BACKGROUND: Since 2006, the New Vaccine Surveillance Network has conducted 
active, population-based surveillance for acute gastroenteritis (AGE) 
hospitalizations and emergency department (ED) visits in 3 United States 
counties. Trends in the epidemiology and disease burden of rotavirus 
hospitalizations and ED visits were examined from 2006 to 2016.
METHODS: Children < 3 years of age hospitalized or visiting the ED with AGE were 
enrolled from January 2006 through June 2016. Bulk stool specimens were 
collected and tested for rotavirus. Rotavirus-associated hospitalization and ED 
visit rates were calculated annually with 2006-2007 defined as the prevaccine 
period and 2008-2016 as the postvaccine period. Rotavirus genotype trends were 
compared over time.
RESULTS: Over 11 seasons, 6954 children with AGE were enrolled and submitted a 
stool specimen (2187 hospitalized and 4767 in the ED). Comparing pre- and 
postvaccine periods, the proportion of children with rotavirus dramatically 
declined for hospitalization (49% vs 10%) and ED visits (49% vs 8%). In the 
postvaccine era, a biennial pattern of rotavirus rates was observed, with a 
trend toward an older median age. G1P[8] (63%) was the predominant genotype in 
the prevaccine period with a significantly lower proportion (7%) in the 
postvaccine period (P < .001). G2P[4] remained stable (8% to 14%) in both 
periods, whereas G3P[8] and G12P[8] increased in proportion from pre- to 
postvaccine periods (1% to 25% and 17% to 40%), respectively.
CONCLUSIONS: The epidemiology and disease burden of rotavirus has been altered 
by rotavirus vaccination with a biennial disease pattern, sustained low rates of 
rotavirus in children < 3 years of age, and a shift in the residual genotypes 
from G1P[8] to other genotypes.