TY - JOUR
T1 - Effectiveness of Pentavalent Rotavirus Vaccine Against a Diverse Range of Circulating Strains in Nicaragua
AU - Patel, Manish
AU - Pedreira, Cristina
AU - De Oliveira, Lúcia Helena
AU - Tate, Jacqueline
AU - Leshem, Eyal
AU - Mercado, Juan
AU - Umaña, Jazmina
AU - Balmaceda, Angel
AU - Reyes, Martha
AU - Kerin, Tara
AU - McDonald, Sharla
AU - Gentsch, Jon
AU - Bowen, Michael D.
AU - Parashar, Umesh
N1 - Publisher Copyright:
© 2016 Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Background. Because >60 rotavirus strains have been reported worldwide, concerns exist about strain replacement after the introduction of rotavirus vaccines, particularly in developing countries with diverse strains and lower efficacy. Methods. We used the case-control design in 4 hospitals in Nicaragua to assess strain-specific vaccine effectiveness (VE) of a pentavalent rotavirus vaccine (RotaTeq) against rotavirus diarrhea. Cases were identified through prospective strain surveillance with reverse transcription-polymerase chain reaction for 3 years among children hospitalized for diarrhea, and controls were children negative for rotavirus. Results. We enrolled 1178 case-patients, 1082 (92%) with G and P typing, and 4927 controls. A different strain predominated each year with increasing age of the vaccine-eligible cohort during the study period: G2P[4] in 2008 (97%; mean age, 11.9 months), G1P[8] in 2009 (55%; mean age, 17.0 months), and G3P[8] in 2010 (78%; mean age, 17.3 months). Overall VE was 45% (95% confidence interval, 25%-59%). Regardless of the strain, VE estimates were 12%-79% lower among children aged ≥12 months relative to those 6-11 months of age. The lower VE for G3P[8] was related to the higher mean age of cases (17.3 months) compared with the G2P[4] strains (11.9 months), with a significant trend (R2 = 0.819; P <. 001) of declining effectiveness with increasing mean age of the cases. Conclusions. Introduction of RotaTeq did not result in sustained emergence of any particular strain in Nicaragua. Variation in strain-specific effectiveness was due to an age-related decline in effectiveness rather than differences in protection against the observed strains.
AB - Background. Because >60 rotavirus strains have been reported worldwide, concerns exist about strain replacement after the introduction of rotavirus vaccines, particularly in developing countries with diverse strains and lower efficacy. Methods. We used the case-control design in 4 hospitals in Nicaragua to assess strain-specific vaccine effectiveness (VE) of a pentavalent rotavirus vaccine (RotaTeq) against rotavirus diarrhea. Cases were identified through prospective strain surveillance with reverse transcription-polymerase chain reaction for 3 years among children hospitalized for diarrhea, and controls were children negative for rotavirus. Results. We enrolled 1178 case-patients, 1082 (92%) with G and P typing, and 4927 controls. A different strain predominated each year with increasing age of the vaccine-eligible cohort during the study period: G2P[4] in 2008 (97%; mean age, 11.9 months), G1P[8] in 2009 (55%; mean age, 17.0 months), and G3P[8] in 2010 (78%; mean age, 17.3 months). Overall VE was 45% (95% confidence interval, 25%-59%). Regardless of the strain, VE estimates were 12%-79% lower among children aged ≥12 months relative to those 6-11 months of age. The lower VE for G3P[8] was related to the higher mean age of cases (17.3 months) compared with the G2P[4] strains (11.9 months), with a significant trend (R2 = 0.819; P <. 001) of declining effectiveness with increasing mean age of the cases. Conclusions. Introduction of RotaTeq did not result in sustained emergence of any particular strain in Nicaragua. Variation in strain-specific effectiveness was due to an age-related decline in effectiveness rather than differences in protection against the observed strains.
KW - RotaTeq
KW - diarrhea
KW - rotavirus
KW - strains
KW - vaccine effectiveness
UR - http://www.scopus.com/inward/record.url?scp=84965155946&partnerID=8YFLogxK
U2 - 10.1093/cid/civ1017
DO - 10.1093/cid/civ1017
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C2 - 27059346
AN - SCOPUS:84965155946
SN - 1058-4838
VL - 62
SP - S127-S132
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -