Rotavirus vaccine: a welcome addition to the immunisation schedule in the UKBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2347 (Published 15 April 2013) Cite this as: BMJ 2013;346:f2347
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In a recent editorial, Iturriza-Gómara and Cunliffe1 describe the benefits of the live oral rotavirus vaccine scheduled for imminent use in the UK. We would like to add a one health perspective and note of caution.
Rotavirus is an RNA virus with a segmented genome. Natural reassortment of these segments can occur in human and animal populations.2,3,4 This process adds to biodiversity, increasing opportunities for evolution, vaccine escape and pathogenesis. Influenza5,6,7 and SARS7,8 demonstrate the importance of this process. Rotarix (GlaxoSmithKline Biologicals), the intended UK vaccine, is an attenuated, monovalent G1P vaccine. It is live, administered orally and appears in the faeces. Although an attenuated common human strain, do we know its species specificity and the effect vaccination may have on the molecular ecology of rotavirus in multi-species populations over time?
Whilst it is clearly our hope, given the tremendous benefits to infants worldwide, that the process of using a live oral vaccination will not drive rotavirus evolution towards vaccine escape or increased virulence, can we be sure? What is the risk? To date, there has been no systematic, population-based survey to assess the extent and importance of anthropozoonotic or zoonotic rotavirus infections and the influence of widespread vaccination on strains circulating between species. Models to investigate the effect of vaccination on genotype distribution have been constructed using developed country data for human infection.9 Consideration of such models alongside human surveillance data, has stimulated consideration of how universal vaccination campaigns might assert selective pressure.10
To try and investigate the question of reassortment and interspecies transmission experimentally would be extremely difficult. If 2% of outbred healthy individuals were susceptible to infection with a particular rotavirus strain, a random sample of 150 animals of each species would need to be challenged to be 95% confident of detecting this event. Experimental conditions can never mirror a real life situation, and the effect of vaccine escape strains, herd immunity, cultural diversity of human-animal contact and seasonality would still need to be addressed.
We need to take advantage of the unique opportunity offered by the implementation of rotavirus vaccination in the UK to collect population-based data on the molecular ecology and epidemiology of rotaviruses in people and animals. This will ensure that the current benefit afforded infants worldwide is sustainable and beneficial for future generations.
1 Iturriza-Gómara M and Cunliffe N. Rotavirus vaccine: a welcome addition to the immunisation schedule in the UK. BMJ 2013;346:f2347
2 Abe M, Ito N, Masatani T, Nakagawa K, Yamaoka S, Kanamaru Y et al. Whole genome characterization of new bovine rotavirus G21P and G24P strains provides evidence for interspecies transmission. J Gen Virol 2011;92:952-960
3 Matthijnssens J, Ciarlet M, Heiman E, Arijs I, Delbeke T, McDonald SM et al. Full Genome-Based Classification of Rotaviruses Reveals a Common Origin between Human Wa-Like and Porcine Rotavirus Strains and Human DS-1-Like and Bovine Rotavirus Strains. J Virol 2008;82:3204-3219
4 Matthijnssens J, Rahman M and Van Ranst M. Two out of the 11 genes of an unusual human G6P rotavirus isolate are of bovine origin. J Gen Virol 2008;89:2630-2635
5 Smith GJD, Vijaykrishna D, Bahl J, Lycett SJ, Worobey M, Pybus OG, et al. Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic. Nature 2009;459:1122-1125
6 Webster RG, Bean WJ, Gorman OT, Chambers TM, and Kawaoka Y. Evolution and ecology of influenza A viruses. Microbiol Mol Biol Rev 1992;56:152-179
7 Pepin KM, Lass S, Pulliam JRC, Read AF, and Lloyd-Smith JO. Identifying genetic markers of adaptation for surveillance of viral host jumps. Nat Rev Microbiol 2010;8:802-813
8 Bell D, Roberton S and Hunter PR. Animal origins of SARS coronavirus: possible links with the international trade in small carnivores. Phil Trans R Soc Lon B 2004;359:1107-1114
9 Pitzera VE, Patel MM, Lopman BA, Viboud C, Parashar UD and Grenfell BT. Modeling rotavirus strain dynamics in developed countries to understand the potential impact of vaccination on genotype distributions. PNAS 2011;108:19353-19358
10 Matthijnssens J, Nakagomi O, Kirkwood CD, M Ciarlet, U Desselberger and Van Ranst M. Group A rotavirus universal mass vaccination: how and to what extent will selective pressure influence prevalence of rotavirus genotypes? Expert Rev. Vaccines 2012;11:1347–1354
Competing interests: ACG and KLM currently work in collaboration with Miren Iturriza-Gómara and Nigel Cunliffe on a feline rotavirus project funded by the Royal College of Veterinary Surgeons Charitable Trust.