Description of New Vaccine Surveillance Network Rotavirus Cases and Controls*

Nucleotide-level genetic distance (GD) distribution of all cases colored by vaccination status for the vaccine-specific analyses.

(A) The RV1-specific analysis includes cases who received at least one dose of RV1 vaccine or were unvaccinated. GD is represented as the percent nucleotide difference between the case and RV1 vaccine strain. (B) The RV5-specific analysis includes cases who received at least one dose of RV5 vaccine or were unvaccinated. GD is represented as the minimum percent nucleotide difference between the case strain to any of the five strains included in the pentavalent RV5 vaccine.

Characterization of the nucleotide-level genetic distance (GD) distribution for cases in the RV1-specific analysis according to genotype and genogroup.

Strains are colored according to (A) GxPx genotype information, and (B) genogroup of the remaining nine-segment backbone. GD is represented as percent nucleotide difference between the case and RV1 vaccine strain. The black dotted line and grey background represent the threshold dividing Strainj=0 vs Strainj=1. Histogram binwidth is set to 1 and due to rounding issues, the threshold line in the figure is set at 10.5 for better visualization; for actual analysis, the threshold is set at 9.6%.

Study-wide and strain-specific vaccine effectiveness (VE) estimates against RVGE from study years 2012 – 2016, based on genetic distance to the RV1 strain.

In the overall analysis, individuals were considered vaccinated if they received at least one dose of either RV1 or RV5. In the RV1-specific analysis, only RV1-vaccinated and unvaccinated individuals w ere included.

Study-wide and strain-specific vaccine effectiveness (VE) estimates against RVGE from study years 2012 – 2016, based on minimum genetic distance to any of the RV5 vaccine strains.

In the overall analysis, individuals were considered vaccinated if they received at least one dose of either RV1 or RV5. In the RV5-specific analysis, only RV5- vaccinated and unvaccinated individuals were included.

Nucleotide-level genetic distance distribution of all cases to the rotavirus vaccine strain* for each of the seven U.S. NVSN study sites (n= 254).

*(A) RV1 vaccine and (B) minimum GD to any of the RV5 vaccine strains.Each site is colored by the proportion of vaccine usage amongst controls. The grey line in the distribution represents median GD for each study site. The red dotted line and light blue shaded area represents the threshold dividing Strainj=0 vs Strainj=1. Study sites are ordered by descending vaccine use (top to bottom).