GENOTYPE DISTRIBUTION AND ROTAVIRUS GASTROENTERITIS HOSPITALIZATIONS FOUR YEARS AFTER VACCINATION IN SAO PAULO, BRAZIL
ESPID Education. Safadi M. Jun 7, 2011; 7784 Disclosure(s): The presenter has received grants/honoraria from GSK and MSD as a consultant, member of advisory boards and lecturer
Assoc. Prof. Marco Safadi
Assoc. Prof. Marco Safadi

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Abstract ________________________________________
Topic: 27. Vaccines and prevention
Title: GENOTYPE DISTRIBUTION AND ROTAVIRUS GASTROENTERITIS HOSPITALIZATIONS FOUR YEARS AFTER VACCINATION IN SAO PAULO, BRAZIL
Author(s): M.A.P. Safadi1, V. Munford2, T. Caruzo3, F.J. Almeida1, M. Mimica1, R.J. Sini de Almeida1, C. Finelli1, A. Simoes1, F. Farias1, E. Berezin1, M.L. Racz2
Institute(s): 1Pediatric Infectiuos Diseases, FCM da Santa Casa de Sao Paulo, 2Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, 3Virology, University of Campinas, Campinas, Brazil
Text: Background: Early effects, after implementation of rotavirus human vaccine in Brazil in 2006, were promising, showing a marked decline in rotavirus gastroenteritis (RVGE) hospitalizations among children aged < 5 years. A high predominance of G2P[4], probably reflecting natural annual fluctuation, was also observed. The aim of this study was to confirm the early impact of immunization on the incidence of severe RVGE and assess genotype distribution over time.

Methods: We performed a 7-year (2004 -2010) prospective surveillance, at two sentinel hospitals in Sao Paulo, monitoring the incidence of RVGE and acute gastroenteritis (AGE) hospitalizations among children younger than 5 years of age. Since 2006 genotypes of positive samples were determined by reverse transcription polymerase chain reaction.

Results: After vaccine introduction we observed a significant reduction in the proportion of rotavirus-positive results among children aged < 5 years hospitalized with RVGE of 42.2%*, 41.2%*, 70.2%* and 60.7%* (*p< 0.001), and a reduction in the number of all-cause hospitalizations for AGE of 29%, 28%, 39% and 40%, respectively from 2007 to 2010.
Genotype G2P[4] accounted for 8.8%, 58.8%, 73.7%, 75% and 66.7% of all cases identified, respectively, from 2006 to 2010.

Conclusions: Four years after vaccine implementation, a marked and sustained decline in RVGE hospitalizations was demonstrated among children aged < 5 years, confirming the early impact benefits of the vaccination. The intriguing persistent predominance of G2P[4], for four consecutive years after vaccine introduction, suggests the possibility that this continued dominance could be related not only to natural fluctuation, but also to vaccine selection. Continued surveillance studies will be crucial to correctly address the impact of oral rotavirus vaccination on the epidemiology of rotavirus disease and the distribution of circulating rotavirus genotypes.

Author Keywords: rotavirus gastroenteritis; rotavirus vaccine; surveillance; genotype; Brazil; children
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