Abstract
ObjectivesTo determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine.MethodsA cross-sectional study was carried out over a period of two years from 2006 – 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping.Results6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593).ConclusionsApproximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.
Highlights
According to global estimates in 2011, over 700,000 children die annually from diarrheal diseases [1,2]
Some burden data on the role of RV as a cause of severe diarrhea in Pakistan are available, there is a lack of systematically collected data from multiple hospital settings across the country with careful description of clinical syndromes representing the most severe diarrhea which can be taken as a proxy for deaths, and inform policy makers on the importance of RV as a cause of child deaths [7,8,9,10,11,12,13,14]
In 2009 the World Health Organization (WHO) recommended that RV vaccines be included in all national immunization programs [15]
Summary
According to global estimates in 2011, over 700,000 children die annually from diarrheal diseases [1,2]. Of these rotavirus (RV) is responsible for an estimated 197,000 diarrhea deaths [2,3]. While global diarrheal mortality has fallen with improvements in hygiene, sanitation and an increase in public health education, RV continues to be the most important cause of severe diarrhea and dehydration in young children the world over [4,5,6]. In Pakistan, a country with the fourth highest burden of child mortality, diarrheal diseases remain major killers [1,6]. Countries that have introduced RV vaccines have shown a substantial decline in diarrhea-related hospital admissions and deaths [16,17]
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