Acute viral gastroenteritis following rotavirus vaccine implementation in Venezuela: Is rotavirus still a cause for concern?

Introduction: Acute gastroenteritis (AGE) remains a major public health concern for the pediatric population. Diarrheal surveillance in Venezuela following the implementation of the rotavirus vaccines has been discontinuous, resulting in a lack of knowledge of the true epidemiological burden. This study investigated retrospectively the occurrence of enteropathogenic virus infections and potential changes in the etiological pattern of diarrheal disease in Venezuelan children during the post-vaccination period.

Methodology: Stool samples from 150 children with AGE and 148 controls under five years old collected in 2012-2013, were analyzed using molecular assays by rotavirus, norovirus, human adenovirus, human astrovirus, and Aichi virus. Clinical and sociodemographic associations were assessed.

Results and conclusions: At least one virus was found in 66 (44%) of the children with AGE, and in 12 (8.1%) of the control group (p < 0.0001), mostly under 24 months old. Norovirus and rotavirus prevailed significantly in the AGE group (19.3% and 18%, respectively) compared to the control group (4.7% and 0%, respectively) (p < 0.001). Astrovirus, adenovirus, and Aichi virus were found in 5.3% or less of the children. Malnutrition, lack of breastfeeding, absence of rotavirus vaccination, and lower socioeconomic status were more frequent among AGE children than in controls (p = 0.014). This study suggests that rotavirus continued circulating widely even after vaccine introduction. It emphasizes the importance of norovirus and other viruses (adenovirus, astrovirus, and Aichi virus) as potentially emerging causes of pediatric diarrhea. Future strategies for precise health management and prevention of viral diarrhea should include surveillance using molecular methods alongside sanitation efforts and measures to reduce poverty and malnutrition.