Genomic epidemiology reveals post-vaccine re-emergence of vaccine-associated G1P rotavirus lineages with variable disease severity
- 1Institute of Infection, Veterinary and Ecological Sciences, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, UK
Abstract
Group A rotavirus G1P[8] strains, which are targeted by the Rotarix vaccine, have persisted in several countries following the introduction of the Rotarix vaccine. However, the evolutionary origins of the persisting strains remain unclear. Here, we leveraged over two decades of rotavirus surveillance data from Malawi to understand the genomic epidemiology of G1P[8] strains in a high-disease-burden sub-Saharan African setting. We observed a reversion of G1P[8] strains to the conventional Wa-like genotype constellation identified pre-vaccination, following transient circulation of DS-1-like G1P[8] strains. Most G1P[8] lineages that re-emerged post-vaccination circulated before vaccine introduction. Furthermore, new strains emerged post-vaccination through re-assortment of pre-existing viruses. The predominant post-vaccination lineage (MW-VP7-L2) contained an N147D substitution at an antigenically important site of the VP7 glycoprotein and showed evidence of episodic diversifying selection. Children infected with the MW-VP7-L2 lineage had a higher severity score of gastroenteritis than infections with other co-circulating lineages. These findings highlight the importance of long-term genomic surveillance to understand rotavirus transmission, evolution, and disease severity, and to guide public health interventions.
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BibTeX
@misc{mhango2026genomic,
title = {{Genomic epidemiology reveals post-vaccine re-emergence of vaccine-associated G1P rotavirus lineages with variable disease severity}},
author = {C. Mhango and E. Chinyama and A. Banda and R. Wachepa and L. Gauti and E. Matambo and F. Kawonga and W. Ndovie and D. Chaima and A. Zuza and A. Kalizang'oma and M. Mhango and N. A. Cunliffe and N. J. Tshiswaka and M. T. Mogotsi and A. E. Ogunbayo and F. E. Dennis and M. M. Nyaga and B. Kumwenda and C. M. Donato and A. W. Kamng'ona and C. Chaguza and K. C. Jere},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.24.26362359},
url = {https://www.medrxiv.org/content/10.64898/2026.09.24.26362359v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Genomic epidemiology reveals post-vaccine re-emergence of vaccine-associated G1P rotavirus lineages with variable disease severity
AU - C. Mhango
AU - E. Chinyama
AU - A. Banda
AU - R. Wachepa
AU - L. Gauti
AU - E. Matambo
AU - F. Kawonga
AU - W. Ndovie
AU - D. Chaima
AU - A. Zuza
AU - A. Kalizang'oma
AU - M. Mhango
AU - N. A. Cunliffe
AU - N. J. Tshiswaka
AU - M. T. Mogotsi
AU - A. E. Ogunbayo
AU - F. E. Dennis
AU - M. M. Nyaga
AU - B. Kumwenda
AU - C. M. Donato
AU - A. W. Kamng'ona
AU - C. Chaguza
AU - K. C. Jere
PY - 2026
DA - 2026/09/24
PB - medRxiv
DO - 10.64898/2026.09.24.26362359
UR - https://www.medrxiv.org/content/10.64898/2026.09.24.26362359v1
AB - Group A rotavirus G1P[8] strains, which are targeted by the Rotarix vaccine, have persisted in several countries following the introduction of the Rotarix vaccine. However, the evolutionary origins of the persisting strains remain unclear. Here, we leveraged over two decades of rotavirus surveillance data from Malawi to understand the genomic epidemiology of G1P[8] strains in a high-disease-burden sub-Saharan African setting. We observed a reversion of G1P[8] strains to the conventional Wa-like genotype constellation identified pre-vaccination, following transient circulation of DS-1-like G1P[8] strains. Most G1P[8] lineages that re-emerged post-vaccination circulated before vaccine introduction. Furthermore, new strains emerged post-vaccination through re-assortment of pre-existing viruses. The predominant post-vaccination lineage (MW-VP7-L2) contained an N147D substitution at an antigenically important site of the VP7 glycoprotein and showed evidence of episodic diversifying selection. Children infected with the MW-VP7-L2 lineage had a higher severity score of gastroenteritis than infections with other co-circulating lineages. These findings highlight the importance of long-term genomic surveillance to understand rotavirus transmission, evolution, and disease severity, and to guide public health interventions.
ER -