Enteropathogen Changes After Rotavirus Vaccine Scale-up

Sarah Blythe Ballard*, David Requena, Holger Mayta, Gerardo Sanchez, Maria Oyola-Lozada, Fabiola Colquechagua, Lilia Cabrera, Macarena D. Vittet Mondonedo, Carmen Taquiri, Drake H. Tilley, Mark P. Simons, Rina A. Meza, Caryn Bern, Mayuko Saito, Dante A. Figueroa-Quintanilla, Robert H. Gilman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


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.

Original languageEnglish
Article numbere2020049884
Issue number1
StatePublished - 1 Jan 2022
Externally publishedYes


Dive into the research topics of 'Enteropathogen Changes After Rotavirus Vaccine Scale-up'. Together they form a unique fingerprint.

Cite this