Changing trends in rotavirus detection, genotypes and clinical severity among children

Abstract

Background: Rotavirus is a major cause of acute gastroenteritis in developing countries like India. Rotavirus causes approximately 11.37 million episodes of acute gastroenteritis (AGE), 872,000 inpatient admissions and 78,000 deaths in children <5 years annually in India. This study aims to detect rotavirus among children <5 years admitted with acute gastroenteritis and to determine the common circulating genotypes and assess their clinical severity. Methods and materials: A total of 772 stool samples were collected from children <5years who were admitted for acute gastroenteritis (AGE) during February 2014 to October 2019. Rotavirus antigen was detected using a commercial enzyme immunoassay kit, Rotaclone®). RNA was extracted from stool samples using viral RNA mini kit (Qiagen, Germany). The extracted RNA was converted into cDNA by MMLV-RT enzyme. The cDNA is used for genotyping by a semi-nested RT-PCR targeting VP7 and VP4. Modified Vesikari scale was used to analyse the severity of acute gastroenteritis and Modified Kuppuswamy scale was used to assess the socio-economic class. Results: Rotavirus was detected in 23.6% of children with AGE. The year-wise detection rate of rotavirus was 33.8% (2014), 29.8% (2015), 26.1% (2016), 19.7% (2017), 17.7% (2018) and 20.9% (2019). Based on Vesikari score rotavirus G2P [4] infected children had more vomiting and episodes (56%) than those infected with G1P [8] (29%) and G3P [8] (32%). Children aged 12–24 months had a higher detection rate of 27.9%. Rotavirus was detected significantly higher among lower-middle class 26.7% in contrast to upper-middle class 17.4% (p = 0.006). G1P [8] (42%) and G3P [8] (32%) were the predominant circulating genotypes. G1P [8] was initially the predominant genotype (2014–2016) and it has been replaced by G3P [8] (2017–2019). Conclusion: Rotavirus shows a declining trend since 2017 and this could probably because of the introduction of rotavirus vaccine in National immunisation schedule. There is a change in genotype distribution of rotavirus G3P [8] replaced G1P [8] as the predominant circulating genotype in the past 3 years however less circulating G2P [4] genotype was associated with longer duration of vomiting and more episodes leads to severe gastroenteritis.