Sustained Decrease in Laboratory Detection of Rotavirus after Implementation of Routine Vaccination — United States, 2000–2014

A weekly report from the CDC (United States of America)
April 10, 2015

Rotavirus infection is the leading cause of severe gastroenteritis among infants and young children worldwide (1,2). Before the introduction of rotavirus vaccine in the United States in 2006, rotavirus infection caused significant morbidity among U.S. children, with an estimated 55,000–70,000 hospitalizations and 410,000 clinic visits annually (3). The disease showed a characteristic winter-spring seasonality and geographic pattern, with annual seasonal activity beginning in the West during December-January, extending across the country, and ending in the Northeast during April-May (4). To characterize changes in rotavirus disease trends and seasonality following introduction of rotavirus vaccines in the United States, CDC compared data from CDC's National Respiratory and Enteric Virus Surveillance System (NREVSS), a passive laboratory reporting system, for prevaccine (2000–2006) and postvaccine (2007–2014) years. National declines in rotavirus detection were noted, ranging from 57.8%–89.9% in each of the 7 postvaccine years compared with all 7 prevaccine years combined. A biennial pattern of rotavirus activity emerged in the postvaccine era, with years of low activity and highly erratic seasonality alternating with years of moderately increased activity and seasonality similar to that seen in the prevaccine era. These results demonstrate the substantial and sustained effect of rotavirus vaccine in reducing the circulation and changing the epidemiology of rotavirus among U.S. children.
NREVSS is a national laboratory-based passive reporting system for respiratory and enteric viruses, including rotavirus. Participating laboratories report weekly data to CDC, including the total number of stool samples tested for rotavirus by enzyme immunoassay and the number of specimens that tested positive. Annually, 75 to 90 laboratories report rotavirus testing data to NREVSS. A reporting year is defined as the period from July (epidemiologic week 27) to June (epidemiologic week 26) of the following year, beginning in July 2000. Rotavirus season onset is defined as the first of 2 consecutive weeks where 10% or more of specimens test positive for rotavirus. Similarly, season offset is defined as the last of 2 consecutive weeks where 10% or more of samples test positive. Peak season intensity is defined as the week with the highest proportion of tests positive for rotavirus. For analysis of season duration and peak intensity, data from all participating laboratories were included. The proportion of samples that tested positive for rotavirus and the mean decrease from the prevaccine years are reported for these data. Analyses of trends in disease were restricted to the 23 laboratories that consistently reported at least 26 weeks of data for each reporting year from July 2000 through June 2014. For this analysis, data are aggregated by week and reported as a 3-week moving average of total number of tests and rotavirus positive tests performed for the prevaccine period (2000–2006) and for each prevaccine season. Data are presented for the United States overall and for each U.S. census region.
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