High prevalence of co-infecting enteropathogens in suspected rotavirus vaccine breakthrough cases

Ceren Simsek, Mandy Bloemen, Daan Jansen, Leen Beller, Patrick Descheemaeker, Marijke Reynders, Marc Van Ranst, and Jelle Matthijnssens

Rotavirus vaccination was introduced in Belgium in 2006 and immediately reached a high coverage. Since then, a significant decrease in rotavirus gastroenteritis has been recorded. Taking the high effectiveness of the rotavirus vaccines into account, we investigated the impact of non-rotavirus (alternative) enteric pathogens in suspected rotavirus vaccine breakthrough infections. A combination of a non-targeted NGS and a sensitive RT-qPCR approach was used to screen for a broad range of enteric viruses, bacteria and parasites in suspected breakthrough cases (n=102, collected from 2007 till 2018). Surprisingly, approximately half of these cases had either an alternative gastroenteritis etiology (31.5%) or were the result of co-infections including rotavirus (14.1%) (Figure below). Most co-infections were unique combinations of viruses, bacteria and parasites, which shows the complexity involved in reaching a correct diagnosis.

Published September 2021 in Journal of Clinical Microbiology