Reply to RE: The burden of Rotavirus gastroenteritis among hospitalized pediatric patients in a tertiary referral hospital in Jeddah.

I would like to thank Prof. Al-Mendalawi for his precious comments and contribution. I guess that the author’s name (Nabih) was misspelled in the comment and the citation.

As regards the first comment, we agree that the prevalence of Rotavirus gastroenteritis is still worrisome for the reasons mentioned in the comment. It is true that Rotavirus vaccination was implemented in Saudi Arabia since the year 2006 but the implementation in the national immunization program started in 2013. This was 3 years after our study, which was conducted in 2010. It is also true that 2.3% of our Rota positive gastroenteritis (RPG) cases were vaccinated, but 8.1% of our Rota negative gastroenteritis (RNG) cases were vaccinated as well. The correct percentage of vaccinated RNGE cases, in our study, was 8.1%, and not 6.1% as mentioned by Prof. Al. Mendalawi.1 Our study recommendation stated, “In view of the high disease prevalence among children, locally and worldwide, and in view of the effectiveness of vaccination shown in the previous studies and our study, we recommend routine Rotavirus vaccination as the most effective available means of control despite improvement in sanitation and hygiene. Surveillance for the efficacy and effectiveness of vaccination as well as the differential efficacy of the 2 available vaccines is recommended.” We hope that with the current vaccination program, the prevalence of RPG will dramatically decrease, and we plan to have further studies to assess the efficacy of vaccination in our community. With the recent introduction of the 2 Rotavirus vaccines, RotaTeq and Rotarix, it appears that the total number of hospitalizations due to Rotavirus infections is being reduced in many countries, at least in developed countries that implemented a universal immunization program. No data analyses are available to clarify whether the Rotavirus vaccine introduction would allow other Rotavirus P and G genotypes—which are not covered by the current vaccines—to emerge into the human population and fill the apparent gap.2 Therefore we agree with Prof. Al-Mendalawi as regards the need for regular surveillance and characterization of Rotavirus. With regard to the second comment, we agree with Prof. Al-Mendalawi about the importance of Norovirus gastroenteritis, but it was not tested in our study. We hope that it could be addressed in further studies.