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This descriptive study included 850 hospitalized children &lt;5 years of age with acute gastroenteritis (AG) between October 2013 and September 2015. Overall, 78 (9.2%) children were positive for RVA during the study period with a positivity rate ranging from 11.3% in the first year of the study to 6.8% in the second year. G1 (47.4%) was the predominant G type, followed by G2 (28.2%) and G9 (10.3%). The most common P type was P[8] (69.2%) followed by P[4] (25.6%). The decrease in the prevalence of G1P[8] from 51% to 37.1% was associated with an increase in the prevalence of G2P[4] from 21.6% to 33.3% during the 2\u2010year study period. This study demonstrated a significant decrease in the prevalence of RVA\u2010AG cases in the first 2\u2010year period after vaccine introduction, especially in the age group between 1 and 12 months, and a reduction in the circulation of G1P[6]. The parallel rise and spread of G2P[4] in post\u2010vaccination period might pose an impact to long\u2010term vaccine efficacy. Continued surveillance studies in different Saudi regions are crucial to document the effectiveness of Rotarix\u00ae vaccine and evaluate the potential emergence of rare\/novel RVA genotypes. <jats:bold><jats:italic>J. Med. 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