title: Incidence of rotavirus and circulating genotypes in Northeast Brazil during 7 years of national rotavirus vaccination.
abstract: OBJECTIVE
  Rotavirus causes severe diarrhoea and Brazil introduced the Rotarix G1P[8] vaccine in 2006. We aimed to describe changes in rotavirus incidence and diarrhoea epidemiology before and after vaccine introduction.
  
  
  METHODS
  
  
  
  METHODS
  (i) hospital-based survey of children with diarrhoea (2006-2012); (ii) diarrhea-mortality and hospitalization surveillance (1999-2012).
  
  
  METHODS
  (i) Aracaju and (ii) state and national level.
  
  
  RESULTS
  1841 children were enrolled and 231 (12.5%) had rotavirus. Rotavirus was less frequent from January-June than from July-December (9.4% versus 20.9%, p<0.01), but the seasonal variation was less defined after 2009. Very few rotavirus cases (8-3.9%) were detected in 2011, with an increase in 2012 (13-18.5%). In 2006, unvaccinated children were more likely to have rotavirus, but thereafter unvaccinated and vaccinated children had equally low incidence. Older children and those with rotavirus were more likely to have severe diarrhea episodes. The most frequent genotype from 2006 to 2010 was G2P[4]; except in 2009, when most cases were G1P[8]. Very few G2P[4] were detected from 2011 and 50% cases in 2012 were G8P[4]. Diarrhoea-hospitalizations decreased nationally from 89,934 (2003) to 53,705 (2012; 40.3% reduction) and in the state from 1729 to 748 (56.7% reduction). Diarrhoea-deaths decreased nationally from 4368 in 1999 to 697 in 2012 (84% reduction, p<0.001) and in the state from 132 to 18 (86% reduction). These changes were much larger after vaccine introduction.
  
  
  CONCLUSIONS
  The vaccine was associated with substantial reductions in rotavirus incidence and diarrhoea-hospitalizations and deaths. The G2P[4] genotype predominance disappeared over time and may be replaced by other heterotypic genotypes.
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Ricardo Q
authors.initials: RQ
authors.lastname: Gurgel
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Alberto De Juan
authors.initials: Ade J
authors.lastname: Alvarez
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Alda
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Robergson R
authors.initials: RR
authors.lastname: Ribeiro
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Sílvio S
authors.initials: SS
authors.lastname: Dolabella
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Natanael L
authors.initials: NL
authors.lastname: Da Mota
authors.affiliation: Federal University of Sergipe, Aracaju, Brazil.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Santos
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Miren
authors.initials: M
authors.lastname: Iturriza-Gomara
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Cunliffe
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Luis E
authors.initials: LE
authors.lastname: Cuevas
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012401:Rotavirus / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification* / Q000502:physiology; D014611:Vaccination