title: Effectiveness of Monovalent and Pentavalent Rotavirus Vaccines in Guatemala.
abstract: BACKGROUND
  Concerns remain about lower effectiveness and waning immunity of rotavirus vaccines in resource-poor populations. We assessed vaccine effectiveness against rotavirus in Guatemala, where both the monovalent (RV1; 2-dose series) and pentavalent (RV5; 3-dose series) vaccines were introduced in 2010.
  
  
  METHODS
  A case-control evaluation was conducted in 4 hospitals from January 2012 to August 2013. Vaccine status was compared between case patients (children with laboratory-confirmed rotavirus diarrhea) and 2 sets of controls: nondiarrhea "hospital" controls (matched by birth date and site) and nonrotavirus "test-negative" diarrhea controls (adjusted for age, birth month/year, and site). Vaccine effectiveness ([1 - odds ratio of vaccination] × 100%) was computed using logistic regression models.
  
  
  RESULTS
  We evaluated 213 case patients, 657 hospital controls, and 334 test-negative controls. Effectiveness of 2-3 doses of a rotavirus vaccine against rotavirus requiring emergency department visit or hospitalization was 74% (95% confidence interval [CI], 58%-84%) with hospital controls, and 52% (95% CI, 26%-69%) with test-negative controls. Using hospital controls, no significant difference in effectiveness was observed between infants 6-11 months (74% [95% CI, 18%-92%]) and children ≥12 months of age (71% [95% CI, 44%-85%]) (P= .85), nor between complete courses of RV1 (63% [95% CI, 23%-82%]) and RV5 (69% [95% CI, 29%-87%]) (P= .96). An uncommon G12P[8] strain, partially heterotypic to strains in both vaccines, was identified in 89% of cases.
  
  
  CONCLUSIONS
  RV1 and RV5 were similarly effective against severe rotavirus diarrhea caused by a heterotypic strain in Guatemala. This supports broader implementation of rotavirus vaccination in low-income countries where >90% global deaths from rotavirus occur.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Gastañaduy
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Contreras-Roldán
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: Chris
authors.initials: C
authors.lastname: Bernart
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: Beatriz
authors.initials: B
authors.lastname: López
authors.affiliation: International Emerging Infections Program, Centers for Disease Control and Prevention, Guatemala City.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Benoit
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: Marvin
authors.initials: M
authors.lastname: Xuya
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: Fredy
authors.initials: F
authors.lastname: Muñoz
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rishi
authors.initials: R
authors.lastname: Desai
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia West African Center for Cell Biology of Infectious Pathogens, Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Legon.
authors.forename: Osbourne
authors.initials: O
authors.lastname: Quaye
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Ka Ian
authors.initials: KI
authors.lastname: Tam
authors.affiliation: National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Diana K
authors.initials: DK
authors.lastname: Evans-Bowen
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Manish
authors.initials: M
authors.lastname: Patel
authors.affiliation: Center for Health Studies, Universidad del Valle de Guatemala.
authors.forename: John P
authors.initials: JP
authors.lastname: McCracken
mesh_terms: D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000821:virology; D004636:Emergency Service, Hospital; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011203:Poverty; D012401:Rotavirus / Q000276:immunology / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage / Q000276:immunology*; D014611:Vaccination; D064166:Vaccine Potency; D014613:Vaccines, Attenuated / Q000008:administration & dosage / Q000276:immunology
chemical_list: C492457:RIX4414 vaccine; C492535:RotaTeq; D022243:Rotavirus Vaccines; D014613:Vaccines, Attenuated
keywords: Guatemala; gastroenteritis; rotavirus; vaccine effectiveness