Abstract
IntroductionRotavirus vaccination with the live-attenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. Since then, there have been significant reductions in rotavirus gastroenteritis incidence.AimWe assessed the vaccine’s impact on rotavirus genotype distribution and diversity 3 years post-vaccine introduction.MethodsEpidemiological and microbiological data on genotyped rotavirus-positive samples between September 2006 and August 2016 were supplied by EuroRotaNet and Public Health England. Multinomial multivariable logistic regression adjusting for year, season and age was used to quantify changes in genotype prevalence in the vaccine period. Genotype diversity was measured using the Shannon’s index (H′) and Simpson’s index of diversity (D).ResultsWe analysed genotypes from 8,044 faecal samples. In the pre-vaccine era, G1P[8] was most prevalent, ranging from 39% (411/1,057) to 74% (527/709) per year. In the vaccine era, G1P[8] prevalence declined each season (35%, 231/654; 12%, 154/1,257; 5%, 34/726) and genotype diversity increased significantly in 6–59 months old children (H’ p < 0.001: D p < 0.001). In multinomial analysis, G2P[4] (adjusted multinomial odds ratio (aMOR): 9.51; 95% confidence interval (CI): 7.02–12.90), G3P[8] (aMOR: 2.83; 95% CI: 2.17–3.81), G12P[8] (aMOR: 2.46; 95% CI: 1.62–3.73) and G4P[8] (aMOR: 1.42; 95% CI: 1.02–1.96) significantly increased relative to G1P[8].ConclusionsIn the context of reduced rotavirus disease incidence, genotype diversity has increased, with a relative change in the dominant genotype from G1P[8] to G2P[4] after vaccine introduction. These changes will need continued surveillance as the number and age of vaccinated birth cohorts increase in the future.
Highlights
Rotavirus vaccination with the liveattenuated monovalent two-dose Rotarix vaccine was introduced in England in July 2013
Since vaccine implementation in the UK, data from laboratory reports, hospital admissions and GP consultations have shown a significant reduction in the incidence of rotavirus gastroenteritis in vaccine eligible children
This study evaluates the impact of routine childhood rotavirus vaccination on relative changes in rotavirus genotype distribution and diversity in England
Summary
Rotavirus vaccination with the liveattenuated monovalent (a G1P[8] human rotavirus strain) two-dose Rotarix vaccine was introduced in England in July 2013. In July 2013, the United Kingdom (UK) introduced the monovalent (G1P[8]) live-attenuated, two-dose oral human vaccine (Rotarix, GlaxoSmithKline Biologicals, Rixensart, Belgium) into the routine childhood immunisation schedule at 8 and 12 weeks of age [4]. G1P[8] Rotarix vaccine against severe rotavirus gastroenteritis was estimated at over 85% and further trials have shown that it is efficacious against multiple rotavirus strains [6,7]. Since vaccine implementation in the UK, data from laboratory reports, hospital admissions and GP consultations have shown a significant reduction in the incidence of rotavirus gastroenteritis in vaccine eligible children
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