{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T09:05:14Z","timestamp":1779959114926,"version":"3.53.1"},"reference-count":50,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Acute gastroenteritis (AGE) remains a leading cause of pediatric mortality and morbidity, with rotavirus as the leading cause of severe disease. Post-vaccine surveillance is essential to monitor circulating pathogens and assess vaccination impact. Sicily was the first Italian region to implement universal rotavirus vaccination in 2012. We retrospectively studied 693 children hospitalized for suspected viral AGE at the Children\u2019s Hospital of Palermo (March 2017\u2013February 2020), testing stool samples for viral and bacterial enteric pathogens. Rotavirus remained the most common agent (13.3%), followed by norovirus (12.1%), adenovirus (11.3%), Salmonella spp. (4.6%) and astrovirus (3.2%). The study population was categorized as rotavirus-associated AGE (RV-AGE) or other-cause AGE (O-AGE). Epidemiological, clinical and virological features were compared with the pre-vaccine period (2011\u20132012). At least one pathogen was detected in 47.5% of samples. RV-AGE cases were older than those with O-AGE (median 32.6 vs. 30.5 months; p &lt; 0.01) and had greater clinical severity, with higher frequency of vomiting, fever and dehydration. Rotavirus infection was significantly associated with unvaccinated status. Compared with the pre-vaccine era, rotavirus prevalence declined (32.6% vs. 13.3%), seasonal patterns were attenuated and genotype distribution shifted toward G2P[4], G9P[8] and equine-like G3P[8] strains. Despite the decline in RV-AGE following vaccine introduction, rotavirus remains a relevant cause of pediatric AGE, underscoring the need for high vaccination coverage and continued surveillance.<\/jats:p>","DOI":"10.3390\/pathogens15060579","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T08:00:36Z","timestamp":1779955236000},"page":"579","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology and Clinical Impact of Pediatric Viral Gastroenteritis Before and After Rotavirus Vaccination in Sicily"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9293-5924","authenticated-orcid":false,"given":"Floriana","family":"Bonura","sequence":"first","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arcangelo","family":"Pepe","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6977-9268","authenticated-orcid":false,"given":"Dario","family":"Genovese","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Igiene, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5482-5268","authenticated-orcid":false,"given":"Emanuele","family":"Amodio","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Igiene, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5876-0406","authenticated-orcid":false,"given":"Chiara","family":"Filizzolo","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Campisi","sequence":"additional","affiliation":[{"name":"P.O. \u201cG.F. Ingrassia\u201d, Dipartimento Attivit\u00e0 Ospedaliere, ASP 6 Palermo, C.so Calatafimi 1009, 90129 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7790-2828","authenticated-orcid":false,"given":"Mariangela","family":"Pizzo","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Palazzotto","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7748-0880","authenticated-orcid":false,"given":"Simona","family":"De Grazia","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-6289","authenticated-orcid":false,"given":"Giovanni M.","family":"Giammanco","sequence":"additional","affiliation":[{"name":"Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza \u201cG. D\u2019Alessandro\u201d, Sezione di Microbiologia, Universit\u00e0 degli Studi di Palermo, Via del Vespro 133, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global Burden of 369 Diseases and Injuries in 204 Countries and Territories, 1990\u20132019: A Systematic Analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1002\/jmv.10449","article-title":"Viral Agents of Acute Gastroenteritis in German Children: Prevalence and Molecular Diversity","volume":"71","author":"Oh","year":"2003","journal-title":"J. Med. 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