Despite these encouraging findings concerns remain that neutralization escape mutants could emerge over time when vaccines are introduced in large scale immunization programs [31]. JQ1 concentration Furthermore, relatively few RV strains were predominant in settings where pre-licensure trials were conducted [19], [21], [22] and [23]. Questions about the performance of these vaccines in regions of the world where different RV strains may be prevalent remain [20], [21], [22], [23] and [24].

Up-to-date, comprehensive data on the distribution of RV strains in different regions of the world are needed to better understand these issues. To understand the global diversity of RV strains and to guide post-vaccine introduction monitoring, we reviewed the literature on rotavirus strains published over the past 12 years. Our aims were to (i) provide an update of strain surveillance results obtained during the last few years and strengthen these data by inclusion of historic data, (ii) estimate the impact of emerging RV strains on extant strain diversity, buy Epacadostat (iii)

put these findings in a regional and temporal context, and (iv) assess the prevalence of strains taking into account regional variations in burden of RV disease, particularly mortality. We conducted a systematic search through PubMed for articles published in English from 1996 to August 2010 using the terms “rotavirus” in combination with “strain”, “genotype”, or “surveillance”. Searching for additional studies

cited in reviews and careful evaluation of data reviewed in some of the original papers allowed us to include further potential studies, regardless of language in the original communication or the literature database indexing policy of the journal where the cited papers were originally all published. Studies reported from the same country were cross-referenced by authors, location and time period to ensure that data was not duplicated. The review process began in early 2008 and was periodically updated; the final update was completed in August 2010. Because previous investigations have failed to identify a consistent association between disease severity and any particular community acquired RV strain [32], [33], [34] and [35], we considered inclusively data from studies that identified strains among children seeking care at the family doctor, emergency department or hospital. No stringent exclusion criteria were defined regarding the surveillance approach (i.e., passive versus active), study design (i.e., cross sectional versus cohort studies), number of strains characterized, or the length of study period, as these factors were unlikely to influence strain patterns. However, studies reporting community outbreaks and nosocomial cases were systematically excluded, as the distribution of strains in these instances could be skewed.