The Burden of Rotavirus Gastroenteritis in Children: A Hospital-Based Prospective Study in Western Rajasthan

Abstract

Objective Rotaviruses are the prime cause of gastroenteritis amongst infants and young children worldwide. In India, the mortality and economic impact caused by rotavirus are high. The objective of this is to understand the burden of rotavirus in acute watery diarrhea and its circulating genotypes in hospitalized children less than five years of age for acute gastroenteritis in western Rajasthan. Methodology This is a hospital-based prospective study conducted in the pediatrics department of Dr. Sampurnanand (S.N.) Medical College of Jodhpur in India for one year during 2018. The study included 399 children less than five years old, presenting with acute gastroenteritis who needed to be admitted for at least six hours. We enrolled subjects after obtaining informed consent from the guardian. Stool samples of 5 gm or ml were collected in a sterile container and stored at minus 20 degrees centigrade while transporting to Christian Medical College (CMC) virology lab in Vellore, India. The stool samples were subjected to Enzyme-Linked Immunosorbent Assay (ELISA) testing, followed by genotype determination. We investigated data through statistical analysis from all collected data. Results A total of 399 patients fulfilled the enrollment criteria; out of them, 92 (23.05%) were positive for rotavirus, and maximum cases were seen in the age group of six months to two years (78.26%). Rotavirus positivity was more in males (64.13%) than females (35.86%). The rotavirus infection was seen throughout the year, with a peak in cases from November to February (73.91%). G3P8 (55.43%) was the most common strain causing rotavirus diarrhea, followed by G1P8 (9.72%) and G3+G12P8 (8.69%). Based on the Vesikari clinical severity score, 70.65% of patients had severe diarrhea. Conclusion This prospective study highlights the healthcare and economic burden of rotavirus, especially in children of less than five years. The incidence of rotavirus is observed in winter months, and its prevalence in all cases of acute diarrhea in our study is 23.05%. G3P8 was the most common genotype causing rotavirus diarrhea in our region in both non-vaccinated and vaccinated children, followed by G1P8 and G3+G12P8, respectively.

Burden of Rotavirus (RV) Infection in Children Below Five Years of Age Having Acute Diarrhoea and Pattern of Circulating Genotypes in a Community in Indore City of Madhya Pradesh

“…Even though G1P8 is the most prevalent circulating rotavirus genotype globally, there are numerous intra-genotyping lineages and their sub-lineages that show genetic variation within G1P8 rotavirus strains. 7 In general, point mutations and gene rearrangements are two methods that contribute to the diversity of rotaviruses. Rotavirus vaccination is essential because the gastroenteritis it causes poses a threat…”

The Current Epidemiology of Rotavirus Infection in Children Less than 5 Years of Age after Introduction of RV Vaccine in India

“…As per Ruuska & Vesikari scoring system the majority of cases were classified as moderate. 4,[26][27][28] The majority of rotavirus-positive cases, (71.42%) were IPD patients and (28.58%) cases were OPD patients. This finding correlates well with other studies.…”

“…In this study, however, no significant correlation was observed in any of the age groups, unlike what has been reported earlier. 28,29 Muendo et al claimed that, hypothetically, malnutrition might be associated with protection due to various reasons, for instance, shortening of villi in malnourished children, hence leading to lesser absorption. 29 In this study, the most common rotavirus G/P genotype was found to be G9P [4], followed by G3P [8] and G1P [8].…”

“…Few recent studies have quite different and diverse genotypic rotavirus strains distribution, which may vary due to sample size, study period, and geographical variation in different settings. 8,10,28,31 However, the increasing trends and emergence of G9P [4] strains was observed throughout the study; it is therefore imperative to conduct regular surveillance to continuously monitor the trends of circulating RV strains to assess the impact of rotavirus vaccination on strain distribution and diversity. 26…”