Abstract
Group A rotavirus (RVA) is the most important cause of severe gastroenteritis among children worldwide, and effective RVA vaccines have been introduced in many countries. Here we performed a molecular epidemiological analysis of RVA infection among pediatric patients in East Java, Indonesia, during 2015–2018. A total of 432 stool samples were collected from hospitalized pediatric patients with acute gastroenteritis. None of the patients in this cohort had been immunized with an RVA vaccine. The overall prevalence of RVA infection was 31.7% (137/432), and RVA infection was significantly more prevalent in the 6- to 11-month age group than in the other age groups (P < 0.05). Multiplex reverse transcription-PCR (RT-PCR) revealed that the most common G-P combination was equine-like G3P[8] (70.8%), followed by equine-like G3P[6] (12.4%), human G1P[8] (8.8%), G3P[6] (1.5%), and G1P[6] (0.7%). Interestingly, the equine-like strains were exclusively detected until May 2017, but in July 2017 they were completely replaced by a typical human genotype (G1 and G3), suggesting that the dynamic changes in RVA genotypes from equine-like G3 to typical human G1/G3 in Indonesia can occur even in the country with low RVA vaccine coverage rate. The mechanism of the dynamic changes in RVA genotypes needs to be explored. Infants and children with RVA-associated gastroenteritis presented more frequently with some dehydration, vomiting, and watery diarrhea, indicating a greater severity of RVA infection compared to those with non-RVA gastroenteritis. In conclusion, a dynamic change was found in the RVA genotype from equine-like G3 to a typical human genotype. Since severe cases of RVA infection were prevalent, especially in children aged 6 to 11 months or more generally in those less than 2 years old, RVA vaccination should be included in Indonesia’s national immunization program.
Highlights
Acute gastroenteritis is a common and important cause of childhood morbidity and mortality in developing countries (Elliott, 2007)
We recently reported equine-like G3P[8]/P[6] strains with a DS-1 like backbone, resulting from a rare human/equine reassortment, circulating among pediatric inpatients with acute gastroenteritis at a private hospital in the suburbs of Surabaya, Indonesia (Utsumi et al, 2018)
A report from Australia pointed out that equine-like G3P[8] was more common in the areas where Rotarix R was being used (Roczo-Farkas et al, 2016), and another study found that the equine-like G3P[8] strain was responsible for the most episodes of severe gastroenteritis (Cowley et al, 2016)
Summary
Acute gastroenteritis is a common and important cause of childhood morbidity and mortality in developing countries (Elliott, 2007). A report from Australia pointed out that equine-like G3P[8] was more common in the areas where Rotarix R was being used (Roczo-Farkas et al, 2016), and another study found that the equine-like G3P[8] strain was responsible for the most episodes of severe gastroenteritis (Cowley et al, 2016). A new study targeting infants with RVA vaccines in private facilities of Surabaya revealed that approximately 70% of infants were immunized with the Rotarix R vaccine (Gunawan et al, 2019) These findings raise the possibility that the Rotarix R vaccine is associated with the emergence of the equine-like strains and that RVA vaccines may induce selective pressure that favors certain genotypes (Roczo-Farkas et al, 2016). The lower prevalence in older children could be due to acquired immunity through previous exposures (Velazquez, 2009)
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