TY - JOUR
T1 - Enteropathogen Changes After Rotavirus Vaccine Scale-up
AU - Ballard, Sarah Blythe
AU - Requena, David
AU - Mayta, Holger
AU - Sanchez, Gerardo
AU - Oyola-Lozada, Maria
AU - Colquechagua, Fabiola
AU - Cabrera, Lilia
AU - Vittet Mondonedo, Macarena D.
AU - Taquiri, Carmen
AU - Tilley, Drake H.
AU - Simons, Mark P.
AU - Meza, Rina A.
AU - Bern, Caryn
AU - Saito, Mayuko
AU - Figueroa-Quintanilla, Dante A.
AU - Gilman, Robert H.
N1 - Publisher Copyright:
© 2022 American Academy of Pediatrics. All rights reserved.
PY - 2022/1/1
Y1 - 2022/1/1
N2 - 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 5 .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 5 .0002] and Clark [12.0 vs 11.4; P 5 .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.
AB - 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 5 .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 5 .0002] and Clark [12.0 vs 11.4; P 5 .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.
UR - http://www.scopus.com/inward/record.url?scp=85123226699&partnerID=8YFLogxK
U2 - 10.1542/peds.2020-049884
DO - 10.1542/peds.2020-049884
M3 - Article
C2 - 34918158
AN - SCOPUS:85123226699
SN - 0031-4005
VL - 149
JO - Pediatrics
JF - Pediatrics
IS - 1
M1 - e2020049884
ER -