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Secular Variation in United States Rotavirus Disease Rates and Serotypes: Implications for Assessing the Rotavirus Vaccination Program

Payne, Daniel C. PhD, MSPH*; Szilagyi, Peter G. MD, MPH; Staat, Mary Allen MD, MPH; Edwards, Kathryn M. MD§; Gentsch, Jon R. PhD; Weinberg, Geoffrey A. MD; Hall, Caroline B. MD; Curns, Aaron T. MPH*; Clayton, Haley MPH*∥; Griffin, Marie R. MD, MPH**; Fairbrother, Gerry PhD; Parashar, Umesh D. MB BS, MPH*

The Pediatric Infectious Disease Journal: November 2009 - Volume 28 - Issue 11 - p 948-953
doi: 10.1097/INF.0b013e3181a6ad6e
Original Studies

Background: Since 2006, we have conducted population-based surveillance for rotavirus disease in children seen in hospitals and emergency departments (EDs) in Monroe County, NY (Rochester), Hamilton County, OH (Cincinnati), and Davidson County, TN (Nashville).

Methods: During the 2006 and 2007 rotavirus seasons, clinical information and stool specimens were obtained from county children who were <3 years presenting with diarrhea and/or vomiting to the hospital or ED of the only children's hospital in each county. Specimens were tested for rotavirus and genotyped, and rates of hospitalization and ED visits were calculated.

Results: While aggregate rotavirus hospitalization rates for the 3 sites were similar in 2006 and 2007 (22.5/10,000 and 26.8/10,000, respectively), individual rates for the 3 counties differed considerably. The rotavirus hospitalization rate in Rochester between 2006 and 2007 increased 3-fold, but decreased by 33% in Cincinnati and 41% in Nashville over the 2 study years. G1 strains accounted for >80% of strains at all 3 sites in 2006. However, in 2007, the uncommon P[8], G12 strain was detected in 69% of Rochester specimens, while the P[8], G1 strain remained predominant in the other 2 sites. No subjects received rotavirus vaccine in 2006 and coverage with 2 to 3 vaccine doses reached 15% in all 3 communities by June 2007.

Conclusions: During the 2006 and 2007 rotavirus seasons, with only limited vaccine use, remarkable variability was observed in the population-based rates of severe rotavirus and in the rotavirus serotypes across the 3 sites. This natural secular variability in rotavirus disease must be considered in the assessment of the impact of vaccine on disease rates and rotavirus serotypes.


From the *Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA; †Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; ‡Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; §Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; ¶Gastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA; ∥Atlanta Research and Education Foundation, Decatur, GA; and **Departments of Preventive Medicine and Medicine, Vanderbilt University Medical Center, Nashville, TN.

Accepted for publication March 23, 2009.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Address for correspondence: Daniel C. Payne, PhD, MSPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, MS–A47, Atlanta, GA 30333. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.