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An infant with acute gastroenteritis caused by a secondary infection with a Rotarix-derived strain

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Abstract

Rotavirus vaccines have been successful in controlling severe diarrhea and have decreased deaths of young children globally. Rotarix and RotaTeq are the two currently available live-attenuated rotavirus vaccines. The vaccine virus can grow in a recipient’s gut and spread from the vaccinee to naïve individuals. The potential for the emergence of revertant viruses is a concern with live-attenuated vaccines. We identified a previously healthy infant with severe acute gastroenteritis that was positive for rotavirus in a non-endemic season. A whole genome sequencing revealed that all of the viral genome segments were highly similar to those of the Rotarix virus, with the exception of five amino acid mutations in viral genes that could be associated with virulence. The younger sibling of this patient was administered Rotarix before the onset of disease in this patient, although no gastrointestinal symptoms were reported. Epidemiological data, circumstantial evidence, and the genome analysis suggest that the vaccine virus was transmitted from the vaccinee to the patient.

Conclusion: This is a severe acute gastroenteritis case most probably attributed to the secondary infection of Rotarix-related virus without underlying diseases. The importance of molecular surveillance of rotavirus infections is discussed.

What is Known:

• The live-attenuated rotavirus vaccines, Rotarix and RotaTeq, have been successful in controlling severe diarrhea and have decreased deaths of young children globally.

• Attenuated vaccine virus can grow in a recipient’s gut and spread to naïve individuals and may revert to cause secondary symptomatic infections.

What is New:

• This is the first report describing a Rotarix-associated secondary infection resulting in severe acute gastroenteritis in an infant without underlying diseases.

• Amino acid mutations that might contribute to viral pathogenesis were identified by whole genome sequencing.

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Abbreviations

ELISA:

Enzyme-linked immunosorbent assay

NSP:

Non-structural protein

PCR:

Polymerase chain reaction

RT:

Reverse transcriptase

USA:

United States of America

VP:

Viral protein

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Author information

Authors and Affiliations

  1. Department of Microbiology, Osaka Institute of Public Health, Osaka, Japan

    Naomi Sakon & Jun Komano

  2. Department of Pediatrics, Osakafu Saiseikai Ibaraki Hospital, Ibaraki, Osaka, Japan

    Ryohei Miyamoto

  3. National Hospital Organization, Nagoya Medical Center, Naka-ku, Nagoya, Aichi, Japan

    Jun Komano

Authors
  1. Naomi Sakon
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  2. Ryohei Miyamoto
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  3. Jun Komano
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Contributions

RM was involved in the clinical management of this patient. NS performed the virological laboratory tests. NS and JK drafted the manuscript. All authors approved the final manuscript. There are no potential conflicts of interests to declare.

Corresponding author

Correspondence to Jun Komano.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from the guardians of the subjects included in the study.

Funding

This work was supported in part by Grant-in-Aid for Scientific Research #25460832 to NS.

Additional information

Communicated by Peter de Winter

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Sakon, N., Miyamoto, R. & Komano, J. An infant with acute gastroenteritis caused by a secondary infection with a Rotarix-derived strain. Eur J Pediatr 176, 1275–1278 (2017). https://doi.org/10.1007/s00431-017-2963-3

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  • DOI: https://doi.org/10.1007/s00431-017-2963-3

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