Evaluation of the Influence of Gastrointestinal Co-Infections on Rotavirus Vaccine Effectiveness in Botswana.

TitleEvaluation of the Influence of Gastrointestinal Co-Infections on Rotavirus Vaccine Effectiveness in Botswana.
Publication TypeJournal Article
Year of Publication2018
AuthorsMokomane M, Tate JE, Steenhoff AP, Esona MD, Bowen MD, Lechiile K, Pernica JM, Kasvosve I, Parashar UD, Goldfarb DM
JournalPediatr Infect Dis J
Start Pagee58
Date Published2018 Mar

BACKGROUND: Studies have demonstrated reduced rotavirus vaccine effectiveness (VE) in resource-limited settings. Enteropathogen co-infections in rotavirus cases have been hypothesized to contribute to the lower vaccine effectiveness in such settings. We sought to determine if co-infections affect rotavirus VE in Botswana.

METHODS: Between June 2013 and April 2015, children <60 months old, presenting with severe gastroenteritis at four hospitals as part of a national rotavirus surveillance were enrolled. Rotavirus EIA positive samples were tested with an in-house real-time polymerase chain reaction (PCR) panel that detected nine pathogens and a commercial 15 multiplex PCR gastrointestinal pathogen panel (GPP). Co-infection was defined as detection of rotavirus plus one of the five pathogens with the highest attributable fractions for diarrhea. Vaccine status was compared between rotavirus case patients and non-rotavirus "test-negative" controls. Vaccine effectiveness was also calculated restricting cases to those with rotavirus as the only pathogen detected.

RESULTS: 242 children tested rotavirus EIA positive and 368 children were negative. Of the 182 rotavirus EIA-positive samples tested with the GPP assay, co-infections were detected in60 (33%). The overall adjusted 2-dose VE was 59% (95% CI 27-77) in the rotavirus co-infection group and 51% (95% CI -14-79) in the rotavirus mono-infection subgroup. Using in-house multiplex PCR panel, out of 213 rotavirus EIA positive subjects, co-infections were detected in 98 samples (46%). The overall adjusted VE for two doses was 48% (95% CI -2-74) and 62% (95% CI 25-80) in rotavirus mono-infection subgroup.

CONCLUSIONS: We could not find evidence of an effect of enteric co-infections on the effectiveness of rotavirus vaccine.

PubMed ID29189612