Abstract
ABSTRACTThis article provides a review of immunity, diagnosis, and clinical aspects of rotavirus disease. It also informs about the changes in epidemiology of diarrheal disease and genetic diversity of circulating group A rotavirus strains following the introduction of vaccines. Group A rotavirus is the major pathogen causing gastroenteritis in animals. Its segmented RNA genome can lead to the emergence of new or unusual strains in human populations via interspecies transmission and/or reassortment events.
Highlights
Acute diarrheal disease (ADD) is a syndrome caused by different agents, and its major manifestation is increased number of bowel movements, with watery or loose stools.(1) Acute diarrheal disease or gastroenteritis is the most common disease all over the world and the main cause of death among children aged under five years.(2) Acute diarrheal disease affects primarily children living in low- and middle-income countries, where the incidence rates are much higher specially due to poor quality of drinking water, inappropriate sanitation and nutritional risk factors, such as suboptimal breastfeeding, and zync and vitamin A defficiency.(3) Brazil is a continent-sized country with much socioeconomic heterogeneity and the ADD monitoring data accounted a total of 33,397,413 reported cases, from 2000 to 2011
This agent was described at least 40 years ago, and was soon recognized as the main cause of morbidity and mortalily associated to diarrhea.(4) Virtually every child in both developed and developing countries will be infected by rotavirus in the first five years of life.(5) All over the world, rotavirus ADD accounts for one third of 1,340,000 deaths, and for 9 million hospital admissions of children aged under 5 years.(2)
The enterocytes are destroyed and migration of cells from the crypt to the cilli occurs faster, leading to temporary loss of the absorptive capacity of the intestine and to diarrhea.(1,11) After cytolytic replication of rotavirus in mature enterocytes, the new viral particles released can infect the most distal parts of the small intestine and/or be excreted through stools.(12) The NSP4 protein plays a crucial role in the development of diarrhea by demonstrating functions of enterotoxin.(1) Recent discoveries suggest that rotavirus infection can disseminate throughout the host body, leading to a systemic infection.(13) Neurological manifestations associated to rotavirus infection have been reported and occur in approximately 2 to 5% of cases, ranging from benign seizures to lethal encephalitis
Summary
Acute diarrheal disease (ADD) is a syndrome caused by different agents (bacteria, viruses and parasites), and its major manifestation is increased number of bowel movements, with watery or loose stools.(1) Acute diarrheal disease or gastroenteritis is the most common disease all over the world and the main cause of death among children aged under five years.(2) Acute diarrheal disease affects primarily children living in low- and middle-income countries, where the incidence rates are much higher specially due to poor quality of drinking water, inappropriate sanitation and nutritional risk factors, such as suboptimal breastfeeding, and zync and vitamin A defficiency.(3) Brazil is a continent-sized country with much socioeconomic heterogeneity and the ADD monitoring data accounted a total of 33,397,413 reported cases, from 2000 to 2011 (http://portal.saude.gov.br). Changes in epidemiology of the disease caused by RVA are expected in the post-vaccine era.(40,45) The tendency of RVA infecting older children (aged 6 to 10 years) after introduction of the vaccine was reported in the United States and Brazil. Distribution of Group A rotavirus strains in humans in the pre- and post-vaccination eras The differentiation of RVA strains determined by the combination of G and P types is widely used in epidemiological studies,(1) and the genotypes are distributed among several animal species.(6,9) Thanks to the segmented feature of the RVA genoma, the genes that encode for VP7 and VP4 can, in theory, segregate in an independent manner, resulting in a large diversity of strains. A certain dominant strain for one or two years can be replaced by another emerging strain.(49,53) Other strains may be periodically or locally important, such as
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