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Effect of rotavirus vaccination on circulating virus strains

2008; Elsevier BV; Volume: 371; Issue: 9609 Linguagem: Inglês

10.1016/s0140-6736(08)60164-6

1474-547X

Ricardo Queiroz Gurgel, Jailson B. Correia, Luís E. Cuevas,

Animal Virus Infections Studies

T Vesikari and colleagues (Nov 24, p 1757)1Vesikari T Karvonen A Prymula R et al.Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study.Lancet. 2007; 370: 1757-1763Summary Full Text Full Text PDF PubMed Scopus (533) Google Scholar confirm the efficacy of the Rotarix vaccine—an oral live attenuated human rotavirus vaccine containing the G1P[8] strain—against rotavirus gastroenteritis in Europe. In an accompanying Comment, Keith Grimwood and Julie Bines2Grimwood K Bines JE Rotavirus vaccines must perform in low-income countries too.Lancet. 2007; 370: 1739-1740Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar stress that, despite these encouraging findings, evidence for the efficacy of these vaccines in Africa and Asia is necessary before their introduction can be recommended. A further concern is that, in areas with high prevalence and strain diversity, vaccines targeting specific G and P genotypes could result in selection of genotypes for which the vaccines have limited efficacy.3Ruiz-Palacios GM Perez-Schael I Velazquez FR et al.Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis.N Engl J Med. 2006; 354: 11-22Crossref PubMed Scopus (1543) Google ScholarBrazil introduced a rotavirus vaccine in 2006 and we have since monitored rotavirus strains in children with diarrhoea attending two hospitals in Aracaju4Gurgel RQ Cuevas LE Vieira SCF et al.Predominance of Rotavirus P[4]G2 in a Vaccinated Population, Brazil.Emerg Infect Dis. 2007; 13: 1571-1573Crossref PubMed Scopus (136) Google Scholar and Recife5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google Scholar, in northeast Brazil. In Aracaju, between October, 2006, and September, 2007, 43 (13%) of 341 samples were positive for rotavirus; 41 were G2P[4], one G2P[non-typeable, NT], and one GNTP[NT]. In Recife, 14 (4%) of 345 samples were rotavirus-positive; 11 were G2P[4]5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google Scholar and one each G2P[NT], GNTP[4], and GNTP[NT]. The proportion of rotavirus cases varied with time, 21 (16%) of 129 samples were positive in the first 4–7 months,4Gurgel RQ Cuevas LE Vieira SCF et al.Predominance of Rotavirus P[4]G2 in a Vaccinated Population, Brazil.Emerg Infect Dis. 2007; 13: 1571-1573Crossref PubMed Scopus (136) Google Scholar and 20 (9%) of 212 in subsequent months in Aracaju. The number of cases of diarrhoea and the proportion that were due to rotavirus were lower than those before the vaccine's introduction.5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google ScholarThis is the first time that a single genotype has been consistently recovered in two separate settings over 1 year. The immunological pressure exerted by the vaccines might have resulted in the selection of strains for which the vaccine is less effective. Although its importance is uncertain, given the unparalleled opportunity to control rotavirus with vaccines, robust surveillance to monitor changes in the ecology of rotavirus infections is crucial to inform immunisation polices.We declare that we have no conflict of interest. T Vesikari and colleagues (Nov 24, p 1757)1Vesikari T Karvonen A Prymula R et al.Efficacy of human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in European infants: randomised, double-blind controlled study.Lancet. 2007; 370: 1757-1763Summary Full Text Full Text PDF PubMed Scopus (533) Google Scholar confirm the efficacy of the Rotarix vaccine—an oral live attenuated human rotavirus vaccine containing the G1P[8] strain—against rotavirus gastroenteritis in Europe. In an accompanying Comment, Keith Grimwood and Julie Bines2Grimwood K Bines JE Rotavirus vaccines must perform in low-income countries too.Lancet. 2007; 370: 1739-1740Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar stress that, despite these encouraging findings, evidence for the efficacy of these vaccines in Africa and Asia is necessary before their introduction can be recommended. A further concern is that, in areas with high prevalence and strain diversity, vaccines targeting specific G and P genotypes could result in selection of genotypes for which the vaccines have limited efficacy.3Ruiz-Palacios GM Perez-Schael I Velazquez FR et al.Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis.N Engl J Med. 2006; 354: 11-22Crossref PubMed Scopus (1543) Google Scholar Brazil introduced a rotavirus vaccine in 2006 and we have since monitored rotavirus strains in children with diarrhoea attending two hospitals in Aracaju4Gurgel RQ Cuevas LE Vieira SCF et al.Predominance of Rotavirus P[4]G2 in a Vaccinated Population, Brazil.Emerg Infect Dis. 2007; 13: 1571-1573Crossref PubMed Scopus (136) Google Scholar and Recife5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google Scholar, in northeast Brazil. In Aracaju, between October, 2006, and September, 2007, 43 (13%) of 341 samples were positive for rotavirus; 41 were G2P[4], one G2P[non-typeable, NT], and one GNTP[NT]. In Recife, 14 (4%) of 345 samples were rotavirus-positive; 11 were G2P[4]5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google Scholar and one each G2P[NT], GNTP[4], and GNTP[NT]. The proportion of rotavirus cases varied with time, 21 (16%) of 129 samples were positive in the first 4–7 months,4Gurgel RQ Cuevas LE Vieira SCF et al.Predominance of Rotavirus P[4]G2 in a Vaccinated Population, Brazil.Emerg Infect Dis. 2007; 13: 1571-1573Crossref PubMed Scopus (136) Google Scholar and 20 (9%) of 212 in subsequent months in Aracaju. The number of cases of diarrhoea and the proportion that were due to rotavirus were lower than those before the vaccine's introduction.5Nakagomi T, Cuevas LE, Gurgel RQ, et al. Apparent extinction of non-G2 rotavirus strains from circulation in Recife, Brazil, after the introduction of rotavirus vaccine. Arch Virol (in press).Google Scholar This is the first time that a single genotype has been consistently recovered in two separate settings over 1 year. The immunological pressure exerted by the vaccines might have resulted in the selection of strains for which the vaccine is less effective. Although its importance is uncertain, given the unparalleled opportunity to control rotavirus with vaccines, robust surveillance to monitor changes in the ecology of rotavirus infections is crucial to inform immunisation polices. We declare that we have no conflict of interest.