Surveillance of human rotaviruses in 2007-2011, Hungary: exploring the genetic relatedness between vaccine and field strains.

BACKGROUND: The availability of rotavirus vaccines has resulted in an intensification of post vaccine strain surveillance efforts worldwide to gain information on the impact of vaccines on prevalence of circulating rotavirus strains. OBJECTIVES: In this study, the distribution of human rotavirus G and P types in Hungary is reported. In addition, the VP4 and VP7 genes of G1P[8] strains were sequenced to monitor if vaccine-derived strains were introduced and/or some strains/lineages were selected against. STUDY DESIGN: The study was conducted in 8 geographic areas of Hungary between 2007 and 2011. Rotavirus positive stool samples were collected from diarrheic patients mostly <5 years of age. Viral RNA was amplified by multiplex genotyping RT-PCR assay, targeting the medically most important G and P types. When needed, sequencing of the VP7 and VP4 genes was performed. RESULTS: In total, 2380 strains were genotyped. During the 5-year surveillance we observed the dominating prevalence of genotype G1P[8] (44.87%) strains, followed by G4P[8] (23.4%), G2P[4] (14.75%) and G9P[8] (6.81%) genotypes. Uncommon strains were identified in a low percentage of samples (4.12%). Phylogenetic analysis of 318 G1P[8] strains identified 55 strains similar to the Rotarix strain (nt sequence identities; VP7, up to 97.9%; VP4, up to 98.5%) although their vaccine origin was unlikely. CONCLUSIONS: Current vaccines would have protected against the majority of identified rotavirus genotypes. A better understanding of the potential long-term effect of vaccine use on epidemiology and evolutionary dynamics of co-circulating wild type strains requires continuous strain surveillance.

Estudio prospectivo de temperatura timpánica en pacientes sometidos a trasplante hemopoyético / Prospective study of tympanic temperature in patients undergoing haemopoietic transplant

Objetivo. Durante el trasplante hemopoyético el paciente se puede ver afectado por variaciones térmicas de su organismo relacionables con potenciales o reales complicaciones. Ante este contexto clínico y cambios normativos ineludibles nos planteamos como objetivos, comprobar si las equivalencias indicadas por la bibliografía se ajustan a nuestra realidad clínica; y, comprobar la posible influencia de la presencia de mucositis en la determinación de la temperatura timpánica. Método. Se ha realizado un estudio descriptivo prospectivo sobre 776 casos en la unidad de trasplante hemopoyético del Hospital Morales Meseguer, de Murcia, del 13 de marzo al 15 de septiembre de 2002, en paciente sometidos a trasplante hemopoyético. En el tratamiento estadístico se ha aplicado el test de chi cuadrado y un IC del 95%. Resultados. La temperatura media timpánica obtenida en el oído derecho es de 37,4°C, mientras que la axilar fue de 36,54°C. Como principal variable relacionada encontramos la presencia de mucositis grado II, como mínimo. Conclusiones. Diversos autores indican que la temperatura timpánica pese a la rapidez, fiabilidad y ausencia de repercusión sobre el medio ambiente está sujeta a diversos imponderables que pueden inducir a errores diagnósticos y en su decisión clínica. En nuestro estudio, los estándares de normalidad han diferido de los obtenidos debido, entre otros factores, a que los estándares están referidos a personas sanas, mientras que en nuestro caso, las determinaciones se realizaron en personas convalecientes con mucositis. Por tanto, dado que el contexto clínico condiciona la fiabilidad del procedimiento, este método no es aplicable en nuestra práctica clínica asistencial(AU)

Objective. During haemopoietic transplant, the patient may be affected by body temperature variations which may be associated with potential or real complications. In this clinical context and due unavoidable changes in values, we established as objectives; to check whether the reference values stated in the literature are adapted to our clinical reality, and to check the possible influence of mucositis in the determination of the tympanic temperature. Method. A prospective descriptive study was performed on 776 cases in the Haemopoietic Transplant Unit of the Hospital Morales Meseguer, of Murcia, from the 13 March to the 15 September of 2002, in patients undergoing stem cells transplant. A 95% confidence level has been applied to the Chi2 test in the statistical analysis. Results. The mean tympanic temperature obtained in the right ear was 37.4°C, whereas the axillary mean was 36.54°C. Grade II mucositis was found to be the main associated variable. Conclusions. Some authors suggest that the tympanic temperature, despite the speed, reliability and lack of impact on the environment, is subject to many uncertainties that can lead to diagnostic errors and subsequent clinical decision. In our study, the reference values have differed from those previously obtained due to, among other things, them being values associated to healthy people, whereas in our case, the determinations were made in convalescents with mucositis. Therefore, given that the clinical condition affects the reliability of the tympanic readings, this method is not applicable in our clinical care(AU)

[Prospective study of tympanic temperature in patients undergoing haemopoietic transplant]. / Estudio prospectivo de temperatura timpánica en pacientes sometidos a trasplante hemopoyético.

OBJECTIVE: During haemopoietic transplant, the patient may be affected by body temperature variations which may be associated with potential or real complications. In this clinical context and due unavoidable changes in values, we established as objectives; to check whether the reference values stated in the literature are adapted to our clinical reality, and to check the possible influence of mucositis in the determination of the tympanic temperature. METHOD: A prospective descriptive study was performed on 776 cases in the Haemopoietic Transplant Unit of the Hospital Morales Meseguer, of Murcia, from the 13 March to the 15 September of 2002, in patients undergoing stem cells transplant. A 95% confidence level has been applied to the Chi(2) test in the statistical analysis. RESULTS: The mean tympanic temperature obtained in the right ear was 37.4 degrees C, whereas the axillary mean was 36.54 degrees C. Grade II mucositis was found to be the main associated variable. CONCLUSIONS: Some authors suggest that the tympanic temperature, despite the speed, reliability and lack of impact on the environment, is subject to many uncertainties that can lead to diagnostic errors and subsequent clinical decision. In our study, the reference values have differed from those previously obtained due to, among other things, them being values associated to healthy people, whereas in our case, the determinations were made in convalescents with mucositis. Therefore, given that the clinical condition affects the reliability of the tympanic readings, this method is not applicable in our clinical care.

[Post vaccination rotavirus surveillance in Hungary, in 2007]. / Posztvakcinációs rotavírus-surveillance Magyarországon, 2007.

Vaccination is the main strategy to control severe dehydrating gastroenteritis caused by rotaviruses in early childhood. The availability of new generation rotavirus vaccines has led to an intensification of strain surveillance worldwide, in part, to gauge the impact of the possible vaccine-driven immune selection of wild-type rotavirus strains. In the present study, authors describe the strain prevalence data obtained in 2007, with the involvement of different regions of Hungary. Genomic RNA was extracted from rotavirus-positive stool samples collected mainly from children and then subjected to genotyping using multiplex RT-PCR assay. Type-specific primers targeted G1 to G4, G6, G8 to G10, and G12 VP7 specificities, and P[4], P[6], and P[8] to P[11] VP4 specificities were used. Out of 489 rotavirus-positive specimens, collected from 482 patients, 466 and 474 were successfully G and P typed, respectively, and both G and P type specificities could be assigned for 457 strains. Prevalence data showed the predominance of G4P[8] (31.5%) strains, followed by G1P[8] (28.3%), G2P[4] (19.3%), and G9P[8] (10.2%). Minority strains were G1P[4] (0.4%), G2P[8] (1.3%), G3P[9] (0.2%), G4P[6] (0.7%), G6P[9] (0.4%), G8P[8] (0.2%), G9P[4] (0.2%), G9P[6] (0.8%), and G12P[8] (0.4%). Mixed infections were found in 1.2% of the samples, while 4.9% remained partially or fully non-typified. Our data indicate that the antigen specificities of medically important rotavirus strains identified in this 1-year study are well represented in the vaccines available in the pharmaceutical private market in Hungary. Depending on the vaccination coverage achievable in the forthcoming years, the post-vaccination rotavirus strain surveillance may allow us to gain comprehensive information on the impact of rotavirus vaccines on the prevalence of circulating rotavirus strains.

First detection of P[6],G9 rotaviruses in Hungary--an imported strain from India?

EuroRotaNet was launched to monitor rotavirus strain prevalence during and after introduction of rotavirus vaccines in Europe. In early 2007, we detected P[6],G9 rotaviruses to appear in Hungary, representing the first documented occurrence of this strain in our surveillance area. Epidemiologic data suggested that this strain was introduced from India.

[EuroRotaNet--European rotavirus strain surveillance network established with Hungarian participation]. / Hazai részvétellel megalakult az Európai Rotavírus-törzs-figyelô Hálózat (EuroRotaNet).

Group A rotaviruses are the most common cause of severe gastroenteritis worldwide. The incidence and distribution of group A rotavirus sero/genotypes varies between geographical areas during a rotavirus season, and from one season to the next. In addition, cocirculation of genetically diverse multitypic rotaviruses and of intratypic variants in any one place and time is common. Assuming widespread use of rotavirus vaccine in the near future, comprehensive surveillance of natural rotavirus infections is vital. EuroRotaNet has been established in order to gather comprehensive information on the rotavirus types co-circulating throughout Europe. The main objectives of the network are to (i) develop methods and algorithms for effective rotavirus strain typing and characterisation, (ii) describe in detail the molecular epidemiology of rotavirus infections in Europe, (iii) monitor the effectiveness of current genotyping methods and respond to changes associated with genetic drift and shift, and (iv) monitor the emergence and spread of novel rotavirus strains within Europe. This infrastructure may serve as a platform for future surveillance activities and nested studies for evaluating the effectiveness of a rotavirus vaccine in the general population. Studies to monitor the reduction in disease associated with common rotavirus types, the possible vaccine-induced emergence of antibody escape mutants of genotypes other than those included in the vaccine and of reassortment between vaccine and naturally circulating wildtype strains are required.