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Published online January 25, 2010
PEDIATRICS (doi:10.1542/peds.2009-1901)
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Case Reports

Sibling Transmission of Vaccine-Derived Rotavirus (RotaTeq) Associated With Rotavirus Gastroenteritis

Daniel C. Payne, PhD, MSPHa, Kathryn M. Edwards, MDb, Michael D. Bowen, PhDc, Erin Keckley, RNb, Jody Peters, MSb, Mathew D. Esona, PhDc, Elizabeth N. Teel, BSc, Diane Kent, RNb, Umesh D. Parashar, MBBS, MPHa, Jon R. Gentsch, PhDc

aEpidemiology Branch and
cGastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, Georgia; and
bDepartment of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee

Although rotavirus vaccines are known to be shed in stools, transmission of vaccine-derived virus to unvaccinated contacts resulting in symptomatic rotavirus gastroenteritis has not been reported to our knowledge. We document here the occurrence of vaccine-derived rotavirus (RotaTeq [Merck and Co, Whitehouse Station, NJ]) transmission from a vaccinated infant to an older, unvaccinated sibling, resulting in symptomatic rotavirus gastroenteritis that required emergency department care. Results of our investigation suggest that reassortment between vaccine component strains of genotypes P7[5]G1 and P1A[8]G6 occurred during replication either in the vaccinated infant or in the older sibling, raising the possibility that this reassortment may have increased the virulence of the vaccine-derived virus. Both children remain healthy 11 months after this event and are without underlying medical conditions.

Key Words: rotavirus • acute gastroenteritis • RotaTeq • rotavirus vaccine • WC3 • sibling transmission • horizontal transmission • shedding • reassortant • New Vaccine Surveillance Network • NVSN

Abbreviations: RT-PCR, reverse transcription-polymerase chain reaction

Accepted Nov 20, 2009.


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