Association between mixed rotavirus vaccination types of infants and rotavirus acute gastroenteritis

Abstract

Introduction: Rotavirus remains the leading cause of severe diarrhea in children under 5 years worldwide. In the US, Rotarix (RV1) and RotaTeq (RV5), have been associated with reductions in and severity of rotavirus disease. Studies have evaluated the impact of RV1 or RV5 but little is known about the impact of incomplete or mixed vaccination upon vaccine effectiveness.

Methods: Case control study to examine association of combined RV1 and RV5 and rotavirus acute gastroenteritis, factoring severity of diarrheal disease. Children born after March 1, 2009 with acute gastroenteritis from three pediatric hospitals in Atlanta, Georgia were approached for enrollment. Survey was administered, stool specimen was collected, and vaccination records were obtained.

Results: 891 of 1127 children with acute gastroenteritis were enrolled. Stool specimens were collected from 708 for rotavirus testing; 215 stool samples tested positively for rotavirus. Children >12 months of age were more likely to have rotavirus. Children categorized with Vesikari score of >11 were almost twice as likely to be rotavirus positive. Prior rotavirus vaccination decreased the mean Vesikari score, p<0.0001. Children with complete single type vaccination were protected against rotavirus (OR 0.21, 95% CI: 0.14-0.31, p<0.0001).

Conclusion: Complete rotavirus vaccination with a single vaccine type resulted in protection against rotavirus diarrhea and decrease in severity of rotavirus gastroenteritis. Incomplete rotavirus vaccination either with a single vaccine or mixed vaccination types also provided some protection.

Keywords: Acute gastroenteritis; Pediatric; Rotavirus; Rotavirus vaccination.

Fig. 1

Diagram of Patients Approached and Enrolled. From the 708 patients whose stool samples were collected, 10 individuals were excluded analysis due to not meeting enrollment criteria: one patient was younger than 55 days, three individuals had stool samples that were collected more than 14 days after enrollment, two patients had previously been enrolled in the study, and one patient was a twin whose twin sibling had been previously enrolled; three additional patients were excluded for not being in the state immunization registry and no provider vaccine record was provided. The majority of the legally authorized representatives who declined participation did so because they did not want to participate in research or for their child to submit a stool specimen.

Fig. 2

Epidemic curves for cases and controls for each year of rotavirus season. Cases were defined as test-positive rotavirus patients, and controls were defined as test-negative rotavirus patients.

Fig. 3

Density function of Vesikari scores. A score of 11 or higher on the Vesikari scale indicates severe disease.

Fig. 4

Density function of Vesikari scores of cases (Panel A) and controls (Panel B). A score of 11 or higher on the Vesikari scale indicates severe disease. Participants in the complete single vaccine type group received either two doses of the RV1 vaccine or three doses of the RV5 vaccine. Those in the complete mixed type vaccine group received two doses of the RV5 vaccine and one dose of the RV1 vaccine.