Assessment of the epidemic potential of a new strain of rotavirus associated with the novel G9 serotype which caused an outbreak in the United States for the first time in the 1995-1996 season

Abstract

Rotavirus causes severe morbidity in developed countries and frequent deaths (> or = 500,000 per year) in less-developed countries. Historically, four serotypes--G1, G2, G3, and G4-have predominated; they are distinguished by one of two surface neutralization antigens (VP7). However, in 1983 and 1984 we described a new rotavirus serotype, designated G9, in five children hospitalized for diarrhea in Philadelphia, Pa. G9 rotavirus was not identified again in the Western Hemisphere until it caused ca. 50% of the rotavirus disease detected in Philadelphia in the 1995-1996 season. This outbreak allowed us to question whether a rotavirus strain completely new to a well-studied community would target either very young infants or older children, cause especially severe disease, or completely displace previously extant serotypes. We observed a significant excess of G9 infections in younger infants (especially in those < 6 months old) that might be attributed to the lack of G9-specific antibodies in mothers. Of further note, six of the seven oldest patients with rotavirus diarrhea were infected with the G9 strains (not significant). However, the age distribution of children with rotavirus did not differ over a 5-year study period regardless of the infecting serotype. Patients with diarrhea associated with G9 strains did not have disease more severe than that caused by the G1, G2, or G3 serotype. G9 strains did not displace the other serotypes but were virtually completely replaced by G1 or G2 serotypes in the three subsequent rotavirus seasons. We conclude that the abrupt appearance of this novel rotavirus serotype did not present a special threat to public health in the community.

FIG. 1.

(A) Distribution of rotavirus G types during five seasons (1994 to 1999). Values for mixtures and values not determined are not included in these pie graphs. In the 1995-1996 season only, all specimens (i.e., those with or without complete electropherotypes) were also serotyped by RT-PCR. (B) Monthly distribution of rotavirus strains by G type (for the year 1995-1996). Undetermined values were not included in the pie graphs.

FIG. 2.

Age distribution of patients with rotavirus-induced diarrhea infected with G9 versus non-G9 serotypes in the 1995-1996 season.

FIG. 3.

Severity score for four G4 types in the 1995-1996 season.

FIG. 4.

Age distributions for infants from 0 to 24 months old for five seasons.