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. 2014 Oct 31;9(10):e110217.
doi: 10.1371/journal.pone.0110217. eCollection 2014.

Incidence of rotavirus and circulating genotypes in Northeast Brazil during 7 years of national rotavirus vaccination

Ricardo Q Gurgel  1 , Alberto De Juan Alvarez  2 , Alda Rodrigues  1 , Robergson R Ribeiro  1 , Sílvio S Dolabella  1 , Natanael L Da Mota  1 , Victor S Santos  1 , Miren Iturriza-Gomara  3 , Nigel A Cunliffe  3 , Luis E Cuevas  2
Affiliations

Incidence of rotavirus and circulating genotypes in Northeast Brazil during 7 years of national rotavirus vaccination

Ricardo Q Gurgel et al. PLoS One. .

Abstract

Background and aims: Rotavirus causes severe diarrhoea and Brazil introduced the Rotarix G1P[8] vaccine in 2006. We aimed to describe changes in rotavirus incidence and diarrhoea epidemiology before and after vaccine introduction.

Design: (i) hospital-based survey of children with diarrhoea (2006-2012); (ii) diarrhea-mortality and hospitalization surveillance (1999-2012).

Setting: (i) Aracaju and (ii) state and national level.

Results: 1841 children were enrolled and 231 (12.5%) had rotavirus. Rotavirus was less frequent from January-June than from July-December (9.4% versus 20.9%, p<0.01), but the seasonal variation was less defined after 2009. Very few rotavirus cases (8-3.9%) were detected in 2011, with an increase in 2012 (13-18.5%). In 2006, unvaccinated children were more likely to have rotavirus, but thereafter unvaccinated and vaccinated children had equally low incidence. Older children and those with rotavirus were more likely to have severe diarrhea episodes. The most frequent genotype from 2006 to 2010 was G2P[4]; except in 2009, when most cases were G1P[8]. Very few G2P[4] were detected from 2011 and 50% cases in 2012 were G8P[4]. Diarrhoea-hospitalizations decreased nationally from 89,934 (2003) to 53,705 (2012; 40.3% reduction) and in the state from 1729 to 748 (56.7% reduction). Diarrhoea-deaths decreased nationally from 4368 in 1999 to 697 in 2012 (84% reduction, p<0.001) and in the state from 132 to 18 (86% reduction). These changes were much larger after vaccine introduction.

Conclusions: The vaccine was associated with substantial reductions in rotavirus incidence and diarrhoea-hospitalizations and deaths. The G2P[4] genotype predominance disappeared over time and may be replaced by other heterotypic genotypes.

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Conflict of interest statement

Competing Interests: Prof Cunliffe received research grant support from GSK for the evaluation of rotavirus vaccination in Malawi and UK and has received honoraria from GSK for participation in rotavirus vaccine advisory board meetings. Dr. Iturriza Gomara reports grants from SPMSD and grants from GSK, outside the submitted work; all other authors have no conflicts of interest to declare. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Number of children enrolled and proportion with rotavirus infection by month, November 2006 to April 2012.
The arrow illustrates the date of vaccine introduction.
Figure 2
Figure 2. Proportion of (a) non-vaccinated and (b) vaccinated children attending the hospital with rotavirus, by age and year.
Percentages for 2012 are incomplete (to March, represented by a dotted line). Arrows illustrate the vaccine introduction.
Figure 3
Figure 3. Proportion of vaccinated and non-vaccinated children attending the Emergency service with severe diarrhea, by age and presence of rotavirus.
Figure 4
Figure 4. Childhood (<5 years old) all cause and diarrhea deaths and hospitalizations in Brazil, Sergipe and Aracaju City.
Arrows illustrate the year of vaccine introduction.
See this image and copyright information in PMC

References

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