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

Group A rotaviruses (RVA) are the leading cause of gastroenteritis in infants, killing more than 200,000 infants per year, as well as causing a high morbidity. Even though there are two widely used rotavirus vaccines (Rotarix and RotaTeq), rotavirus vaccine breakthrough infections remain a public health problem. In this study, we investigated the presence of co-infecting enteropathogens in alleged rotavirus vaccine breakthrough infections using viral metagenomics (NGS) and (RT-)qPCR approaches.

We selected 92 samples (collected between 2007 and 2018) of Rotarix vaccinated patients, diagnosed with RVA gastroenteritis. Overall, we identified co-infections in 80% of the cases. Enteropathogens such as Adenovirus (32%), Enterovirus (15%), EAEC (14%), Astrovirus (10%), EPEC (10%), Blastocystis spp. (10%), Parechovirus (9%), Norovirus (9%), C. difficile (9%), D. fragilis (9%), Sapovirus (8%), C. jejuni (4%), G. lamblia (4%), STEC (1%) were detected. Except for a few reassortant rotavirus strains, no unusual rotavirus genotypes or genotype combinations were identified. However, in addition to well-known enteric viruses, divergent variants of enteroviruses and non-classic astroviruses were identified. We estimated that in 31.5% of the patients, rotavirus was most likely of minor importance for gastroenteritis and in 14.1% of the patients it contributed together with another pathogen(s). The remaining 54.4% of the patients likely had a 'true vaccine breakthrough infection'. The high prevalence of alternative enteropathogens in the alleged rotavirus vaccine breakthrough cases suggests that gastroenteritis is often the result of a co-infection, and the rotavirus vaccine effectiveness might be underestimated in many clinical and epidemiological studies.


Ceren Simsek (1), Mandy Bloemen (1), Daan Jansen (1), Leen Beller (1), Patrick Descheemaeker (2), Marijke Reynders (2), Marc Van Ranst (1), Jelle Matthijnssens (1)


"Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven (1) Department of Laboratory Medicine, Medical Microbiology, AZ Sint-Jan (2)"

Presenting author

Ceren Simsek, PhD, KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research
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