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Vaccine-derived rotavirus strains in infants in England
  1. Charlotte Mary Gower1,
  2. Jake Dunning2,3,
  3. Sameena Nawaz3,
  4. David Allen3,4,
  5. Mary Elizabeth Ramsay1,
  6. Shamez Ladhani1,5
  1. 1 Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
  2. 2 Tuberculosis; Acute Respiratory, Gastrointestinal, Emerging and Zoonotic Infections; and Travel and Migrant Health Division (TARGET), National Infection Service, Public Health England, London, UK
  3. 3 Enteric Virus Unit, Virus Reference Department, National Infection Service Laboratories, Public Health England, London, UK
  4. 4 Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
  5. 5 Paediatric Infectious Disease Research Group, St George's, University of London, London, UK
  1. Correspondence to Dr Shamez Ladhani, Immunisation and Counter-Measures Division, National Infection Service, Public Health England, London NW9 5EQ, UK; shamez.ladhani{at}


Objective To describe infants with acute gastroenteritis symptoms in primary and secondary care who have the Rotarix vaccine-derived G1P[8] rotavirus strain identified in their stools.

Design This is a prospective national surveillance conducted by Public Health England (PHE). Rotavirus-positive samples from vaccine-eligible children are routinely submitted to PHE for confirmation, and general practitioners are requested to complete a surveillance questionnaire for all cases. The modified Vesikari Score was used to assess severity of gastroenteritis.

Setting England, July 2013–September 2016.

Results 2637 rotavirus strains were genotyped and 215 (8%) identified as the Rotarix vaccine-derived G1P[8] strain. There were no Rotarix vaccine-derived G1P[8] strains detected in unimmunised infants. Rotarix vaccine-derived G1P[8] strains clustered around the time of rotavirus vaccination and were responsible for 82% (107 of 130) of rotavirus-positive samples in 2-month-old infants and 68% (36 of 53) in 3-month-old infants. However, 13 samples were obtained more than 7 weeks after the last vaccination date; 10 of these specimens were from six children who were subsequently diagnosed with severe combined immunodeficiency (SCID). Diarrhoea was the single most common presenting symptom (83.0%) in infants with Rotarix vaccine-derived G1P[8] strains, who were less likely to present with fever, vomiting, dehydration or severe gastroenteritis than infants with wild-type rotavirus infection.

Conclusions Rotavirus identified in stools of infants around the time of their routine immunisations is most likely the Rotarix vaccine-derived G1P[8] strain. Infants with undiagnosed SCID at the time of rotavirus immunisation may experience prolonged gastroenteritis symptoms. Most infants with vaccine strains in their stools more than 7 weeks after immunisation had SCID.

  • immunisation
  • infectious diseases

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  • Twitter @outbreakjake, @virologydavid, @shamezladhani

  • Contributors SL is responsible for the enhanced surveillance of the national rotavirus vaccination programme and designed the study. CMG contributed to study design, carried out patient follow-up and analysed the data. JD (and previously DA and SN) is responsible for laboratory surveillance of the rotavirus immunisation programme. MER manages the immunisation programmes at PHE. All authors contributed to interpretation of the data, drafting the manuscript and final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval PHE has legal permission, provided by Regulation 3 of the Health Service (Control of Patient Information) Regulations 2002, to process confidential information for national surveillance of communicable diseases ( This includes PHE's responsibility to monitor the safety and effectiveness of vaccines, and as such individual patient consent is not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.