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. 2022 Jan 1;149(1):e2020049884.
doi: 10.1542/peds.2020-049884.

Enteropathogen Changes After Rotavirus Vaccine Scale-up

Sarah-Blythe Ballard  1   2   3 , David Requena  1 , Holger Mayta  4   5 , Gerardo J Sanchez  4 , Maria G Oyola-Lozada  4 , Fabiola D Colquechagua Aliaga  5 , Lilia Cabrera  5 , Macarena D Vittet Mondonedo  4 , Carmen Taquiri  4 , Capt Drake H Tilley  3   6 , Cdr Mark P Simons  3 , Rina A Meza  3 , Caryn Bern  7 , Mayuko Saito  4   8 , Dante A Figueroa-Quintanilla  9 , Robert H Gilman  1   4   5
Affiliations

Enteropathogen Changes After Rotavirus Vaccine Scale-up

Sarah-Blythe Ballard et al. Pediatrics. .

Abstract

Objectives: To inform next steps in pediatric diarrhea burden reduction by understanding the shifting enteropathogen landscape after rotavirus vaccine implementation.

Methods: We conducted a case-control study of 1788 medically attended children younger than 5 years, with and without gastroenteritis, after universal rotavirus vaccine implementation in Peru. We tested case and control stools for 5 viruses, 19 bacteria, and parasites; calculated coinfection-adjusted attributable fractions (AFs) to determine pathogen-specific burdens; and evaluated pathogen-specific gastroenteritis severity using Clark and Vesikari scales.

Results: Six pathogens were independently positively associated with gastroenteritis: norovirus genogroup II (GII) (AF 29.1, 95% confidence interval [CI]: 28.0-32.3), rotavirus (AF 8.9, 95% CI: 6.8-9.7), sapovirus (AF 6.3, 95% CI: 4.3-7.4), astrovirus (AF 2.8, 95% CI: 0.0-4.0); enterotoxigenic Escherichia coli heat stable and/or heat labile and heat stable (AF 2.4, 95% CI: 0.6-3.1), and Shigella spp. (AF 2.0, 95% CI: 0.4-2.2). Among typeable rotavirus cases, we most frequently identified partially heterotypic strain G12P[8] (54 of 81, 67%). Mean severity was significantly higher for norovirus GII-positive cases relative to norovirus GII-negative cases (Vesikari [12.7 vs 11.8; P < .001] and Clark [11.7 vs 11.4; P = .016]), and cases in the 6- to 12-month age range relative to cases in other age groups (Vesikari [12.7 vs 12.0; P = .0002] and Clark [12.0 vs 11.4; P = .0016]).

Conclusions: Norovirus is well recognized as the leading cause of pediatric gastroenteritis in settings with universal rotavirus vaccination. However, sapovirus is often overlooked. Both norovirus and sapovirus contribute significantly to the severe pediatric disease burden in this setting. Decision-makers should consider multivalent vaccine acquisition strategies to target multiple caliciviruses in similar countries after successful rotavirus vaccine implementation.

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Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Norovirus (solid line), norovirus GII (dashed line), and norovirus GII.4 (dotted line) prevalence among children younger than 5 years with medically attended gastroenteritis over time, Peru 2013–2015.
FIGURE 2
FIGURE 2
Rotavirus (solid line) and rotavirus G12P8 (dashed line) prevalence among children younger than 5 years with medically attended gastroenteritis over time, Peru, 2013–2015.
FIGURE 3
FIGURE 3
Sapovirus (solid line), astrovirus (dashed line), and aichivirus (dotted line) prevalence among children younger than 5 years with medically attended gastroenteritis over time, Peru, 2013–2015.
See this image and copyright information in PMC

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