, and RT-PCR. Solicited adverse events were collected on study subjects and any symptoms of fever, vomiting and diarrhea in HHC.
Rotavirus antigen shedding after immunization was detected, with positive rotavirus EIA results in 53.3% of premature infants and in 22.1% of 86 stool samples collected. Shedding rates by RT-PCR were higher with 86.7% of infants and 76.7% of samples being positive. Only 42% of EIA positive samples were positive by cell culture (8/86 total samples, 9.3%). None of 53 HHC reported symptoms of rotavirus infection during the 4 weeks following immunization of the infants.
The findings of this study demonstrate that premature infants have positive stools by EIA, viral culture, and RT-PCR at varying time points during 2 weeks following first-dose immunization with RV5. RT-PCR shedding rates need to be clinically evaluated in the context of virus quantification by cell culture, which was low. No symptomatic transmission to HHC was detected in this study, supporting low transmissibility of vaccine virus shed by these infants born prematurely.
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ABSTRACT: Rotavirus vaccines were introduced in the United States in 2006. Full-series coverage is lower than for other vaccines, and disease continues to occur. We examined variation in vaccine coverage among provider locations and correlated coverage with the detection of rotavirus in children who sought treatment of severe acute gastroenteritis (AGE). Vaccine records of children enrolled in an AGE surveillance program were obtained and children were grouped by the location that administered each child's 2-month vaccines. Cases were children with laboratory-confirmed rotavirus AGE; controls were children with rotavirus-negative AGE or acute respiratory infection. Location-level coverage was calculated using ≥1 dose rotavirus vaccine coverage among controls and classified as low (<40%), medium (≥40% to <80%), or high (≥80%). Rotavirus detection rates among patients with AGE were calculated by vaccine coverage category. Of controls, 80.4% (n = 1123 of 1396) received ≥1 dose of rotavirus vaccine from 68 locations. Four (5.9%) locations, including a NICU, were low coverage, 22 (32.3%) were medium coverage, and 42 (61.8%) were high coverage. In low-coverage locations, 31.4% of patients with AGE were rotavirus-positive compared with 13.1% and 9.6% in medium- and high-coverage locations, respectively. Patients with AGE from low-coverage locations had 3.3 (95% confidence interval 2.4-4.4) times the detection rate of rotavirus than patients with AGE from high vaccine coverage locations. We observed the highest detection of rotavirus disease among locations with low rotavirus vaccine coverage, suggesting that ongoing disease transmission is related to failure to vaccinate. Educational efforts focusing on timely rotavirus vaccine administration to age-eligible infants are needed. Copyright © 2015 by the American Academy of Pediatrics.Pediatrics 01/2015; 135(2). DOI:10.1542/peds.2014-0208 · 5.30 Impact Factor
Archives of Disease in Childhood - Fetal and Neonatal Edition 07/2014; 99(6). DOI:10.1136/archdischild-2013-305744 · 3.86 Impact Factor
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ABSTRACT: There is limited data on the spectrum and prevalence of rotavirus genotypes in older children and adults in Asia. This pilot study conducted between November 2012 and April 2013 tested for rotavirus in older children (>12 years of age), and adults with gastroenteritis from southern India. Stool samples from patients who were hospitalized or attended out-patient units with diarrhea were screened for rotavirus using Premier™ Rotaclone®. Confirmatory testing was by another antigen detection sandwich, in-house ELISA, based on capture by a polyclonal serum and VP6 PCR. Genotyping for VP7 and VP4 was done using hemi-nested PCRs for G- and P-types circulating in India. A total of 626 stool samples from older children and adults were screened and 52 (8.4%) were initially positive for rotavirus by antigen detection. A high proportion of samples (27/51) were found to be false positives on confirmatory testing. Of the 23 samples for which genotyping results were obtained, G1P was the most common genotype. There was one each of G1P, G1P and two strains of G9P while one sample showed mixed genotypes of G2 and G9P. This study shows that group A rotavirus is found in 3.8% of diarrheal specimens in older children and adults with gastroenteritis in southern India and that common genotypes circulate in children and adults.Vaccine 08/2014; 32:A33–A35. DOI:10.1016/j.vaccine.2014.03.008 · 3.49 Impact Factor