Evaluating the Impact of Breastfeeding on Rotavirus Antigenemia and Disease Severity in Indian Children.

Sushmita Das,Utpal Kant Singh,Ganesh Chandra Sahoo,Anil Kumar Jaiswal,Prachi Singh,Rishikesh Kumar,Pradeep Das,Ranjeet Kumar,Ravi Jhaveri

doi:10.1371/journal.pone.0146243

Abstract

ObjectivesTo evaluate the contribution of breastfeeding to Rotavirus (RV)-induced antigenemia and/or RNAemia and disease severity in Indian children (<2 yrs age).MethodsPaired stool and serum samples were collected from (a) hospitalized infants with diarrhea (n = 145) and (b) healthy control infants without diarrhea (n = 28). Stool RV-antigen was screened in both groups by commercial rapid-test and enzyme immunoassay. The disease severity was scored and real-time-PCR was used for viral-load estimation. Serum was evaluated for RV-antigenemia by EIA and RV-RNAemia by RT-PCR. Data was stratified by age-group and breastfeeding status and compared.ResultsPresence of RV-antigenemia and RV-RNAemia was positively related with presence of RV in stool. Disease severity and stool viral-load was significantly associated with RV-antigenemia[(r = 0.74; CI:0.66 to 0.84; P<0.0001,R2 = 0.59) and (r = -0.55; CI:-0.68 to -0.39; P<0.0001,R2 = 0.31) respectively], but not with RV-RNAemia. There was significant reduction in RV-antigenemiarate in the breast-fed group compared to non-breastfed infants, especially in 0–6 month age group (P<0.001). Non-breastfed infants were at risk for RV-antigenemia with severe disease manifestations in form of high Vesikari scores correlating with high fever, more vomiting episodes and dehydration.ConclusionRV-antigenemia was common in nonbreastfed children with severe RV-diarrhea and correlated with stool RV-load and disease severity.

Highlights

Rotavirus (RV) is the major worldwide cause of acute gastroenteritis (AGE) with severe dehydrating diarrheain children below 5 years [1]
Disease severity and stool viral-load was significantly associated with RV-antigenemia[(r = 0.74; CI:0.66 to 0.84; P
Non-breastfed infants were at risk for RVantigenemia with severe disease manifestations in form of high Vesikari scores correlating with high fever, more vomiting episodes and dehydration

Summary

Introduction

Rotavirus (RV) is the major worldwide cause of acute gastroenteritis (AGE) with severe dehydrating diarrheain children below 5 years [1]. Antigenemia, a common phenomenon detected in RV-infected children, is characterized by transient presence of antigen in the blood [6,7,8] and could explain the mechanism for extraintestinal RV infections. Detection of serum rotavirus antigen ranges from 43–90% in acute phase of the infection. The phase of antigenemia is transient as peak levels of RV-antigen are usually seen during early days of infection and are undetectable beyond a week. RV-RNAemia (presence of RV-RNA in blood) has been reported earlier [6]. Several studies have attempted to find rotavirus RNA/nonstructural proteins from extraintestinal samples [5,6,7]

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