Journal Article

Case-Control Evaluation of the Effectiveness of the G1P[8] Human Rotavirus Vaccine during an Outbreak of Rotavirus G2P[4] Infection in Central Australia

T. L. Snelling, R. M. Andrews, C. D. Kirkwood, S. Culvenor and J. R. Carapetis

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 52, issue 2, pages 191-199
Published in print January 2011 | ISSN: 1058-4838
Published online January 2011 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1093/cid/ciq101
Case-Control Evaluation of the Effectiveness of the G1P[8] Human Rotavirus Vaccine during an Outbreak of Rotavirus G2P[4] Infection in Central Australia

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Summary. The human rotavirus vaccine was evaluated during an outbreak of rotavirus G2P[4] infection in central Australia. No overall protective effect against hospitalization was demonstrated, raising concerns over the durability of vaccine protection against heterotypic strains.

Background. Two and a half years after commencing routine vaccination with human rotavirus vaccine, an outbreak of rotavirus G2P[4] infection occurred in central Australia. Vaccine effectiveness against a P[8]-containing strain (G9P[8]) had been demonstrated previously in this setting. This subsequent outbreak provided the opportunity to evaluate vaccine effectiveness against hospitalizations for a non–vaccine-related genotype in the same population.

Methods. A case-control study was nested within a cohort of vaccine-eligible children listed on a population-based immunization register. Children with rotavirus-confirmed gastroenteritis were individually matched by date of birth and Indigenous status with 4 control subjects.

Results. Forty-one cases met the inclusion criteria, and 21 were severe cases among infants aged <12 months. Nineteen (46%) of 41 case patients had received 2 doses of human rotavirus vaccine, compared with 87 (53%) of 164 control subjects. Vaccine effectiveness against rotavirus-related hospitalization was 19% (odds ratio, .81; 95% confidence interval, .32–2.05) for 2 doses compared with none. On secondary analysis, there was evidence of a protective effect against disease complicated by acidosis in the subset of infants aged <12 months (odds ratio, .15; 95% confidence interval, .03–.84).

Conclusions. Evidence was not found for an overall protective effect of human rotavirus vaccine against hospitalization for rotavirus disease in this setting. Post hoc analyses suggested a protective effect against severe disease in young infants.

Journal Article.  4496 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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