Abstract
BackgroundRotavirus group A (RVA) is considered the leading cause of pediatric diarrhea, responsible for the high burden of diarrheal diseases in sub-Saharan Africa. Despite recent studies, the existent data are scarce for some African countries like Angola, a country with one of the highest RVA-related death estimates. The aim of this study was to determine the RVA detection rate and circulating genotypes in children less than five years of age with acute gastroenteritis attended at the Bengo General Hospital in Caxito, Bengo province, Angola, before vaccine introduction.MethodsBetween September 2012 and December 2013, 342 fecal specimens were collected from children enrolled. Positive samples for RVA by immunochromatographic rapid test were G and P-typed by hemi-nested type-specific multiplex PCR, and subgrouped for the VP6 gene. VP4 and VP7 genes from a subset of samples were sequenced for phylogenetic analysis.ResultsDuring the study period, a high RVA detection rate was registered (25.1%, 86/342).The age group most affected by RVA infection includes children under 6 months of age (p<0.01). Vomiting was highly associated with RVA infection (72.1%; p<0.001).From the 86 RVA-positive samples, 72 (83.7%) were genotyped. The most prevalent genotype was G1P[8] (34/72; 47.2%), followed by the uncommon G1P[6] (21/72; 29.2%), and G2P[4] (9/72; 12.5%). Only two G-types were found: G1 (60/72; 83.3%) and G2 (11/72; 15.3%). Among the P-genotypes, P[8] was the most prevalent (34/72; 47.2%), followed by P[6] (22/72; 30.6%) and P[4] (9/72; 12.5%). In the phylogenetic trees, the identified G and P-types clustered tightly together and with reference sequences in specific monophyletic groups, with highly significant bootstrap values (≥92%).ConclusionThis pre-vaccination study revealed, for the first time for Bengo province (Angola), the RVA genotype profile, including phylogenetic relationships, and a high RVA detection rate, supporting the immediate introduction of a RVA vaccine in the national immunization programme.
Highlights
Rotavirus group A (RVA) remains the most important etiological agent of severe diarrhea in children under five years of age [1, 2], especially in remote areas with difficult or inexistent access to the healthcare infrastructure and inadequate domestic sanitation conditions [2, 3].According to the global estimates from 2008, RVA was responsible for 453,000 deaths among children under five years of age each year, with African children accounting for more than 50% of the total [4], but a recent study showed a decline in this number, up to 215,000 deaths in 2013, the majority of them in India [5]
The age group most affected by RVA infection includes children under 6 months of age (p
The mean age was significantly lower for children with RVA infection as detected by the RVA antigen immunochromatographic assay (9.2±5.00 versus 17.6±13.40 months, p
Summary
Rotavirus group A (RVA) remains the most important etiological agent of severe diarrhea in children under five years of age [1, 2], especially in remote areas with difficult or inexistent access to the healthcare infrastructure and inadequate domestic sanitation conditions [2, 3].According to the global estimates from 2008, RVA was responsible for 453,000 deaths among children under five years of age each year, with African children accounting for more than 50% of the total [4], but a recent study showed a decline in this number, up to 215,000 deaths in 2013, the majority of them in India [5]. A third RVA vaccine, the low-cost, live attenuated Rotavac (Bharat Biotech International, India) was licensed for use in India but not yet pre-qualified for the Global Alliance for Vaccines and Immunization (GAVI) market [7]. Both recommended vaccines require multiple dose administration (two doses for Rotarix and three for RotaTeq), the first to be administered between 6 and 15 weeks of age [8], and raise homo- and heterotypic immune response against RVA different strains [9]. The aim of this study was to determine the RVA detection rate and circulating genotypes in children less than five years of age with acute gastroenteritis attended at the Bengo General Hospital in Caxito, Bengo province, Angola, before vaccine introduction.
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