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Previous Volume 335:1022-1028 October 3, 1996 Number 14 Next

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ABSTRACT

Background Rotavirus is the leading cause of severe diarrhea in infants. To provide a base line for assessing the efficacy of rotavirus vaccines, we evaluated the protection that is conferred by natural rotavirus infection.

Methods We monitored 200 Mexican infants from birth to two years of age by weekly home visits and stool collections. A physician assessed the severity of any episodes of diarrhea and collected additional stool specimens for testing by enzyme immunoassay and typing of strains. Serum collected during the first week of life and every four months thereafter was tested for antirotavirus IgA and IgG.

Results A total of 316 rotavirus infections were detected on the basis of the fecal excretion of virus (56 percent) or a serologic response (77 percent), of which 52 percent were first and 48 percent repeated infections. Children with one, two, or three previous infections had progressively lower risks of both subsequent rotavirus infection (adjusted relative risk, 0.62, 0.40, and 0.34, respectively) and diarrhea (adjusted relative risk, 0.23, 0.17, and 0.08) than children who had no previous infections. No child had moderate-to-severe diarrhea after two infections, whether symptomatic or asymptomatic. Subsequent infections were significantly less severe than first infections (P = 0.024), and second infections were more likely to be caused by another G type (P = 0.054).

Conclusions In infants, natural rotavirus infection confers protection against subsequent infection. This protection increases with each new infection and reduces the severity of the diarrhea.

Source Information

From the Department of Infectious Diseases, Instituto Nacional de la Nutrición, Mexico City, Mexico (F.R.V., J.J.C., M.L.G., G.M.R.-P.); the Center for Pediatric Research, Children's Hospital of the King's Daughters, and Eastern Virginia Medical School, Norfolk (D.O.M., A.L.M., L.K.P.); Harvard School of Public Health, Boston (S.C.-C.); Viral Gastroenteritis Unit, Centers for Disease Control and Prevention, Atlanta (R.I.G.); and the Division of Molecular Virology, Baylor College of Medicine, Houston (M.K.E.). Presented in part at the annual meeting of the Society for Pediatric Research, Seattle, May 1994, and the Rotavirus Vaccine Workshop, Atlanta, October 1995.

Address reprint requests to Dr. Ruiz-Palacios at the Department of Infectious Diseases, Instituto Nacional de la Nutrición, Vasco de Quiroga No. 15, Delegación Tlalpan, Mexico City 14000, D.F., Mexico.

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