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Usman M, Rana MS, Salman M, Alam MM, Khurshid A, Umair M, Ullah N, Anas M, Ahmed M, Ayub A, Habib S, Zohaib A, Javed A. Molecular characterization of rotavirus indicates predominance of G9P[4] genotype among children with acute gastroenteritis: First report after vaccine introduction in Pakistan. J Med Virol 2024; 96:e29761. [PMID: 38924137 DOI: 10.1002/jmv.29761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Globally, Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in children under 5 years old, with Pakistan having the highest rates of RVA-related morbidity and mortality. The current study aims to determine the genetic diversity of rotavirus and evaluate the impact of Rotarix-vaccine introduction on disease epidemiology in Pakistan. A total of 4749 children, hospitalized with acute gastroenteritis between 2018 and 2020, were tested at four hospitals in Lahore and Karachi. Of the total, 19.3% (918/4749) cases were tested positive for RVA antigen, with the positivity rate varying annually (2018 = 22.7%, 2019 = 14.4%, 2020 = 20.9%). Among RVA-positive children, 66.3% were under 1 year of age. Genotyping of 662 enzyme-linked immuno sorbent assay-positive samples revealed the predominant genotype as G9P[4] (21.4%), followed by G1P[8] (18.9%), G3P[8] (11.4%), G12P[6] (8.7%), G2P[4] (5.7%), G2P[6] (4.8%), and 10.8% had mixed genotypes. Among vaccinated children, genotypes G9P[4] and G12P[6] were more frequently detected, whereas a decline in G2P[4] was observed. Phylogenetic analysis confirmed the continued circulation of indigenous genotypes detected earlier in the country except G9 and P[6] strains. Our findings highlight the predominance of G9P[4] genotype after the vaccine introduction thus emphasizing continual surveillance to monitor the disease burden, viral diversity, and their impact on control of rotavirus gastroenteritis in children.
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Affiliation(s)
- Muhammad Usman
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Muhammad Salman
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | | | - Adnan Khurshid
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Massab Umair
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Nadeem Ullah
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Muhammad Anas
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Muzzamil Ahmed
- Department of Virology, National Institute of Health, Islamabad, Pakistan
| | - Aaima Ayub
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Sabahat Habib
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Ali Zohaib
- Department of Microbiology, The Islamia University of Bahawalpur, Baghdad-ul-Jadeed Campus, Bahawalpur, Pakistan
| | - Aneela Javed
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
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Omatola CA, Olaniran AO. Genetic heterogeneity of group A rotaviruses: a review of the evolutionary dynamics and implication on vaccination. Expert Rev Anti Infect Ther 2022; 20:1587-1602. [PMID: 36285575 DOI: 10.1080/14787210.2022.2139239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Human rotavirus remains a major etiology of acute gastroenteritis among under 5-year children worldwide despite the availability of oral vaccines. The genetic instability of rotavirus and the ability to form different combinations from the different G- and P-types reshapes the antigenic landscape of emerging strains which often display limited or no antigen identities with the vaccine strain. As evidence also suggests, the selection of the antigenically distinct novel or rare strains and their successful spread in the human population has raised concerns regarding undermining the effectiveness of vaccination programs. AREAS COVERED We review aspects related to current knowledge about genetic and antigenic heterogeneity of rotavirus, the mechanism of genetic diversity and evolution, and the implication of genetic change on vaccination. EXPERT OPINION Genetic changes in the segmented genome of rotavirus can alter the antigenic landscape on the virion capsid and further promote viral fitness in a fully vaccinated population. Against this background, the potential risk of the appearance of new rotavirus strains over the long term would be better predicted by a continued and increased close monitoring of the variants across the globe to identify any change associated with disease dynamics.
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Affiliation(s)
- Cornelius A Omatola
- Discipline of Microbiology, School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban, Republic of South Africa
| | - Ademola O Olaniran
- Discipline of Microbiology, School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal, Durban, Republic of South Africa
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Rotavirus Strain Trends in United States, 2009–2016: Results from the National Rotavirus Strain Surveillance System (NRSSS). Viruses 2022; 14:v14081775. [PMID: 36016397 PMCID: PMC9414880 DOI: 10.3390/v14081775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Before the introduction of vaccines, group A rotaviruses (RVA) were the leading cause of acute gastroenteritis in children worldwide. The National Rotavirus Strain Surveillance System (NRSSS) was established in 1996 by the Centers for Disease Control and Prevention (CDC) to perform passive RVA surveillance in the USA. We report the distribution of RVA genotypes collected through NRSSS during the 2009–2016 RVA seasons and retrospectively examine the genotypes detected through the NRSSS since 1996. During the 2009–2016 RVA seasons, 2134 RVA-positive fecal specimens were sent to the CDC for analysis of the VP7 and VP4 genes by RT-PCR genotyping assays and sequencing. During 2009–2011, RVA genotype G3P[8] dominated, while G12P[8] was the dominant genotype during 2012–2016. Vaccine strains were detected in 1.7% of specimens and uncommon/unusual strains, including equine-like G3P[8] strains, were found in 1.9%. Phylogenetic analyses showed limited VP7 and VP4 sequence variation within the common genotypes with 1–3 alleles/lineages identified per genotype. A review of 20 years of NRSSS surveillance showed two changes in genotype dominance, from G1P[8] to G3P[8] and then G3P[8] to G12P[8]. A better understanding of the long-term effects of vaccine use on epidemiological and evolutionary dynamics of circulating RVA strains requires continued surveillance.
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Avoka JA, Dun-Dery EJ, Seidu I, Abou ANE, Twene P, Tandoh IO, Dun-Dery F. Time series analysis of the relationship between diarrhea in children and Rota 2 vaccine in the Fanteakwa District of the eastern region of Ghana. BMC Pediatr 2021; 21:88. [PMID: 33607970 PMCID: PMC7893935 DOI: 10.1186/s12887-021-02540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Rotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana. METHODS The study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases. RESULTS The study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt - 1),0.346 to 0.735), two months ago ((Xt - 2),0.383 to 0.746), three months ago ((Xt - 3), 0.330 to 0.737) and four months ago ((Xt - 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month's Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36. CONCLUSION Seasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.
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Affiliation(s)
- James Atampiiga Avoka
- Ghana Health Service, Birim Central Municipal Health Directorate, Box 429, Akim Oda, Ghana
| | - Elvis J. Dun-Dery
- Department of Population and Health Research, Research Web Africa, Box 233, Sunyani, Ghana
| | - Issah Seidu
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Armel N. E. Abou
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Paul Twene
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Isaac Obeng Tandoh
- Department of Statistics, University of Ghana, P.O.Box LG 115, Legon-Accra, Ghana
- Institutional Public Health Unit, Eastern Regional Hospital, Koforidua, Ghana
- Fanteakwa North District Health Directorate, Box 60, Begoro, Eastern Region Ghana
- Eastern Regional Health Directorate, Ghana Health Service, Eastern Region Koforidua, Ghana
| | - Frederick Dun-Dery
- Disease Control in Disadvantaged Populations, Heidelberg Institute of Global Health, Medical Faculty, Ruprecht-Karls Universität, Heidelberg, Germany
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Simwaka J, Seheri M, Mulundu G, Kaonga P, Mwenda JM, Chilengi R, Mpabalwani E, Munsaka S. Rotavirus breakthrough infections responsible for gastroenteritis in vaccinated infants who presented with acute diarrhoea at University Teaching Hospitals, Children's Hospital in 2016, in Lusaka Zambia. PLoS One 2021; 16:e0246025. [PMID: 33539399 PMCID: PMC7861525 DOI: 10.1371/journal.pone.0246025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background In Zambia, before rotavirus vaccine introduction, the virus accounted for about 10 million episodes of diarrhoea, 63 000 hospitalisations and 15 000 deaths in 2015, making diarrhoea the third leading cause of death after pneumonia and malaria. In Zambia, despite the introduction of the vaccine acute diarrhoea due to rotaviruses has continued to affect children aged five years and below. This study aimed to characterise the rotavirus genotypes which were responsible for diarrhoeal infections in vaccinated infants aged 2 to 12 months and to determine the relationship between rotavirus strains and the severity of diarrhoea in 2016. Methods Stool samples from infants aged 2 to 12 months who presented to the hospital with acute diarrhoea of three or more episodes in 24 hours were tested for group A rotavirus. All positive specimens that had enough sample were genotyped using reverse transcriptase Polymerase Chain Reaction (RT-PCR). A 20-point Vesikari clinical score between 1–5 was considered as mild, 6–10 as moderate and greater or equal to 11 as severe. Results A total of 424 stool specimens were tested of which 153 (36%, 95% CI 31.5% to 40.9%) were positive for VP6 rotavirus antigen. The age-specific rotavirus infections decreased significantly (p = 0.041) from 2–4 months, 32.0% (49/118) followed by a 38.8% (70/181) infection rate in the 5–8 months’ category and subsequently dropped in the infants aged 9–12 months with a positivity rate of 27.2%. 38.5% of infants who received a single dose, 34.5% of those who received a complete dose and 45.2% (19/42) of the unvaccinated tested positive for rotavirus. The predominant rotavirus genotypes included G2P[6] 36%, G1P[8] 32%, mixed infections 19%, G2P[4] 6%, G1P[6] 4% and G9P[6] 3%. Discussion and conclusion Results suggest breakthrough infection of heterotypic strains (G2P[6] (36%), homotypic, G1P[8] (32%) and mixed infections (19%) raises concerns about the effects of the vaccination on the rotavirus diversity, considering the selective pressure that rotavirus vaccines could exert on viral populations. This data indicates that the rotavirus vaccine has generally reduced the severity of diarrhoea despite the detection of the virus strains.
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Affiliation(s)
- Julia Simwaka
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
- * E-mail:
| | - Mapaseka Seheri
- World Health Organization Regional Office for Africa (WHO/AFRO), Brazzaville, Congo
| | - Gina Mulundu
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
- Department of Internal Medicine, University Teaching Hospital, Tropical Gastroenterology and Nutrition Group, Lusaka, Zambia
| | - Jason M. Mwenda
- Department of Virology, Diarrhoea Pathogens Research Unit and WHO AFRO Rotavirus Regional Reference Laboratory, South African Medical Research Council, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Roma Chilengi
- Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Evans Mpabalwani
- Department of Paediatric and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sody Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
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6
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Rakau KG, Nyaga MM, Gededzha MP, Mwenda JM, Mphahlele MJ, Seheri LM, Steele AD. Genetic characterization of G12P[6] and G12P[8] rotavirus strains collected in six African countries between 2010 and 2014. BMC Infect Dis 2021; 21:107. [PMID: 33482744 PMCID: PMC7821174 DOI: 10.1186/s12879-020-05745-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND G12 rotaviruses were first observed in sub-Saharan Africa in 2004 and since then have continued to emerge and spread across the continent and are reported as a significant human rotavirus genotype in several African countries, both prior to and after rotavirus vaccine introduction. This study investigated the genetic variability of 15 G12 rotavirus strains associated with either P[6] or P[8] identified between 2010 and 2014 from Ethiopia, Kenya, Rwanda, Tanzania, Togo and Zambia. METHODS The investigation was carried out by comparing partial VP7 and partial VP4 sequences of the African G12P[6] and G12P[8] strains with the available GenBank sequences and exploring the recognized neutralization epitopes of these strains. Additionally, Bayesian evolutionary analysis was carried out using Markov Chain Monte Carlo (MCMC) implemented in BEAST to estimate the time to the most recent ancestor and evolutionary rate for these G12 rotavirus strains. RESULTS The findings suggested that the VP7 and VP4 nucleotide and amino acid sequences of the G12 strains circulating in African countries are closely related, irrespective of country of origin and year of detection, with the exception of the Ethiopian strains that clustered distinctly. Neutralization epitope analysis revealed that rotavirus VP4 P[8] genes associated with G12 had amino acid sequences similar to those reported globally including the vaccine strains in RotaTeq and Rotarix. The estimated evolutionary rate of the G12 strains was 1.016 × 10- 3 substitutions/site/year and was comparable to what has been previously reported. Three sub-clusters formed within the current circulating lineage III shows the diversification of G12 from three independent ancestries within a similar time frame in the late 1990s. CONCLUSIONS At present it appears to be unlikely that widespread vaccine use has driven the molecular evolution and sustainability of G12 strains in Africa. Continuous monitoring of rotavirus genotypes is recommended to assess the long-term impact of rotavirus vaccination on the dynamic nature of rotavirus evolution on the continent.
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Affiliation(s)
- Kebareng G Rakau
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Martin M Nyaga
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Next Generation Sequencing Unit and Department of Medical Microbiology and Virology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Maemu P Gededzha
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,National Health Laboratory Service, Department of Molecular Medicine and Haematology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Jason M Mwenda
- African Rotavirus Surveillance Network, Immunization, Vaccines and Development Cluster, WHO African Regional Office, Brazzaville, Congo
| | - M Jeffrey Mphahlele
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,South African Medical Research Council, Soutpansberg Road, Pretoria, South Africa
| | - L Mapaseka Seheri
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - A Duncan Steele
- Diarrhoeal Pathogens Research Unit, Department of Virology, WHO AFRO Rotavirus Regional Reference Laboratory, Sefako Makgatho Health Sciences University, Pretoria, South Africa. .,Present address: Enteric and Diarrheal Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, WA, USA.
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Reverse Genetics Approach for Developing Rotavirus Vaccine Candidates Carrying VP4 and VP7 Genes Cloned from Clinical Isolates of Human Rotavirus. J Virol 2020; 95:JVI.01374-20. [PMID: 33087468 DOI: 10.1128/jvi.01374-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Species A rotaviruses (RVs) are a leading cause of severe acute gastroenteritis in infants and children younger than 5 years. Currently available RV vaccines were adapted from wild-type RV strains by serial passage of cultured cells or by reassortment between human and animal RV strains. These traditional methods require large-scale screening and genotyping to obtain vaccine candidates. Reverse genetics is a tractable, rapid, and reproducible approach to generating recombinant RV vaccine candidates carrying any VP4 and VP7 genes that provide selected antigenicity. Here, we developed a vaccine platform by generating recombinant RVs carrying VP4 (P[4] and P[8]), VP7 (G1, G2, G3, G8, and G9), and/or VP6 genes cloned from human RV clinical samples using the simian RV SA11 strain (G3P[2]) as a backbone. Neutralization assays using monoclonal antibodies and murine antisera revealed that recombinant VP4 and VP7 monoreassortant viruses exhibited altered antigenicity. However, replication of VP4 monoreassortant viruses was severely impaired. Generation of recombinant RVs harboring a chimeric VP4 protein for SA11 and human RV gene components revealed that the VP8* fragment was responsible for efficient infectivity of recombinant RVs. Although this system must be improved because the yield of vaccine viruses directly affects vaccine manufacturing costs, reverse genetics requires less time than traditional methods and enables rapid production of safe and effective vaccine candidates.IMPORTANCE Although vaccines have reduced global RV-associated hospitalization and mortality over the past decade, the multisegmented genome of RVs allows reassortment of VP4 and VP7 genes from different RV species and strains. The evolutionary dynamics of novel RV genotypes and their constellations have led to great genomic and antigenic diversity. The reverse genetics system is a powerful tool for manipulating RV genes, thereby controlling viral antigenicity, growth capacity, and pathogenicity. Here, we generated recombinant simian RVs (strain SA11) carrying heterologous VP4 and VP7 genes cloned from clinical isolates and showed that VP4- or VP7-substituted chimeric viruses can be used for antigenic characterization of RV outer capsid proteins and as improved seed viruses for vaccine production.
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Giri S, Kumar CPG, Khakha SA, Chawla-Sarkar M, Gopalkrishna V, Chitambar SD, Ray P, Venkatasubramanian S, Borkakoty BJ, Roy S, Bhat J, Dwibedi B, Das P, Paluru V, Ramani S, Babji S, Arora R, Mehendale SM, Gupte MD, Kang G. Diversity of rotavirus genotypes circulating in children < 5 years of age hospitalized for acute gastroenteritis in India from 2005 to 2016: analysis of temporal and regional genotype variation. BMC Infect Dis 2020; 20:740. [PMID: 33036575 PMCID: PMC7547507 DOI: 10.1186/s12879-020-05448-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 09/23/2020] [Indexed: 11/13/2022] Open
Abstract
Background From 2016, the Government of India introduced the oral rotavirus vaccine into the national immunization schedule. Currently, two indigenously developed vaccines (ROTAVAC, Bharat Biotech; ROTASIIL, Serum Institute of India) are included in the Indian immunization program. We report the rotavirus disease burden and the diversity of rotavirus genotypes from 2005 to 2016 in a multi-centric surveillance study before the introduction of vaccines. Methods A total of 29,561 stool samples collected from 2005 to 2016 (7 sites during 2005–2009, 3 sites from 2009 to 2012, and 28 sites during 2012–2016) were included in the analysis. Stools were tested for rotavirus antigen using enzyme immunoassay (EIA). Genotyping was performed on 65.8% of the EIA positive samples using reverse transcription- polymerase chain reaction (RT-PCR) to identify the G (VP7) and P (VP4) types. Multinomial logistic regression was used to quantify the odds of detecting genotypes across the surveillance period and in particular age groups. Results Of the 29,561 samples tested, 10,959 (37.1%) were positive for rotavirus. There was a peak in rotavirus positivity during December to February across all sites. Of the 7215 genotyped samples, G1P[8] (38.7%) was the most common, followed by G2P[4] (12.3%), G9P[4] (5.8%), G12P[6] (4.2%), G9P[8] (4%), and G12P[8] (2.4%). Globally, G9P[4] and G12P[6] are less common genotypes, although these genotypes have been reported from India and few other countries. There was a variation in the geographic and temporal distribution of genotypes, and the emergence or re-emergence of new genotypes such as G3P[8] was seen. Over the surveillance period, there was a decline in the proportion of G2P[4], and an increase in the proportion of G9P[4]. A higher proportion of mixed and partially typed/untyped samples was also seen more in the age group 0–11 months. Conclusions This 11 years surveillance highlights the high burden of severe rotavirus gastroenteritis in Indian children < 5 years of age before inclusion of rotavirus vaccines in the national programme. Regional variations in rotavirus epidemiology were seen, including the emergence of G3P[8] in the latter part of the surveillance. Having pre-introduction data is important to track changing epidemiology of rotaviruses, particularly following vaccine introduction.
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Affiliation(s)
- Sidhartha Giri
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.,Indian Council of Medical Research, New Delhi, India
| | | | - Shainey Alokit Khakha
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mamta Chawla-Sarkar
- National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | | | | | | | | | | | - Subarna Roy
- National Institute of Traditional Medicine, Belgaum, Karnataka, India
| | - Jyothi Bhat
- National Institute for Research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | | | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Vijayachari Paluru
- Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India
| | - Sasirekha Ramani
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India.,Baylor College of Medicine, Houston, TX, USA
| | - Sudhir Babji
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rashmi Arora
- Indian Council of Medical Research, New Delhi, India.,Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana, India
| | | | - Mohan D Gupte
- Indian Council of Medical Research, New Delhi, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India. .,Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana, India.
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9
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Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso. Epidemiol Infect 2020; 148:e245. [PMID: 32998792 PMCID: PMC7592103 DOI: 10.1017/s0950268820002320] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Several studies report norovirus as the new leading cause of severe gastroenteritis in children after the global introduction of rotavirus vaccines. Burkina Faso introduced general rotavirus vaccination with the oral pentavalent vaccine RotaTeq in November 2013 and quickly reached a vaccine coverage of >90%. This study describes detection rates, clinical profiles and the molecular epidemiology of norovirus and rotavirus infections in 146 children aged <5 years with severe acute gastroenteritis in Ouagadougou, consecutively enrolled from a hospital between January 2015 and December 2015. Virus detection was performed with an antigen test or real-time polymerase chain reaction (PCR) and genotyping was performed by nucleotide sequencing or multiplex PCR. Rotavirus was found in 14% and norovirus in 20% of faecal samples. Norovirus infection was significantly more associated with severe dehydration compared to rotavirus (P < 0.001). Among genotyped norovirus samples 48% (12/25) belonged to GII.4 which caused significantly more diarrhoeal episodes than non-GII.4 genotypes (P = 0.01). The most common rotavirus genotypes were G2P[4] (30%), G12P[6] (25%) and G12P[8] (20%). Fifty percent of the rotavirus positive children were infected with fully or partly heterotypic strains. In conclusion, this study found a higher proportion of norovirus causing more severe symptoms in children with diarrhoea in Burkina Faso after the introduction of rotavirus vaccination.
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10
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Continuing rotavirus circulation in children and adults despite high coverage rotavirus vaccination in Finland. J Infect 2020; 80:76-83. [DOI: 10.1016/j.jinf.2019.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/26/2019] [Indexed: 12/31/2022]
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11
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Pérez-Ortín R, Santiso-Bellón C, Vila-Vicent S, Carmona-Vicente N, Rodríguez-Díaz J, Buesa J. Rotavirus symptomatic infection among unvaccinated and vaccinated children in Valencia, Spain. BMC Infect Dis 2019; 19:998. [PMID: 31771522 PMCID: PMC6880582 DOI: 10.1186/s12879-019-4550-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human group A rotavirus is the leading cause of severe acute gastroenteritis in young children worldwide. Immunization programs have reduced the disease burden in many countries. Vaccination coverage in the Autonomous Region of Valencia, Spain, is around 40%, as the rotavirus vaccine is not funded by the National Health System. Despite this low-medium vaccine coverage, rotavirus vaccination has substantially reduced hospitalizations due to rotavirus infection and hospital-related costs. However, there are very few studies evaluating symptomatic rotavirus infections not requiring hospitalization in vaccinated children. The objective of this study was to investigate symptomatic rotavirus infections among vaccinated children in the health area served by the Hospital Clínico Universitario of Valencia, Spain, from 2013 to 2015. METHODS A total of 133 children younger than 5 years of age with rotavirus infection were studied. Demographic and epidemiological data were collected and informed consent from their caretakers obtained. Rotavirus infection was detected by immunological methods and G/P rotavirus genotypes were determined by RT-PCR, following standard procedures from the EuroRotaNet network. RESULTS Forty infants (30.1%; 95% CI: 22.3-37.9) out of 133 were diagnosed with symptomatic rotavirus infection despite having been previously vaccinated, either with RotaTeq (85%) or with Rotarix (15%). Children fully vaccinated against rotavirus (24.8%), partially vaccinated (5.3%) and unvaccinated (69.9%) were found. The infecting genotypes showed high G-type diversity, although no significant differences were found between the G/P genotypes infecting vaccinated and unvaccinated children during the same time period. G9P[8], G12P[8] and G1P[8] were the most prevalent genotypes. Severity of gastroenteritis symptoms required 28 (66.6%) vaccinated and 67 (73.6%) unvaccinated children to be attended at the Emergency Room. CONCLUSION Rotavirus vaccine efficacy in reducing the incidence of severe rotavirus infection has been well documented, but symptomatic rotavirus infection can sometimes occur in vaccinees.
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Affiliation(s)
- Raúl Pérez-Ortín
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Cristina Santiso-Bellón
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Susana Vila-Vicent
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Noelia Carmona-Vicente
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Jesús Rodríguez-Díaz
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Javier Buesa
- Department of Microbiology, School of Medicine, University of Valencia and Microbiology Service, Hospital Clínico Universitario and Instituto de Investigación INCLIVA, Avda. Blasco Ibañez, 17, 46010, Valencia, Spain.
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12
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Bucardo F, Reyes Y, Rönnelid Y, González F, Sharma S, Svensson L, Nordgren J. Histo-blood group antigens and rotavirus vaccine shedding in Nicaraguan infants. Sci Rep 2019; 9:10764. [PMID: 31341254 PMCID: PMC6656718 DOI: 10.1038/s41598-019-47166-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/11/2019] [Indexed: 12/20/2022] Open
Abstract
ABO, Lewis and secretor histo-blood group antigens (HBGA) are susceptibility factors for rotavirus in a P-genotype dependent manner and can influence IgA seroconversion rates following rotavirus vaccination. To investigate the association between HBGA phenotypes and rotavirus vaccine shedding fecal samples (n = 304) from a total of 141 infants vaccinated with Rotarix (n = 71) and RotaTeq (n = 70) were prospectively sampled in three time frames (≤3, 4–7 and ≥8 days) after first vaccination dose. Rotavirus was detected with qPCR and genotypes determined by G/P multiplex PCR and/or sequencing. HBGAs were determined by hemagglutination and saliva based ELISA. Low shedding rates were observed, with slightly more children vaccinated with RotaTeq (19%) than Rotarix (11%) shedding rotavirus at ≥4 days post vaccination (DPV). At ≥4 DPV no infant of Lewis A (n = 6) or nonsecretor (n = 9) phenotype in the Rotarix cohort shed rotavirus; the same observation was made for Lewis A infants (n = 7) in the RotaTeq cohort. Putative in-vivo gene reassortment among RotaTeq strains occurred, yielding mainly G1P[8] strains. The bovine derived P[5] genotype included in RotaTeq was able to replicate and be shed at long time frames (>13 DPV). The results of this study are consistent with that HBGA phenotype influences vaccine strain shedding as similarly observed for natural infections. Due to the low overall shedding rates observed, additional studies are however warranted.
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Affiliation(s)
- Filemón Bucardo
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua.
| | - Yaoska Reyes
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua
| | - Ylva Rönnelid
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Fredman González
- Department of Microbiology, Faculty of Medical Science, National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua
| | - Sumit Sharma
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lennart Svensson
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Johan Nordgren
- Division of Molecular Virology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
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13
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Letsa V, Damanka S, Dennis F, Lartey B, Armah GE, Betrapally N, Gautam R, Esona MD, Bowen MD, Quaye O. Distribution of rotavirus genotypes in the postvaccine introduction era in Ashaiman, Greater Accra Region, Ghana, 2014-2016. J Med Virol 2019; 91:2025-2028. [PMID: 31286526 DOI: 10.1002/jmv.25542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/03/2019] [Indexed: 11/07/2022]
Abstract
Group A Rotaviruses (RVAs) are the most important etiological agents of acute gastroenteritis (AGE) in children less than 5 years of age. Mortality resulting from RVA gastroenteritis is higher in developing countries than in developed ones, causing a huge public health burden in global regions like Africa and South-East Asia. This study reports RVA genotypes detected in Ashaiman, Greater Accra Region, Ghana, in the postvaccine introduction era for the period 2014-2016. Stool samples were collected from children less than 5 years of age who visited Ashaiman Polyclinic with AGE from November 2014 to May 2015 and from December 2015 to June 2016. The samples were tested by enzyme immunoassay (EIA), and one-step multiplex reverse transcription polymerase chain reaction was performed on the EIA positive samples for gel-based binomial genotyping. Of the 369 stool samples collected from children with AGE, 145 (39%) tested positive by EIA. Five VP7 (G1, G3, G9, G10, and G12) and three VP4 (P[4], P[6] and P[8]) genotypes were detected. Eight G/P combinations were identified of which, G3P[6], G12P[8], G1P[8], and G9P[4] were the most prevalent and responsible for 93 (68%) of the AGE cases, and seven mixed-types were detected which represented 8% of the RVA cases. High prevalence, diversity, and mixed-types of RVAs were detected from Ashaiman with the emergence of unusual genotypes.
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Affiliation(s)
- Victor Letsa
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
| | - Susan Damanka
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Francis Dennis
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Belinda Lartey
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - George E Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Naga Betrapally
- Division of Viral Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rashi Gautam
- Division of Viral Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mathew D Esona
- Division of Viral Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D Bowen
- Division of Viral Diseases, NCIRD, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Osbourne Quaye
- West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra, Ghana
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14
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Anaya-Molina Y, De La Cruz Hernández SI, Andrés-Dionicio AE, Terán-Vega HL, Méndez-Pérez H, Castro-Escarpulli G, García-Lozano H. A one-step real-time RT-PCR helps to identify mixed rotavirus infections in Mexico. Diagn Microbiol Infect Dis 2018; 92:288-293. [PMID: 30076043 DOI: 10.1016/j.diagmicrobio.2018.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/08/2018] [Accepted: 06/29/2018] [Indexed: 12/14/2022]
Abstract
Rotaviruses continue being the most important pathogens responsible of diarrhea in young children worldwide. Seminested reverse transcription polymerase chain reaction (RT-PCR) is used to determine rotavirus genotype; however, this technique employs multistep procedures. The real-time RT-PCR is a fast and reliable tool that can be used as rotavirus genotyping tool, especially in rotavirus outbreaks. In this study, we tested a real-time RT-PCR to identify rotavirus genotype using a panel of 252 samples from patients with diarrheal disease caused by G9P[4] and G12P[8] genotypes, which were identified as emerging rotaviruses in 2 outbreaks in Chiapas, Mexico. Our results show that the real-time RT-PCR assay detected these rotaviruses, and it allowed us to identify mixed genotype infections, G/P combinations, and the viral abundance in some samples in which the seminested assay could not identify them. Therefore, the real-time RT-PCR is a molecular tool that can be great support during rotavirus outbreaks.
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Affiliation(s)
- Yazmin Anaya-Molina
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico; Laboratorio de Bacteriología Médica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Santo Tomás, 11340, Miguel Hidalgo, CDMX, Mexico.
| | - Sergio Isaac De La Cruz Hernández
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico.
| | - Atenea Estela Andrés-Dionicio
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico.
| | - Heidi Lizbeth Terán-Vega
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico.
| | - Héctor Méndez-Pérez
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico.
| | - Graciela Castro-Escarpulli
- Laboratorio de Bacteriología Médica, Departamento de Microbiología, Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Santo Tomás, 11340, Miguel Hidalgo, CDMX, Mexico.
| | - Herlinda García-Lozano
- Laboratorio de Virus Gastrointestinales, Departamento de Virología, Instituto de Diagnóstico y Referencia Epidemiológicos (InDRE), Francisco de P Miranda 177, Lomas de Plateros, 01480, Álvaro Obregón, CDMX, Mexico.
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15
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Bonkoungou IJO, Ouédraogo N, Tamini L, Teguera RK, Yaméogo P, Drabo MK, Medah I, Barro N, Sharma S, Svensson L, Nordgren J. Rotavirus and norovirus in children with severe diarrhea in Burkina Faso before rotavirus vaccine introduction. J Med Virol 2018; 90:1453-1460. [PMID: 29718582 DOI: 10.1002/jmv.25213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/19/2018] [Indexed: 11/06/2022]
Abstract
Burkina Faso introduced rotavirus vaccine (RotaTeq) to the national immunization program in November 2013. This study describes the detection rates, clinical profiles, and molecular epidemiology of rotavirus and norovirus (NoV) infections among children <5 years hospitalized (n = 154) because of acute diarrhea in Ouagadougou, Burkina Faso, from December 2012 to November 2013, just before the start of vaccination. Overall, 44% and 23% of fecal samples were positive for rotavirus and NoV, respectively, most of them detected during the cold dry season (December-March). The predominant G/P combinations were G12P[8] (47%) and G6P[6] (30%). G2P[4] (n = 3), G12P[6] (n = 3), and G6P[8] (n = 1) were also detected. Nearly all (94%) successfully genotyped NoV strains belonged to genotype GII.4. The predominance of rotavirus and NoV was noteworthy in the age group ≤6 months, with 67% rotavirus and 22% NoV, respectively. Vomiting was significantly more common among rotavirus-infected children. To conclude, this study shows high detection rates of both rotavirus and NoV in children with severe diarrhea in Burkina Faso just before the introduction of rotavirus group A vaccination. The results can be used for estimating the impact of rotavirus group A vaccination, which started in the end of 2013. Furthermore, this study shows that the G6P[6] rotavirus strains emerging in Burkina Faso in 2010 is now established as a regionally important genotype.
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Affiliation(s)
- Isidore Juste O Bonkoungou
- UFR/SVT, Department of Biochemistry and Microbiology, University Ouaga 1, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Department of Medical Biology, National Public Health Laboratory, Ouagadougou, Burkina Faso
| | - Nafissatou Ouédraogo
- UFR/SVT, Department of Biochemistry and Microbiology, University Ouaga 1, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Laure Tamini
- UFR/SVT, Department of Biochemistry and Microbiology, University Ouaga 1, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso.,Department of Pediatric, Charles de Gaulle Pediatric University Hospital, Ouagadougou, Burkina Faso
| | | | - Pouiré Yaméogo
- Department of Medical Biology, National Public Health Laboratory, Ouagadougou, Burkina Faso
| | - Maxime Koiné Drabo
- Department of Medical Biology, National Public Health Laboratory, Ouagadougou, Burkina Faso
| | - Isaïe Medah
- National Immunization Program, Ministry of Health, Ouagadougou, Burkina Faso
| | - Nicolas Barro
- UFR/SVT, Department of Biochemistry and Microbiology, University Ouaga 1, Pr Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Sumit Sharma
- Division of Molecular Virology, Linköping University, Linköping, Sweden
| | - Lennart Svensson
- Division of Molecular Virology, Linköping University, Linköping, Sweden.,Division of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Johan Nordgren
- Division of Molecular Virology, Linköping University, Linköping, Sweden
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16
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Nnukwu SE, Utsalo SJ, Oyero OG, Ntemgwa M, Ayukekbong JA. Point-of-care diagnosis and risk factors of infantile, rotavirus-associated diarrhoea in Calabar, Nigeria. Afr J Lab Med 2018; 6:631. [PMID: 29435424 PMCID: PMC5803522 DOI: 10.4102/ajlm.v6i1.631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/08/2017] [Indexed: 12/24/2022] Open
Abstract
Background Rotaviruses are the primary cause of acute gastroenteritis in young children worldwide and a significant proportion of these infections occur in Africa. Objectives In the present study, we determined the prevalence and risk factors of rotavirus infection among children younger than age 5 years with or without diarrhoea in Calabar, Nigeria, using a rapid point-of-care test. Methods Two hundred infants younger than age 5 years presenting with acute gastroenteritis and a control group of 200 infants without diarrhoea were tested for rotavirus. Each stool sample was homogenised in an extraction buffer and the supernatant added into the sample well of the Rida Quick rotavirus test cassette and allowed to run for 5 minutes at room temperature. When both the control band and test band were visible on the test cassette a positive result was recorded, whereas when only the control band was visible a negative results was recorded. Results Rotavirus was detected in 25 (12.5%) of children with diarrhoea and in no children without diarrhoea. Our results demonstrated that children who were exclusively breast-fed by their mothers were not infected with rotavirus and that 92% of the infants infected with rotavirus experienced vomiting. Conclusion These data demonstrate that asymptomatic rotavirus infection is rare and that rotavirus is commonly detected in stool samples of children suffering from diarrhoea with concomitant vomiting. Use of point-of-care rotavirus tests will enhance early diagnosis of rotavirus-associated diarrhoea and reduce irrational use of antibiotics.
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Affiliation(s)
- Samuel E Nnukwu
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Simon J Utsalo
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Olufunmilayo G Oyero
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Michel Ntemgwa
- Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - James A Ayukekbong
- Section for Clinical Virology, Redeem Biomedical, Buea, South West Region, Cameroon.,Metabiota, Nanaimo, British Columbia, Canada
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17
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The Lewis A phenotype is a restriction factor for Rotateq and Rotarix vaccine-take in Nicaraguan children. Sci Rep 2018; 8:1502. [PMID: 29367698 PMCID: PMC5784145 DOI: 10.1038/s41598-018-19718-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/04/2018] [Indexed: 11/14/2022] Open
Abstract
Histo-blood group antigens (HBGAs) and the Lewis and secretor antigens are associated with susceptibility to rotavirus infection in a genotype-dependent manner. Nicaraguan children were prospectively enrolled in two cohorts vaccinated with either RotaTeq RV5 (n = 68) or Rotarix RV1 (n = 168). Lewis and secretor antigens were determined by saliva phenotyping and genotyping. Seroconversion was defined as a 4-fold increase in plasma IgA antibody titer 1 month after administration of the first dose of the vaccine. Regardless of the vaccine administered, significantly fewer of the children with Lewis A phenotype (0/14) seroconverted after receiving the first vaccine dose compared to 26% (45/175) of those with the Lewis B phenotype and 32% (15/47) of the Lewis negative individuals (P < 0.01). Furthermore, following administration of the RV1 vaccine, secretor-positive ABO blood group B children seroconverted to a significantly lesser extent (5%) compared to secretor-positive children with ABO blood groups A (26%) and O (27%) (P < 0.05). Other factors such as pre-vaccination titers, sex, breastfeeding, and calprotectin levels did not influence vaccine-take. Differences in HBGA expression appear to be a contributing factor in the discrepancy in vaccine-take and thus, in vaccine efficacy in different ethnic populations.
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18
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Wylie KM, Stanley KM, TeKippe EM, Mihindukulasuriya K, Storch GA. Resurgence of Rotavirus Genotype G12 in St. Louis During the 2014-2015 Rotavirus Season. J Pediatric Infect Dis Soc 2017; 6:346-351. [PMID: 27988496 PMCID: PMC5907883 DOI: 10.1093/jpids/piw065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/27/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rotaviruses are a leading cause of gastroenteritis. Rotavirus vaccination has dramatically reduced rotavirus occurrence; however, we have noticed mild to moderate recurrences in the St. Louis area in alternate years. In 2013, we found rotavirus genotype G12 to be the dominant strain in the St. Louis region. In this study, we again determined the distribution of genotypes and ascertained vaccine history in patients infected with rotavirus G12 during the 2014-15 season. METHODS Samples submitted to the St. Louis Children's Hospital Microbiology Laboratory were tested for rotavirus using an antigen assay. We determined the VP7 genotype using amplicon sequence analysis. We determined genome sequences using high-throughput sequencing. We evaluated rotavirus immunization records when available. RESULTS Of 30 typed viruses from 2014-15, 29 were G12 (97%). Whole-genome sequencing revealed few changes from G12 viruses analyzed in 2012-13. VP4 and VP7 sequences were >99% identical to previously sequenced G12 strains from St. Louis, and immune epitopes were conserved. Vaccination histories were available from 17 patients. Of these, 4 had been vaccinated, 3 had received incomplete vaccination or had a vaccine history that could not be confirmed, and 10 had not been vaccinated. CONCLUSIONS G12 re-emerged as the predominant rotavirus genotype in 2014-15, comprising a higher percentage of cases than in 2012-13. The majority of patients with G12 and available vaccination histories were unvaccinated. There was no genomic evidence to indicate that the G12 strains in St. Louis had evolved to escape vaccine protection. Our work emphasizes the need for continued surveillance.
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Affiliation(s)
- Kristine M Wylie
- Department of Pediatrics,The McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri
| | | | - Erin McElvania TeKippe
- Departments of Pathology and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | | | - Gregory A Storch
- Department of Pediatrics,Correspondence: G. A. Storch, MD, The Department of Pediatrics, Washington University School of Medicine Campus Box 8208, 660 S. Euclid Avenue, St. Louis, MO 63110 ()
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19
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Durmaz R, Bakkaloglu Z, Unaldi O, Karagoz A, Korukluoglu G, Kalaycioglu AT, Acar S, Kilic S. Prevalence and diversity of rotavirus A genotypes cirulating in Turkey during a 2-year sentinel surveillance period, 2014-2016. J Med Virol 2017; 90:229-238. [PMID: 28892173 DOI: 10.1002/jmv.24945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/01/2017] [Indexed: 12/29/2022]
Abstract
Human rotavirus A (RVA) is the main etiological agent of watery diarrhea among children under 5 years of age worldwide. The aims of this study were to investigate the prevalence and diversity of RVA genotypes circulating in Turkey during a 2-year sentinel surveillance study. A total of 1639 rotavirus antigen-positive stool samples were obtained from children younger than 5 years of age hospitalized with acute gastroenteritis. Rotavirus G and P genotypes were determined by reverse transcription polymerase chain reaction (RT-PCR) with consensus primers for the VP7 and VP4 genes, followed by semi-nested type-specific multiplex PCR. Rotavirus RNA was detected in 1396 (85.3%) of the samples tested. The highest detection rate (38.2%) was obtained among children in the 0-12 months age group, followed by children in the 13-24 months age group (36.2%). The most prevalent genotype was G1P[8] (24.6%) followed by G3P[8] (19.6%), G9P[8] (12.2%), G2P[4] (9.5%), G2P[8] (6.5%), and G4P[8] (4.8%). The proportions of uncommon and mixed genotypes were 21.5% and 1.14%, respectively. The large number of genotypes observed, including common, uncommon, and mixed types, indicates a high heterogeneity of RVA strains circulating in Turkey. The current study also exhibited dramatic fluctuations on the prevalences of the common genotypes, with increases in G3 and G1 and decreases in G9 and G2 from 2014-2016.
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Affiliation(s)
- Riza Durmaz
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey.,Department of Medical Microbiology, Faculty of Medicine Yildirim Beyazit University, Ankara, Turkey
| | - Zekiye Bakkaloglu
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey
| | - Ozlem Unaldi
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey
| | - Alper Karagoz
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey
| | - Gulay Korukluoglu
- Virology Reference Central Laboratory, Public Health Agency of Turkey, Ankara, Turkey
| | - Atila T Kalaycioglu
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey.,Department of Basic Pharmaceutical Sciences, Faculty of Pharmacy, Karadeniz Technical University, Trabzon, Turkey
| | - Sumeyra Acar
- Molecular Microbiology Research and Applied Laboratory, Public Health Agency of Turkey, Ankara, Turkey
| | - Selcuk Kilic
- Microbiology Reference Laboratories, Public Health Agency of Turkey, Ankara, Turkey
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20
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The Association Between Fecal Biomarkers of Environmental Enteropathy and Rotavirus Vaccine Response in Nicaraguan Infants. Pediatr Infect Dis J 2017; 36:412-416. [PMID: 27977553 DOI: 10.1097/inf.0000000000001457] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Environmental enteropathy (EE) is a common intestinal condition among children living in low- and middle-income countries and is associated with diminished enteric immunity to gastrointestinal pathogens, and possibly to oral vaccine antigens. The goal of this study was to examine associations between biomarkers of EE and immunogenicity to the pentavalent rotavirus vaccine (RV5). METHODS Infants were recruited 1 day before their first RV5 immunization in León, Nicaragua, from public health rosters. Infants provided a preimmunization blood and stool sample, and a second blood sample 1 month after receipt of RV5. We measured immunoglobin A (IgA) seroconversion to the first dose of RV5 and concentrations of 4 previously identified fecal biomarkers of EE (alpha-1 antitrypsin, neopterin, myeloperoxidase and calprotectin). We then assessed associations between concentrations of these biomarkers, both individually and as combined scores, and seroconversion to the first dose of RV5. RESULTS Of the 43 enrolled infants, 24 (56%) seroconverted after the first dose of RV5. As compared with infants who seroconverted, those who did not seroconvert had higher median concentrations of both myeloperoxidase (3.1 vs. 1.1 µg/mL, P = 0.002) and calprotectin (199.1 vs. 156.2 µg/mL, P = 0.03). Further, those who did not seroconvert had a higher median combined score of the 4 biomarkers as compared with those who seroconverted (6.5 vs. 4.5, P = 0.017). CONCLUSIONS We found an association between biomarkers of EE and seroconversion to the first dose of RV5. It is possible that interventions that prevent or ameliorate EE may also improve oral rotavirus vaccine response.
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Bowen MD, Mijatovic-Rustempasic S, Esona MD, Teel EN, Gautam R, Sturgeon M, Azimi PH, Baker CJ, Bernstein DI, Boom JA, Chappell J, Donauer S, Edwards KM, Englund JA, Halasa NB, Harrison CJ, Johnston SH, Klein EJ, McNeal MM, Moffatt ME, Rench MA, Sahni LC, Selvarangan R, Staat MA, Szilagyi PG, Weinberg GA, Wikswo ME, Parashar UD, Payne DC. Rotavirus Strain Trends During the Postlicensure Vaccine Era: United States, 2008-2013. J Infect Dis 2016; 214:732-8. [PMID: 27302190 PMCID: PMC5075963 DOI: 10.1093/infdis/jiw233] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/26/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Group A rotaviruses (RVA) are a significant cause of pediatric gastroenteritis worldwide. The New Vaccine Surveillance Network (NVSN) has conducted active surveillance for RVA at pediatric hospitals and emergency departments at 3-7 geographically diverse sites in the United States since 2006. METHODS Over 6 consecutive years, from 2008 to 2013, 1523 samples from NVSN sites that were tested positive by a Rotaclone enzyme immunoassay were submitted to the Centers for Disease Control and Prevention for genotyping. RESULTS In the 2009, 2010, and 2011 seasons, genotype G3P[8] was the predominant genotype throughout the network, with a 46%-84% prevalence. In the 2012 season, G12P[8] replaced G3P[8] as the most common genotype, with a 70% prevalence, and this trend persisted in 2013 (68.0% prevalence). Vaccine (RotaTeq; Rotarix) strains were detected in 0.6%-3.4% of genotyped samples each season. Uncommon and unusual strains (eg, G8P[4], G3P[24], G2P[8], G3P[4], G3P[6], G24P[14], G4P[6], and G9P[4]) were detected sporadically over the study period. Year, study site, and race were found to be significant predictors of genotype. CONCLUSIONS Continued active surveillance is needed to monitor RVA genotypes in the United States and to detect potential changes since vaccine licensure.
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Affiliation(s)
- Michael D Bowen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mathew D Esona
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rashi Gautam
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Carol J Baker
- Texas Children's Hospital Baylor College of Medicine, Houston, Texas
| | | | - Julie A Boom
- Texas Children's Hospital Baylor College of Medicine, Houston, Texas
| | - James Chappell
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | | | | | | | | | - Mary E Moffatt
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Marcia A Rench
- Texas Children's Hospital Baylor College of Medicine, Houston, Texas
| | | | | | - Mary A Staat
- Cincinnati Children's Hospital Medical Center, Ohio
| | | | | | - Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Chenoll E, Casinos B, Bataller E, Buesa J, Ramón D, Genovés S, Fábrega J, Rivero Urgell M, Moreno Muñoz JA. Identification of a Peptide Produced by Bifidobacterium longum CECT 7210 with Antirotaviral Activity. Front Microbiol 2016; 7:655. [PMID: 27199974 PMCID: PMC4855034 DOI: 10.3389/fmicb.2016.00655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/19/2016] [Indexed: 12/21/2022] Open
Abstract
Rotavirus is one of the main causes of acute diarrhea and enteritis in infants. Currently, studies are underway to assess the use of probiotics to improve rotavirus vaccine protection. A previous work demonstrated that the probiotic strain Bifidobacterium longum subsp. infantis CECT 7210 is able to hinder rotavirus replication both in vitro and in vivo. The present study takes a systematic approach in order to identify the molecule directly involved in rotavirus inhibition. Supernatant protease digestions revealed both the proteinaceous nature of the active substance and the fact that the molecule responsible for inhibiting rotavirus replication is released to the supernatant. Following purification by cationic exchange chromatography, active fractions were obtained and the functional compound was identified as an 11-amino acid peptide (MHQPHQPLPPT, named 11-mer peptide) with a molecular mass of 1.282 KDa. The functionality of 11-mer was verified using the synthesized peptide in Wa, Ito, and VA70 rotavirus infections of both HT-29 and MA-104 cell lines. Finally, protease activity was detected in B. longum subsp. infantis CECT 7210 supernatant, which releases 11-mer peptide. A preliminary identification of the protease is also included in the study.
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Affiliation(s)
- Empar Chenoll
- Department of AgroFood Biotechnology, Biópolis S.L. Valencia, Spain
| | - Beatriz Casinos
- Department of AgroFood Biotechnology, Biópolis S.L. Valencia, Spain
| | - Esther Bataller
- Department of AgroFood Biotechnology, Biópolis S.L. Valencia, Spain
| | - Javier Buesa
- Department of Microbiology, School of Medicine, University of Valencia - Hospital Clínico Universitario Valencia, Spain
| | - Daniel Ramón
- Department of AgroFood Biotechnology, Biópolis S.L. Valencia, Spain
| | - Salvador Genovés
- Department of AgroFood Biotechnology, Biópolis S.L. Valencia, Spain
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23
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Langa JS, Thompson R, Arnaldo P, Resque HR, Rose T, Enosse SM, Fialho A, de Assis RMS, da Silva MFM, Leite JPG. Epidemiology of rotavirus A diarrhea in Chókwè, Southern Mozambique, from February to September, 2011. J Med Virol 2016; 88:1751-8. [PMID: 27003797 DOI: 10.1002/jmv.24531] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 11/12/2022]
Abstract
Acute diarrhea disease caused by Rotaviruses A (RVA) is still the leading cause of morbidity and mortality in children ≤5 years old in developing countries. An exploratory cross-sectional study was conducted between February and September, 2011 to determine the proportion of acute diarrhea caused by RVA. A total of 254 stool specimens were collected from children ≤5 years old with acute diarrhea, including outpatients (222 children) and inpatients (32 children), in three local health centers in Chókwè District, Gaza Province, South of Mozambique. RVA antigens were detected using enzyme immunoassay (EIA); the RVA G (VP7) and P (VP4) genotypes were determined by RT-PCR or analysis sequencing. Sixty (24%) out of 254 fecal specimens were positive for RVA by EIA; being 58 (97%) from children ≤2 years of age. RVA prevalence peaks in June and July (coldest and drier months) and the G[P] binary combination observed were G12P[8] (57%); G1P[8] (9%); G12P[6] (6%); and 2% for each of the following genotypes: G1P[6], G2P[6] G4P[6], and G9P[8]. Non-Typeable (NT) G and/or P genotypes were observed as follows: G12P [NT] (6%); G1P [NT], G3P[NT] and GNTP[NT] (4%). Considering the different GP combinations, G12 represented 67% of the genotypes. This is the first data showing the diversity of RVA genotypes in Mozambique highlighting the epidemiological importance of these viruses in acute diarrhea cases in children ≤2 years old. In addition, these findings will provide a baseline data before the introduction of the RVA monovalent (Rotarix(®) ) vaccine in the National Immunization Program in September 2015. J. Med. Virol. 88:1751-1758, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jerónimo S Langa
- Chokwe Health Research and Training Centre (CITSC), National Institute of Health, Maputo, Mozambique.,Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Ricardo Thompson
- Chokwe Health Research and Training Centre (CITSC), National Institute of Health, Maputo, Mozambique
| | - Paulo Arnaldo
- Chokwe Health Research and Training Centre (CITSC), National Institute of Health, Maputo, Mozambique
| | - Hugo Reis Resque
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Virology Section, Evandro Chagas Institute, Ananindeua, Pará, Brazil
| | - Tatiana Rose
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Sonia M Enosse
- Chokwe Health Research and Training Centre (CITSC), National Institute of Health, Maputo, Mozambique
| | - Alexandre Fialho
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | | | - Marcelle Figueira Marques da Silva
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.,Faculty of Biology, Laboratory of Virus Contaminants of Water and Food, University of Barcelona, Barcelona, Spain
| | - José Paulo Gagliardi Leite
- Laboratory of Comparative and Environmental Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
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24
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Desselberger U. 6th European Rotavirus Biology Meeting, Dijon, France, 17–20 May 2015. Future Virol 2015. [DOI: 10.2217/fvl.15.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The European Rotavirus Biology Meeting was established 12 years ago and takes place biannually. Approximately 100 scientists, medical doctors and students of biomedical sciences from 28 countries of five continents participated in this meeting, which was efficiently organized by Pierre Pothier and his staff. Their hospitality and inventive social program were highly appreciated. The aim of the meeting was to review and discuss new developments of rotavirus (RV) research, pathophysiology, immunology, molecular epidemiology and prevention.
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Affiliation(s)
- Ulrich Desselberger
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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25
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Bucardo F, Nordgren J. Impact of vaccination on the molecular epidemiology and evolution of group A rotaviruses in Latin America and factors affecting vaccine efficacy. INFECTION GENETICS AND EVOLUTION 2015; 34:106-13. [PMID: 26079278 DOI: 10.1016/j.meegid.2015.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 12/15/2022]
Abstract
Despite high rotavirus (RV) vaccine coverage (∼83%) and good effectiveness (∼77%) against RV-diarrhea hospitalization, RV is still contributing to the burden of diarrhea that persists in hospital settings in several Latin American countries, where RV vaccination is being implemented. Due to the extensive genomic and antigenic diversity, among co-circulating human RV, a major concern has been that the introduction of RV vaccination could exert selection pressure leading to higher prevalence of strains not included in the vaccines and/or emergence of new strains, thus, reducing the efficacy of vaccination. Here we review the molecular epidemiology of RV in Latin America and explore issues of RV evolution and selection in light of vaccination. We further explore etiologies behind the large burden of diarrhea remaining after vaccination in some countries and discuss plausible reasons for vaccine failures.
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Affiliation(s)
- Filemón Bucardo
- Department of Microbiology, National Autonomous University of León, Nicaragua (UNAN-León), Nicaragua.
| | - Johan Nordgren
- Division of Molecular Virology, Clinical and Experimental Medicine, Medical Faculty University of Linköping, 581 85 Linköping, Sweden
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