EuroRotaNet: Rotavirus Strain Surveillance 2006-2017

Rotavirus SymposiumMinsk 2018

EuroRotaNet Surveillance of rotavirus types co-circulating in 14 European , pre-and post- vaccine introduction. 16 participating European Countries.

Rotavirus vaccination introduced:• Austria (2006): Alternating Rotarix and RotaTeq• Belgium (2006): both available but predominantly Rotarix• Finland (2009): Rotateq• United Kingdom (2013): Rotarix

• Germany (regional recommendation since 2008, nationally 2013) both available

RV vaccine not in childhood vaccination schedule: Low coverage (private health) or only regional coverage:

• Denmark, France, Greece, Hungary, Italy, The Netherlands, Slovenia, Spain, Sweden

ROTAVIRUS DIVERSITY IN EUROPEAN COUNTRIES WITH AND WITHOUT ROTAVIRUS VACCINATION:

10 YEARS OF ROTAVIRUS STRAIN SURVEILLANCE

Country Single genotype (N) (%)Mixed or partially

typed (N) (%) Total (N)

Austria 1025 85 188 15 1213Belgium 4184 99.0 7

RV genotypes with a prevalence >1% Sept 2006 –Aug. 2017

Genotypes in countries with RV vaccine

RV strain distribution in the UK pre and post-vaccine introduction

Genotypes in countries with low or no RV vaccine coverage

Age Distribution

• In the pre-vaccine era, the median age was 13 months (IQR 9-24) compared to 19 months (IQR 11-29) in the vaccine period (p

Conclusions :

• High degree of diversity of rotavirus strains co-circulate in the European population. Few genotypes are found circulating with a prevalence of >1% (6 out of 49 genotypes).

• Up until 2014/15 G1P[8] rotaviruses were the most prevalent but there has been a decline in prevalence since; in 2016/17 they no longer dominated in any of the 14 countries.

• Could the decline in G1P[8] strains across countries with and without infant rotavirus immunization schedules suggest that the increase in vaccinated cohorts across Europe is having an impact across borders?

• In the UK vaccine-derived strains were detected post-vaccine introduction in infants less than 6 months of age; likely to be shedding vaccine strain post-vaccination with symptoms possibly caused by other infectious or non-infectious etiologists (and coincides with increase use of molecular methods for front line diagnosis)

• During 2016/17, and for the first time since EuroRotaNet began, G2P[4] was overall the predominant rotavirus type (35%), but the most frequently detected rotavirus type in 4/14 countries.

•The increase in G2P[4] occurred in 4 of the 5 countries with routine rotavirus vaccination.

•In Finland the decline in G1P[8] strains has not been accompanied by displacement by another different type, but with greater strain diversity overall.

•There has been no significant number of novel or emerging strains detected in any of the countries under surveillance (equine like G3 P[8] strain identified in a small number of samples since 2016 in Spain and Germany)

•There is no evidence to date that rotavirus vaccination programs are driving the emergence of rotavirus vaccine escape strains, and in countries with RV vaccination, shifts in genotype distribution are in the context of significantly reduced rotavirus disease incidence.

Conclusions II:

Acknowledgements: The EuroRotaNet group of collaboratorsDaniel Hungerford University of Liverpool Stephan Aberle Department of Virology, Medical University of Vienna, Austria

Jelle Matthijnssens Rega Institute for Medical Research, University of Leuven, Belgium

Sofie Midgely, Thea Fisher Statens Serum Institute, Copenhagen, Denmark

V P Syriopoulou, Dimitra M Koukou

First Department of Pediatrics, Athens University, Athens, 11527, Greece

Krisztián Banyai Veterinary Medical Research Institute, Hungarian Academy of Sciences, Hungary

Alexis de Rougemont/Jerome Kaplon

Laboratoire de Virologie, CHI de Bocage, Dijon, France.

Leena Maunula Helsinki University Central Hospital, Division of Virology, Helsinki, Finland

Carita Savolainen-Kopra/Haide Al-Hello

Virology Unit, National Institute for Health and Welfare, Helsinki, Finland

Franco Ruggeri, Giovanni Ianiro,Marina Monini

Dipartimento di Sanità alimentare e animale, Istituto Superiore di Sanità, Rome, Italy

Annelies Kroneman RIVM, Bilthoven, The Netherlands

Mateja Poljsak-Prijatelj, Andrej Steyer

Institute of Microbiology and Immunology, Ljubljana, Slovenia

Javier Buesa University of Valencia, Valencia, Spain

Gustavo Cilla, Mila Montes Servicio de Microbiología Clínica, Hospital Donostia, San Sebastián, Spain

Mia Brytting, Lottie Schloss Swedish Institute for Infectious Disease Control, Solna, Sweden

Andreas Mas Marques Molecular Virology, Robert-Koch Institute, Berlin, Germany

S Nawaz, DJ Allen, Jake Dunning Virus Reference Department, PHE United Kingdom and LSHTM

Funding: Joint Research Grant from GSK and Merck & Co., Inc

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