Distribution of rotavirus genotypes in Europe, 2004-2005: The REVEAL study

Background. Rotavirus gastroenteritis (RVGE) constitutes a significant burden of pediatric disease. Knowledge of currently cocirculating rotavirus genotypes is required to help guide immunization strategies. Methods. During the 2004-2005 RVGE season, a prospective, multicenter, observational study of RVGE was conducted in children < 5 years of age seeking health care in primary care, emergency department, and hospital settings in selected areas of Belgium, France, Germany, Italy, Spain, Sweden, and the United Kingdom. Rotavirus was identified by enzyme-linked immunosorbent assay ( ELISA), and genotypes were determined by reverse-transcription polymerase chain reaction (RT-PCR) analysis of stool samples for which ELISA results were positive. Results. ELISA results were available for 2712 of the 2846 children with acute gastroenteritis who were recruited for the study; of these 2712 children, 1102 (40.6%) were rotavirus positive. RT-PCR results were available for 1031 children with ELISA-positive samples. G1-G4 and G9 were the most prevalent genotypes identified: G1 was identified in Spain, Sweden, and the United Kingdom; G9 in Italy, France, and Belgium; and G4 in Germany. Only the G4 and G9 genotypes were identified in all study areas. Rotavirus infections showed seasonal variation, with different patterns noted among the genotypes. Conclusions. Rotavirus genotypes G1-G4 and G9 are associated with the majority of RVGE infections in the areas studied, with geographic and seasonal variation in the distributions of rotavirus strains. Rotavirus vaccines should, therefore, provide protection against all major genotypes to decrease effectively the RVGE disease burden in Europe.