Rotavirus in Adults in the Post-Rotavirus Vaccine Era
Background: Rotavirus (RV) has been increasingly recognized as a pathogen of adults. Data from the pre-vaccine era suggested that the seasonality of RV mirrored that of children with most cases occurring in the winter and spring. Implementation of pediatric RV vaccination has resulted in declines in the prevalence of RV in both children and adults but with marked biennial variability. The seasonality, prevalence, and clinical characteristics of adult rotavirus disease in the post-vaccine era are poorly understood.
Methods: Residual stools were collected Jan 1, 2013 – Feb 28, 2014 from specimens submitted for bacterial stool culture (BSC) to Emory Healthcare Microbiology Laboratory in Atlanta, GA. Duplicate specimens, those from subjects <18 years or hospitalized for ≥72 hours were excluded. BSCs were tested retrospectively for RV by Rotaclone® EIA to determine the prevalence of RV. The prevalence, seasonality, and clinical characteristics of those with RV were compared to those with routinely cultured bacterial pathogens (e.g., Salmonella, Shigella, Campylobacter, Aeromonas). Shiga toxin testing results were excluded since these were not routinely performed until July 2013.
Results: A total of 3,080 BSCs were sent of which 386 (13%) did not meet eligibility criteria. Of the 2694 eligible BSCs, 2062 (77%) were saved and available for RV testing, and 82 (4.0%) of these had RV detected. In contrast, routinely cultured bacterial pathogens were identified in 61 eligible and saved specimens (3.0%). The prevalence and seasonality of RV and these bacterial pathogens combined is demonstrated in the figure below. Compared to those with bacterial pathogens identified, those with RV were older (mean of 52 vs. 43 years, P<0.003), more frequently admitted (56% vs. 31%, p<0.004), but less likely to have traveled internationally (5% vs. 16%, p<0.05).
Conclusion: In this convenience sample of BSC samples from adults that was collected primarily during a peak pediatric rotavirus year (2013), winter-spring seasonality was observed. The prevalence of RV in adults was similar to the combined prevalence of all other routinely cultured bacterial pathogens. Those with RV were older, more frequently admitted, but had less international travel.
C. Kraft, None
A. L. Shane, None
R. Jerris, None
E. J. Anderson, None