8%, South-east Asian region, 7.7% and 12.9%, Eastern Mediterranean region, 5.3% and 11.6%, European region, 3% and 3.7%) When both G and P antigen specificities together were considered for inclusion, we identified 74,497 strains. Information on 686 strains was not available for reasons similar to those outlined above. Of the 73,811 strains with available information, the 5 globally common G1P[8], G2P[4], G3P[8], G4P[8], and G9P[8] strains accounted for a total of 74.7% of all strains (Fig. 2B). Furthermore, 15 unusual G–P combinations circulating in a majority of WHO

regions, either with common G and P types or some other VX770 antigen specificities, mainly representing common G types in combination with the P[6] genotype, accounted for an additional 9.8% of all strains (range, 0.2% for G4P[4] or G9P[4] and 1.9% for G4P[6]). Rare strains (each with prevalence <0.2%) accounted for an additional 0.5%; these novel strains included at least 54 G–P combinations. The combined prevalence of (partially) untypeable strains and infections with multiple G and/or P types was 15%. Collectively, the globally common, unusual and rare human strains together include at least 12 G types, 15 P types and >70 G–P genotype combinations (Fig. 3). For the nested study to determine the spatiotemporal trends of rotavirus strain distribution over a 12-year time span, we considered published data on G types. Of the 110,223

strains with G type information, Selleckchem RAD001 data on 7390 strains could not be distributed into one of our predefined time intervals. Nonetheless, we were still able to include 102,970 strains from 259 studies (Table 1, Supplementary file). For the period 1996–1999, 39 countries worldwide provided data on 18,628 strains. This number increased to 46 countries and 25,475 strains in 2000–2003 and 93

countries and 58,867 strains in 2004–2007 (2008). In each region except the African and the South-east Asian region, the number of countries providing data increased over the three time periods. The proportion of countries reporting data in each WHO region varied considerably (range, much 10% for Eastern Mediterranean region in 1996–1999 and 64% for South-east Asian region in 2003–2007). Globally, most strains identified were G1 over each of the 3 time periods, although the relative frequency of this type appeared to decrease slightly over time (Fig. 4). In contrast, the number of identified G3 and G9 strains increased during the same period, while those of G2, G4 and G8 remained constant. Type G12 strains emerged during the 2003–2007 period to represent 1.3% of all strains. The prevalence of other types was below 1%. The rate of untypeable strains slightly decreased over time, while mixed infections remained equally prevalent (not shown). To better understand this fluctuation in strain prevalence over time, we examined the 7 medically important G types by geographic region (Fig. 4, Supplementary file).