Rotavirus Gastroenteritis Research Articles

Expert consensus on immunoprophylaxis of childhood rotavirus gastroenteritis (2024 version)

Rotavirus gastroenteritis (RVGE) is a global public health challenge that seriously threatens the health of children under 5 years of age. In China, the burden associated with RVGE is substantial and its prevention and control are difficult. On the basis of Expert Consensus on Immunoprophylaxis of Childhood Rotavirus Gastroenteritis (2020 Version) and Rotavirus Vaccines: WHO Position Paper-July 2021, in this updated consensus we systematically review advances in RVGE epidemiological research; safety, effectiveness/efficacy, and immune persistence of post-marketing rotavirus (RV) vaccines; and RV immunization strategies. We also provide guidance for RVGE diagnosis and treatment. Following the principles of prioritizing prevention and integrating medical and preventive approaches, we aim to facilitate the implementation of comprehensive prevention and control measures focusing on RV vaccination to reduce the childhood RVGE disease burden and provide reference for professionals working for disease control and prevention, vaccination, clinical diagnosis and treatment, and related fields.

Prediction of effectiveness of universal rotavirus vaccination in Southwestern Vietnam based on a dynamic mathematical model

Vaccinating young children against rotavirus (RV) is a promising preventive strategy against rotavirus gastroenteritis (RVGE). We evaluated the relative risk reduction of RVGE induced by universal vaccination in Vietnam through dynamic model analysis. We developed an age-stratified dynamic Vaccinated-Susceptible-Infectious-Recovered-Susceptible model to analyze RV transmission and assess vaccine effectiveness (VE). We assumed 3 different vaccine efficacies: 55%, 70%, and 85%. For model calibration, we used a database of patients under 5 years of age admitted to Ho Chi Minh No.1 Hospital with RVGE between January 2013 and December 2018. Assuming a vaccination rate of 95%, the number of RVGE hospitalizations after 5 years from universal RV vaccination decreased from 92,502 cases to 45,626 with 85% efficacy, to 54,576 cases with 70% efficacy, and to 63,209 cases with 55% efficacy. Additionally, RVGE hospitalizations after 10 years decreased from 177,950 to 89,517 with 85% efficacy and to 121,832 cases with 55% efficacy. The relative risk reductions of RVGE after 10 years were 49.7% with 85% efficacy, 40.6% with 70% efficacy, and 31.5% with 55% efficacy. The VE was 1.10 times (95% CI, 1.01–1.22) higher in the 4-months to 1-year-old age group than in the other age groups (P = 0.038), when applying 85% efficacy with 95% coverage. In conclusion, despite its relatively lower efficacy compared to high-income countries, RV vaccination remains an effective intervention in Southwestern Vietnam. In particular, implementing universal RV vaccination with higher coverage would result in a decrease in RVGE hospitalizations among Vietnamese children under 5 years of age.

In vitro inhibition of rotavirus multiplication by copper oxide nanoparticles.

Group A rotaviruses are the most common cause of gastroenteritis in children under five years of age worldwide. Rotavirus gastroenteritis can be related to mild to severe diarrhea in children and in some cases, can lead to death due to severe dehydration. Approximately 146,480 people die annually from rotavirus infection worldwide, and most of these deaths occur in low-income countries in Africa and Asia. Since there are no specific effective drugs to treat rotavirus infections, and infected patients can only be treated supportively, new antiviral agents need to be developed. Copper oxide nanoparticles (CuO NPs) have a wide range of applications in the magnetic and electrical industries, as well as in biology. The antiviral activity of nanoparticles (CuO NPs) is well documented. This study aimed to investigate the antiviral effect of CuO NPs on rotaviruses. The cytotoxic effects of CuO NPs on MA-104 cells were examined by methyl thiazolyl tetrazolium assay. In addition, the anti-rotavirus activity of CuO NPs was evaluated by TCID50 and real-time polymerase chain reaction PCR assay. Our results showed that exposure of rotavirus-infected cells to various non-toxic concentrations of CuO NPs did not cause a decrease in viral titer, compared to the control. However, the virucidal effect of CuO NPs on rotavirus was observed at concentrations of 80 and 100 μg/ml (P<0.001). Our study suggested that CuO NPs had significant antiviral activity against rotavirus replication. However, the exact mechanism of anti-rotavirus activity of CuO NPs remained unknown. According to the virucidal assay, it appears that the loss of capsid integrity and genome disruption in the presence of CuO NPs are possible mechanisms of its anti-rotavirus activity.

Incidence of Rotavirus-Related Hospitalizations in an Italian Southern Region from 2015 to 2021.

(1) Background: Rotavirus is one of the leading causes of severe diarrhea and dehydration in infants and young children worldwide. The economic and social burden of rotavirus-related hospitalizations, particularly among children, remains a pressing concern for healthcare systems across the globe. Healthcare infrastructure and access to medical care can vary significantly within the region. Differences in the availability of healthcare facilities and the quality of care may influence the management and outcomes of rotavirus cases. (2) Methods: This was a retrospective study performed in the Abruzzo region, Italy. The study considered all hospitalization due to rotavirus gastroenteritis that occurred in the Abruzzo region from the year 2015 to 2021. Data were extracted from the hospital discharge records. The trend in hospital admissions, hospitalization costs and length of stay were evaluated and analyzed. (3) Results: A total of 664 admissions were reported during the study period. The incident rate grew till year 2019 with an annual percentage change of +13.9% (95%CI 12.6-15.2, p < 0.001). During the pandemic years, the incident rate showed a significant decrease with an annual percentage change of 12.5% (95%CI 15.5-9.3, p = 0.004). The length of stay of admissions was significantly higher among patients aged less than 1 year. (4) Conclusions: Rotavirus admission represents a heavy burden even in a high-income country such as Italy. These findings have the potential to inform targeted public health interventions, including vaccination strategies, and improve the overall well-being of children.

Assessment of the Correlation Between Arterial Blood Gas Indices and Duration of Stay in the Emergency Department Observation Unit for Pediatric Patients Aged 0-18 with Rotavirus Gastroenteritis

Purpose: Rotavirus (RV) is the predominant pathogen responsible for the onset of infectious acute gastroenteritis among children younger than five years of age, which is one of the important public health concerns and one of the childhood gastroenteritis that can cause morbidity and mortality. Although definitive diagnostic methods are important in such cases, these methods are not always easily accessible. That study aims to investigate the association between blood gas parameters in respondents who have tested positive for RV antigen and their subsequent observation time in the emergency department as well as the length of their hospitalization. Materials and methods: In this retrospective analysis encompassed 237 individuals ranging from 0 to 18 years old who sought medical attention at the outpatient clinic or emergency department of Adiyaman University Faculty of Medicine Training and Research Hospital and were found to have a positive RV antigen test. Respondents were segregated into cohorts in accordance with age, gender, blood gas parameters, hemogram, biochemical parameters, duration of stay in the emergency observation room, and duration of stay in the pediatric ward. The respondents were categorized based on various criteria including age, sex, blood gas readings, complete blood count, biochemical markers, duration of stay in the emergency observation area, and hospitalization period in the pediatric unit. Comprehensive demographic, blood gas, hematologic, and biochemical data were compiled and analyzed employing SPSS version 22.0. Results: The study identified significant differences in the pH, pO2, and HCO3 levels, along with the mean platelet volume (MPV) among the participants. Notably, a significant correlation was established between the pH levels of blood gases in the emergency room observation space and the observation span for respondents testing positive for RV, whereas no significant link was observed between blood gas values and the duration of hospital stay. Conclusion: The findings suggest that while blood gas analysis outcomes may not predict hospitalization length in cases of Rotavirus gastroenteritis, respondents presenting with lower blood pH levels tend to spend less time in the emergency observation unit. Therefore, it is recommended that blood gas analysis be conducted routinely for respondents presenting with symptoms of Rotavirus gastroenteritis upon their arrival at the emergency medical services.

Psidium guajava: An Insight into Ethnomedicinal Uses, Phytochemistry, and Pharmacology.

Psidium guajava (guava) is widely distributed in tropical and subtropical regions and adapted to various environmental conditions. Guava is an important economic fruit widely used as food and folk medicine. It contains flavonoids, alkaloids, tannins, triterpenoids, reducing sugars, essential oils, carotenoids, polyphenols, etc. The presence of triterpenoid acids such as guavacoumaric, ursolic, jacoumaric, guajavanoic, guavenoic, and Asiatic acids helps to develop novel drugs against various diseases. It is used traditionally for medicinal purposes, mainly for antioxidant, antimicrobial, antispasmodic, antidiabetic, anticancer, antiallergy, anti-inflammatory, and hepato-protective properties. The systematic literature study aims to summarize its botanical description, phytochemicals, pharmacological activities, and clinical trials. This review focuses on the plant's chemical composition and scientific approaches to human welfare. A systematic literature search was done on Psidium guajava through previous literature and online databases such as Google Scholar, Pubmed, Science Direct, etc., to explain its ethnomedicinal uses, phytochemistry, and pharmacological applications. Previous literature studies of Psidium guajava suggest it can serve as antioxidant, antimicrobial, antispasmodic, antidiabetic, anticancer, anti-allergy, anti-inflammatory, and hepatoprotective effects. Successful clinical trials performed on the plant extracts against infantile rotaviral enteritis and infectious gastroenteritis showed future directions to work with the plant for clinical applications. In this review, an attempt is made to show all literature studied, especially in phytochemistry, pharmacology, clinical trials and uses as traditional folk medicine around the world. The leaves have been used by folklore over the years to treat various ailments such as skin ulcers, diarrhoea, vaginal irritation, cough, conjunctivitis, etc. Further studies are required to explore more therapeutic remedies and to develop new medicines for future perspectives.

Rotavirus Gastroenteriti Olan Hastalarda Elektrolit Dengesizliği ve Kan Gazı Parametrelerinin Değerlendirilmesi

Aim: In the present study, the cases admitted to the hospital because of acute gastroenteritis and diagnosed with common RVGE were evaluated in terms of demographic, epidemiological, clinical, and laboratory data. Methods: The clinical and laboratory data of the cases who applied to Selçuk University Faculty of Medicine, Pediatric Emergency Clinic because of acute gastroenteritis aged 0-18 were evaluated retrospectively in the study. Clinical findings, time of admission, place of observation, blood gas and electrolyte levels, electrolyte imbalance, and length of hospital stays of the patients were recorded. Results: Among the AGE patients who were included in the study, 148 (61.2%) were male and 94 (38.8%) were female. The incidence of hypokalemia in patients who had RV(+) GE was statistically significant. Statistically significant differences were detected between the groups in terms of creatinine, potassium, AST, ALT and albumin values of biochemical parameters. When the blood gas analysis of patients who had AGE was evaluated, although acidosis was detected in 24 (9.9%) patients who had pH value, alkalosis was detected in 27 (11.2%) patients. Conclusion: Cases with metabolic acidosis in rotavirus gastroenteritis are hospitalized more frequently, and for this reason, blood gas studies in cases of RV gastroenteritis will guide clinicians.

Clinical factors predicting rotavirus diarrhea in children: A cross-sectional study from two hospitals.

Rotavirus is still a significant contributing morbidity and mortality in pediatric patients. To look at clinical signs and symptoms and laboratory findings that can predict rotavirus gastroenteritis compared to non-rotavirus gastroenteritis. This was a cross-sectional study with medical records obtained from December 2015 to December 2019. Inclusion criteria for this study include all hospitalised pediatric patients (0-18 years old) diagnosed with suspected rotavirus diarrhea. The receiver operating curve and Hosmer-Lemeshow test would be used to assess the final prediction findings' calibration (goodness of fit) and discrimination performance. This study included 267 participants with 187 (70%) rotavirus-diarrhea cases. The patients were primarily male in both rotavirus (65.2%) and non-rotavirus (62.5%) groups. The median age is 1.33 years old (0.08-17.67 years old). Multivariate analysis shows that wet season (ORadj = 2.5; 95%CI: 1.3-4.8, Padj = 0.006), length of stay (LOS) ≥ 3 days (ORadj = 5.1; 95%CI: 1.4-4.8, Padj = 0.015), presence of abdominal pain (ORadj = 3.0; 95%CI: 1.3-6.8, Padj = 0.007), severe dehydration (ORadj = 2.9; 95%CI: 1.1-7.9, Padj = 0.034), abnormal white blood cell counts (ORadj = 2.8; 95%CI: 1.3-6.0, Padj = 0.006), abnormal random blood glucose (ORadj = 2.3; 95%CI: 1.2-4.4, Padj = 0.018) and presence of fecal leukocytes (ORadj = 4.1, 95%CI: 1.7-9.5, Padj = 0.001) are predictors of rotavirus diarrhea. The area under the curve for this model is 0.819 (95%CI: 0.746-0.878, P value < 0.001), which shows that this model has good discrimination. Wet season, LOS ≥ 3 d, presence of abdominal pain, severe dehydration, abnormal white blood cell counts, abnormal random blood glucose, and presence of fecal leukocytes predict rotavirus diarrhea.

Differences in Rotavirus Shedding and Duration by Infant Oral Rotavirus Vaccination Status in Dhaka, Bangladesh, 2011-2014.

To evaluate how breakthrough rotavirus disease contributes to transmission, we examined the impact of rotavirus vaccination on fecal shedding and duration of illness. We used multivariable linear regression to analyze rotavirus quantity by RT-qPCR and duration among 184 episodes of rotavirus diarrhea positive by ELISA in the PROVIDE study. Vaccinated children had less fecal viral shedding compared to unvaccinated children (mean difference = -0.59 log copies per gram of stool; 95% confidence interval [CI], -.99 to -.19). Duration of illness was on average 0.47 days (95% CI, -.23 to 1.17 days) shorter among vaccinated children. Rotarix vaccination reduces shedding burden among breakthrough cases of rotavirus gastroenteritis. Clinical Trials Registration . NCT01375647.

A 7-Year Survey (2015-2021) in One Pediatric Hospital (Brasov, Romania) on Rotavirus Gastroenteritis Specified as Community- or Hospital-Acquired Infection in Young Children.

This project is an observational, descriptive study evaluating frequencies of rotavirus disease in hospitalized children aged less than 5 years old between 2015 and 2021 in the Pediatric Hospital of Brasov, Central Romania. The study compares socio-demographic (age, sex, place of living and ethnicity), clinical, and treatment aspects between community-acquired rotavirus gastroenteritis (CARG) and hospital-acquired rotavirus gastroenteritis (HARG). During that period, 1913 hospitalized children had a rapid positive immunichromatographic rotavirus test from stool specimens. Among them, 1620 (84.6%) were CARG and 293 (15.4%) were HARG. CARG conditions represented 28.5% of all acute hospitalized gastroenteritis (n = 5673) whereas HARG represented 5.2%. Around the same percentage of urban children were seen in CARG as in HARG (58.5% (n = 948) for CARG and 56.3% (n = 164) for HARG). About 64.9% (n = 1052) of CARG cases were from Roma population, and 66.5% (n = 195) in HARG. The age group with the highest frequency of the disease was 12 to 24 months old for both CARG and HARG. The average hospital duration was 5.09 days for CARG and 7.62 days for HARG. Diarrhea was the principal symptom in both CARG and HARG (92.6% (n = 1500) for CARG and 93.9% (n = 275) for HARG). Most CARG patients (61% (n = 989)) were treated for symptomatic management with iv fluids. Most HARG (60.4% (n = 177)) were treated for symptomatic management with iv fluids and antibiotics. A significant seasonal shift to a later period in the year was observed during the last registration year of 2021, possibly due to the COVID-19 epidemic. The seasonal disease burden of rotavirus infection in children remains high in hospital care in Romania, which may justify the systematic introduction of rotavirus vaccination across the whole country.

Genotype analysis of rotaviruses isolated from children during a phase III clinical trial with the hexavalent rotavirus vaccine in China

The oral hexavalent live human-bovine reassortant rotavirus vaccine (RV6) developed by Wuhan Institute of Biological Products Co., Ltd (WIBP) has finished a randomized, placebo-controlled phase III clinical trial in four provinces of China in 2021. The trail demonstrated that RV6 has a high vaccine efficacy against the prevalent strains and is safe for use in infants. During the phase III clinical trial (2019–2021), 200 rotavirus-positive fecal samples from children with RV gastroenteritis (RVGE) were further studied. Using reverse transcription-polymerase chain reaction and high-throughput sequencing, VP7 and VP4 sequences were obtained and their genetic characteristics, as well as the differences in antigenic epitopes of VP7, were analyzed in detail. Seven rotavirus genotypes were identified. The predominant rotavirus genotype was G9P [8] (77.0%), followed by prevalent strains G8P [8] (8.0%), G3P [8] (3.5%), G3P [9] (1.5%), G1P [8] (1.0%), G2P [4] (1.0%), and G4P [6] (1.0%). The amino acid sequence identities of G1, G2, G3, G4, G8, and G9 genotypes of isolates compared to the vaccine strains were 98.8%, 98.2%–99.7%, 88.4%–99.4%, 98.2%, 94.2%–100%, and 93.9%–100%, respectively. Notably, the vaccine strains exhibited high similarity in amino acid sequence, with only minor differences in antigenic epitopes compared to the Chinese endemic strains. This supports the potential application of the vaccine in preventing diseases caused by rotaviruses.

Study of the safety and immunogenicity of VLP-based vaccine for the prevention of rotavirus infection in neonatal minipig model

In Russia, almost half of the cases of acute intestinal infections of established etiology in 2022 are due to rotavirus infection (RVI). There is no specific treatment for rotavirus gastroenteritis. There is a need to develop modern, effective and safe vaccines to combat rotavirus infection that are not capable of multiplying (replicating) in the body of the vaccinated person. A promising approach is to create vaccines based on virus-like particles (VLPs). Study of the safety and immunogenicity of a vaccine against rotavirus infection based on virus-like particles of human rotavirus A in newborn minipigs with multiple intramuscular administration. Newborn minipigs were used as an animal model in this study. The safety of the tested vaccine was assessed based on thermometry data, clinical examination, body weight gain, clinical and biochemical blood parameters, as well as necropsy and histological examination. When studying the immunogenic properties of the Gam-VLP-rota vaccine in doses of 30 and 120 µg, the cellular, humoral and secretory immune response was studied. The results of assessing the general condition of animals during the immunization period, data from clinical, laboratory and pathomorphological studies indicate the safety of the vaccine against human rotavirus infection based on VLP (Gam-VLP-rota) when administered three times intramuscularly. Good local tolerance of the tested vaccine was demonstrated. The results of the assessment of humoral immunity indicate the formation of a stable immune response after three-time immunization with Gam-VLP-rota, stimulation of the production of antigen-specific IgG antibodies and their functional activity to neutralize human rotavirus A. It was shown that following the triple immunization with the minimum tested concentration of 30 µg/dose, animals developed a cell-mediated immune response. The results of the IgA titer in blood serum and intestinal lavages indicate the formation of both a systemic immunological response and the formation of specific secretory immunity to human rotavirus A. Thus, three-time intramuscular immunization of minipigs with the Gam-VLP-rota vaccine forms stable protective humoral and cellular immunity in experimental animals. Evaluated vaccine is safe and has good local tolerability.

Economic Evaluation of Rotavirus Vaccination in Children Aged Under Five Years in South Africa.

Evidence on the economic value of rotavirus vaccines in middle-income countries is limited. We aimed to model the implementation of three vaccines (human rotavirus, live, attenuated, oral vaccine [HRV, 2 doses]; rotavirus vaccine, live, oral, pentavalent [HBRV, 3 doses] and rotavirus vaccine, live attenuated oral, freeze-dried [BRV-PV, 3 doses] presented in 1-dose and 2-dose vials) into the South African National Immunisation Programme. Cost and cost-effectiveness analyses were conducted to compare three rotavirus vaccines using a static, deterministic, population model in children aged <5 years in South Africa from country payer and societal perspectives. Deterministic and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The human rotavirus, live, attenuated, oral vaccine (HRV)was associated with cost savings versus HBRV from both perspectives, and versus BRV-PV 1-dose vial from the societal perspective. In the cost-effectiveness analysis, HRV was estimated to avoid 1,107 home care rotavirus gastroenteritis (RVGE) events, 247 medical visits, 35 hospitalisations, and 4 RVGE-related deaths versus HBRV and BRV-PV. This translated to 73 quality-adjusted life years gained. HRV was associated with lower costs versus HBRV from both payer (-$3.9M) and societal (-$11.5M) perspectives and versus BRV-PV 1-dose vial from the societal perspective (-$3.8M), dominating those options. HRVwas associated with higher costs versus BRV-PV 1-dose vial from the payer perspective and versus BRV-PV 2‑dose vial from both payer and societal perspectives (ICERs: $51,834, $121,171, and $16,717, respectively), exceeding the assumed cost-effectiveness threshold of 0.5 GDP per capita. Vaccination with a 2-dose schedule of HRV may lead to better health outcomes for children in South Africa compared with the 3-dose schedule rotavirus vaccines.

Epidemiology of common infectious diseases before and during the COVID-19 pandemic in Bavaria, Germany, 2016 to 2021: an analysis of routine surveillance data.

BackgroundUnprecedented non-pharmaceutical interventions to control the COVID-19 pandemic also had an effect on other infectious diseases.AimWe aimed to determine their impact on transmission and diagnosis of notifiable diseases other than COVID-19 in Bavaria, Germany, in 2020 and 2021.MethodsWe compared weekly cases of 15 notifiable infectious diseases recorded in Bavaria between 1 January 2016 and 31 December 2021 in time series analyses, median age and time-to-diagnosis using Wilcoxon rank sum test and hospitalisation rates using univariable logistic regression during three time periods: pre-pandemic (weeks 1 2016-9 2020), pandemic years 1 (weeks 10-52 2020) and 2 (2021).ResultsWeekly case numbers decreased in pandemic year 1 for all diseases assessed except influenza, Lyme disease and tick-borne encephalitis; markedly for norovirus gastroenteritis (IRR = 0.15; 95% CI: 0.12-0.20) and pertussis (IRR = 0.22; 95% CI: 0.18-0.26). In pandemic year 2, influenza (IRR = 0.04; 95% CI: 0.02-0.09) and pertussis (IRR = 0.11; 95% CI: 0.09-0.14) decreased markedly, but also chickenpox, dengue fever, Haemophilus influenzae invasive infection, hepatitis C, legionellosis, noro- and rotavirus gastroenteritis and salmonellosis. For enterohaemorrhagic Escherichia coli infections, median age decreased in pandemic years 1 and 2 (4 years, interquartile range (IQR): 1-32 and 3 years, IQR: 1-18 vs 11 years, IQR: 2-42); hospitalisation proportions increased in pandemic year 1 (OR = 1.60; 95% CI: 1.08-2.34).ConclusionReductions for various infectious diseases and changes in case characteristics in 2020 and 2021 indicate reduced transmission of notifiable diseases other than COVID-19 due to interventions and under-detection.

Global vaccination policies in rotavirus infection

Before rotavirus vaccines first became available in 2006, almost every child up to the age of 3-5 years had at least one episode of diarrhoea due to rotavirus infection. According to statistics, in the 2000s rotavirus was the leading cause of severe, dehydrating diarrhoea in children under 5 years of age globally, causing an estimated 500 000 child deaths and more than 2 million hospitalisations worldwide. Currently available rotavirus vaccines are live, oral, attenuated rotavirus strains of human and/or animal origin that replicate in the human gut to elicit an immune response. The first 2 rotavirus vaccines prequalified by the WHO were RotaTeq27 (Merck &amp; Co. Inc., Whitehouse Station, NJ, USA) in 2008 and Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium) in 2009. Each of the WHO pre-qualified vaccines against rotavirus has demonstrated a high level of safety. Rotavirus vaccination is costeffective in most low- and middle-income countries compared to no vaccination. Given the continuing burden of severe rotavirus gastroenteritis even after vaccination and in the second year of life in high morbidity and mortality settings, current research priorities include investigating alternative schedules, including neonatal schedules and booster doses.

The results of rotavirus vaccine implementation in the Republic of Moldova

The Republic of Moldova was one of the first countries with different incomes in the European region of the World Health Organization to introduce the rotavirus vaccine (July 2012). Intended purpose to evaluate the impact of the rotavirus vaccination program and to estimate the effectiveness of the rotavirus vaccine. Surveillance of rotavirus gastroenteritis was carried out in 2 hospitals of the capital Chisinau since September 2009. Monthly age-related rotavirus admissions were examined before and after the introduction of rotavirus vaccination using interrupted time-series molecular biology analyses. We conducted a case-control study of vaccine efficacy by comparing patients with rotavirus case with test-negative participants. Coverage with at least 1 dose of vaccine increased from 35% in the first year to 55% in the second year for children under 1 year of age. The percentage of positive admissions for rotavirus decreased from 45% in the post-vaccination period to 25%. Rate reduction of 36% (confidence interval [CI] 95%) in the first year and 14% (rate reduction, 67%) in the second year after vaccine introduction, among children under 5 years of age. The most pronounced reductions were among children up to 1 year old. These significant reductions in gastroenteritis among vaccinated cohorts with age for vaccination suggest indirect benefits. The effectiveness of the two-dose vaccine was 79% against hospitalization with rotaviruses and 84% against cases with moderate to severe manifestations. The results obtained consistently indicate the profound impact on the direct and group immunity of the rotavirus vaccination program in children up to 5 years of age. There remains the potential for further disease reduction.

Detection of Rotavirus in Respiratory Specimens From Bangladeshi Children Aged

To examine the potential for respiratory transmission of rotavirus, we systematically assessed if rotavirus RNA is detectable by real-time quantitative reverse transcription-polymerase chain reaction from nasal and oropharyngeal swab specimens of Bangladeshi children with acute rotavirus gastroenteritis. Forehead swabs were collected to assess skin contamination. Among 399 children aged <2 years hospitalized for gastroenteritis during peak rotavirus season, rotavirus RNA was detected in stool, oral, nasal and forehead swab specimens of 354 (89%). A subset was genotyped; genotype was concordant within a child's specimen set and several different genotypes were detected across children. These findings support possible respiratory transmission of rotavirus and warrant further investigation.

Molecular epidemiology of rotavirus among children in Western Canada: Dynamic changes in genotype prevalence in four consecutive seasons.

Rotavirus molecular surveillance remains important in the postvaccine era to monitor the changes in transmission patterns, identify vaccine-induced antigenic changes and discover potentially pathogenic vaccine-related strains. The Canadian province of Alberta introduced rotavirus vaccination into its provincial vaccination schedule in June 2015. To evaluate the impact of this program on stool rotavirus positivity rate, strain diversity, and seasonal trends, we analyzed a prospective cohort of children with acute gastroenteritis recruited between December 2014 and August 2018. We identified dynamic changes in rotavirus positivity and genotype trends during pre- and post-rotavirus vaccine introduction periods. Genotypes G9P[8], G1P[8], G2P[4], and G12P[8] predominated consecutively each season with overall lower rotavirus incidence rates in 2016 and 2017. The demographic and clinical features of rotavirus gastroenteritis were comparable among wild-type rotaviruses; however, children with G12P[8] infections were older (p < 0.001). Continued efforts to monitor changes in the molecular epidemiology of rotavirus using whole genome sequence characterization are needed to further understand the impact of the selection pressure of vaccination on rotavirus evolution.

Rotavirus vaccination as a public health strategy to reduce the burden of hospitalization: The field experience of Italy (2008-2018).

Rotavirus (RV) infection is a leading cause of severe diarrhea among children younger than 5 years old and a considerable cause of RVgastroenteritis (RVGE) hospitalization. This study aimed to evaluate the impact of vaccination in Italy in the reduction of the burden of RV-related disease, estimating the relation between vaccination coverage and hospitalization rates.RVGE-related hospitalizations that occurred in Italy from 2008 to 2018 among children aged 0-35 months were assessed by consulting the Hospital Discharge Record database and including records whose ICD-9-CM diagnosis code was 008.61 in the first or in any diagnosis position.In the 2008-2018 period, a total of 17 535 791 at-risk person-years were considered and 74 211 (423.2 cases × 100 000 per year) RVGE hospitalizations were observed. Higher hospitalization rates occurred in males (456.6 vs. 387.9 × 100 000 per year) and in children aged 1 year (507.8 × 100 000 per year). Poisson regression analysis showed a decrease of -1.25% in hospitalization rates (-1.19% to -1.31%, p < 0.001) per unit increase in vaccination coverage.This is the first study that correlates hospitalization rate reduction with a percentage increase in vaccination coverage. Our findings strongly support RV vaccination as an effective public health strategy for reducing RVGE-related hospitalizations.

Network Meta-analysis of oral Chinese patent medicine in adjuvant treatment of rotavirus gastroenteritis in children

This study aimed to evaluate the efficacy and safety of various oral Chinese patent medicines in the adjuvant treatment of rotavirus gastroenteritis(RVGE) in children based on network Meta-analysis. Randomized controlled trial(RCT) of oral Chinese patent medicine in the adjuvant treatment of RVGE in children was retrieved from the databases such as CNKI, Wanfang, VIP, SinoMed, PubMed, Cochrane Library, EMbase, and Web of Science from database inception to October 22, 2022. The quality of the included RCT was evaluated according to the Cochrane risk-of-bias tool, and the data were analyzed by RevMan 5.4 and Stata 16 software. Sixty-three RCTs were included, with 11 oral Chinese patent medicines involved, including Xingpi Yanger Granules, Weichang'an Pills, Qiuxieling Mixture, Erxieting Granules, and Changyanning Granules/Syrup. The results of the network Meta-analysis showed that in terms of clinical total effective rate, the top 3 optimal interventions were Changyanning Granules/Syrup, Xiaoer Guangpo Zhixie Oral Liquid, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the anti-diarrheal time, the top 3 optimal interventions were Shenling Baizhu Granules, Qiuxieling Mixture, and Shuangling Zhixie Oral Liquid combined with conventional western medicine. In terms of the antiemetic time, the top 3 optimal interventions were Changyanning Granules/Syrup, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of the antipyretic time, the top 3 optimal interventions were Shenling Baizhu Granules, Xiaoer Shuangjie Zhixie Granules, and Qiuxieling Mixture combined with conventional western medicine. In terms of the negative conversion rate of rotavirus, the top 3 optimal interventions were Xingpi Yanger Granules, Erxieting Granules, and Cangling Zhixie Oral Liquid combined with conventional western medicine. In terms of reducing creatine kinase isoenzyme MB(CK-MB) level, the top 3 optimal interventions were Weichang'an Pills, Xingpi Yanger Granules, and Xiaoer Shuangjie Zhixie Granules combined with conventional western medicine. In terms of adverse reactions, no se-rious adverse reactions were reported in all studies. Oral Chinese patent medicines in the adjuvant treatment of children with RVGE have their own advantages, Specifically, Changyanning Granules/Syrup + conventional western medicine focuses on improving the clinical total effective rate and shortening the antiemetic time, Shenling Baizhu Granules + conventional western medicine on shortening the anti-diarrheal time and antipyretic time, Xingpi Yanger Granules + conventional western medicine on improving the negative conversion rate of rotavirus, and Weichang'an Pills + conventional western medicine on reducing the CK-MB level. Limited by the quantity and quality of literature included in this study, the results need to be verified by high-quality RCT with a larger sample size.