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Indian Pediatr 2016;53:
651-652 |
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Hospital-based Surveillance of Rotavirus
Diarrhea among Under- five Children in Chandigarh
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Madhu Gupta, *MP Singh, #Vishal Guglani, KS
Mahajan and ¢S Pandit
From School of Public Health and Departments of
*Virology, PGIMER; and Department of Pediatrics,
#GMCH and ¢gmsh; Chandigarh, India.
Email: [email protected]
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In a prospective hospital-based
surveillance of 958 under five children admitted with acute
gastroenteritis in Chandigarh (May 2011 to July 2012), 239 stool samples
were collected. Rotavirus antigen was detected in 18.8% of samples by
reverse transcriptase polymerase chain reaction. Genotypes G1P[8]
(53.3%), G12P[6] (15.6%) were prevalent, and G3 not detected.
Key words: Epidemiology, Prevalence, Rotavirus
infections.
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A
prospective hospital-based rotavirus
surveillance was set up as part of a multicenteric study to estimate the
prevalence of rotavirus infection and identify circulating genotypes
among under-five children hospitalized with acute gastroenteritis in
Chandigarh, between May 2011 to July 2012 [1].
The study was approved by the Institute Ethics
Committe. All under-five children presenting with acute gastroenteritis
requiring hospitalization for rehydration treatment for at least 6 hours
were eligible for inclusion. Prior written informed consent was obtained
from the parents.
Systematic random sampling technique was used to
select children for collecting stool samples from cases. Assuming
prevalence of rotavirus positivity to be 35%, sample size calculated was
216 for 6.5% precision. Under-five children admitted with acute
gastroenteritis during the study period was estimated to be 1000 (based
on hospital records); hence the sampling interval was calculated as 4.6,
and stool samples were collected from every fifth case. A pediatrician
performed the medical examination and routine assessments. The severity
of diarrhea was assessed using the Vesikari scoring system [2].
Diarrheal episode was considered mild for a score of
£5, moderate for a
score between 6 and 10, severe cor scores 11 to 15, and very severe for
a score ³16.
About 5 g stool sample was collected within 24 hours of enrolment and
transported in cold chain for testing for rotavirus VP6 antigen using a
commercial enzyme immunoassay kit (Premier Rota clone Qualitative EIA,
Meridian Bioscience Inc. Cincinnati, USA). The stool samples
positive for rotavirus antigen were stored at -800C
and shipped in frozen state to Christian Medical College, Vellore for
strain characterization.
Out of 958 admissions of under-five children with
diarrhea, 239 stool samples were collected during study period.
Rotavirus antigen was detected in 18.8% (45/239) of the stool samples.
Majority (84%) of children with rotavirus diarrhea were less than one
year of age. Duration of diarrhea varied from 1 to 60 days. About 36%
children had a history of diarrhea for 1 day, and 23% had it for two
days. The mean duration of hospital stay of enrolled children was 3.6
days. Rotavirus infection was significantly higher (58%) during colder
months (November to April). (P<0.001). Sixty percent children
with rotavirus diarrhea had severe, and 20% each had moderate and very
severe dehydration. The commonest strains were combination of G1P[8]
(24, 53%) and G12 P[6] (7,16%). The G1P[8] strains were associated with
very severe disease. However, one case had G12 strain with very severe
disease. Genotypes G1, G12, G4, P[6], P[8], P[8]P[6] were detected
throughout the year while G3 was not detected. G9P[4] was identified
mainly in winter months.
The burden of rotavirus diarrheal disease of 18.8% in
this study is similar to previous studies from Chandigarh [3-4], but
lower than documented in other parts of the country [5,6]. This study
reports a trend in the emergence of G12 genotype and absence of G3
genotype from Chandigarh, which is similar to the trend observed in
Delhi [7] and Manipur [8], and with that reported in a systematic review
[9]. Large diversity of rotavirus strains with evolving virological
characteristics is challenging for prevention of rotavirus disease by
existing rotavirus vaccine, which emphasizes the need for continuous
rotavirus surveillance [10].
Acknowledgements: Dr Rajesh Kumar and Dr RK Ratho,
PGIMER, Chandigarh; Dr Jitaly Randhawa, Research Officer; and Dr
Gagandeep Kang, Christian Medical College, Vellore.
Contributors: All authors were involved in the
conception of the work, analysis and interpretation of data, drafting
the manuscript, and its final approval.
Funding: Shantha Biotech Limited, Hyderabad,
India. Competing interests: None stated.
References
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