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Rotavirus Vaccine Effectiveness and Case-control Study on Risk Factors for Breakthrough Infections in Germany, 2010–2011

Adlhoch, Cornelia VMD*†; Hoehne, Marina PhD; Littmann, Martina MD§; Marques, Andreas Mas PhD; Lerche, Almuth§; Dehnert, Manuel PhD; Eckmanns, Tim MD; Wichmann, Ole MD, MCTM**; Koch, Judith MD**

The Pediatric Infectious Disease Journal: February 2013 - Volume 32 - Issue 2 - p e82–e89
doi: 10.1097/INF.0b013e3182720b71
Vaccine Reports

Background: In the German federal state Mecklenburg-Western Pomerania, routine rotavirus (RV) vaccination in infants has been recommended since 2009. The effectiveness of RV vaccination was investigated after an unexpectedly high number of RV infections in fully vaccinated children occurred.

Methods: Intensified RV surveillance was performed in Mecklenburg-Western Pomerania between 2010 and 2011. The screening method was applied to assess vaccine effectiveness (VE) in children up to 24 months after vaccination. To identify risk factors for breakthrough infections, a case-control study and genotyping were conducted in vaccinated and unvaccinated RV-infected children.

Results: VE for the prevention of RV infection requiring medical attention or hospitalization was 68% (95% confidence interval [CI]: 61–71) and 80% (95% CI: 77–83), respectively. VE for preventing hospitalization but not medical attention remained stable over 2 years. Vaccinated were less often hospitalized (23%) than unvaccinated RV-infected children (61%; P < 0.001). Breastfeeding (odds ratio, 3.99; 95% CI: 1.92–8.27) and attending daycare (odds ratio, 3.42; 95% CI: 1.64–7.12) were independently associated with breakthrough infections. Genotype G1P[8] was detected more frequently in RotaTeq-vaccinated (44% versus 11%; P < 0.03) and G2P[4] in Rotarix-vaccinated children (42% versus 6%; P < 0.02).

Conclusions: RV vaccination protects young children effectively from RV disease and can reduce disease severity. Breastfeeding might impair VE, but further research is needed to identify the critical time window for this interference and to develop appropriate recommendations.

From the *Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden; Division of Molecular Epidemiology of Viral Pathogens, Robert Koch Institute, Berlin; §State Office for Public Health and Social Affairs, Mecklenburg-Western Pomerania, Rostock; Department for Infectious Disease Epidemiology; Surveillance Unit; and **Immunization Unit, Robert Koch Institute, Berlin, Germany.

Supported by internal funds of the Robert Koch Institute. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: Cornelia Adlhoch, VMD, Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.