Abstract
Despite substantial interventions in the understanding and case management of acute gastroenteritis, diarrheal diseases are still responsible for a notable amount of childhood deaths. Although the rotavirus is known to cause a considerable burden of pediatric diarrheal cases, the roles of other viruses remain undefined for the Pakistani population. This study was based on tertiary care hospital surveillance, from January 2009 to December 2010, including the detection of rotavirus, norovirus, astrovirus, and human parechovirus in children under the age of five using serological or molecular assays. Rotavirus, human parechovirus, norovirus, and astrovirus were detected in 66%, 21%, 19.5%, and 8.5% subjects, respectively. Human parechovirus genotypes, determined through analysis of VP1 gene sequences, showed a great diversity among co-circulating strains. Eighty percent of hospitalized children had dual or multiple viral infections, while 98% parechovirus positive cases were co-infected with rotavirus. The remarkable diversity of viruses associated with the childhood diarrhea in Pakistan calls for large-scale epidemiological surveys, coupled with case control studies, to ascertain their role in clinical manifestations. In addition, these findings also highlight the need for the implementation of up-to-date health interventions, such as the inclusion of a rotavirus vaccine in routine immunization programs for the improvement of quality in child health care.
Highlights
Acute viral gastroenteritis is a major public health problem in children below the age of five [1].Viruses, including the rotavirus (RV), norovirus (NV), and astrovirus (AstV), are established etiological agents associated with acute gastroenteritis [2]
Our present study presents the first comprehensive analysis of clinical significance and molecular epidemiology of viruses associated with acute dehydrating gastroenteritis in the indigenous Pakistani population
The highest proportion of enrolled children was positive for rotavirus (66%; n = 371) followed by parechovirus (21%; n = 118), Norovirus (19.5%; n = 110), and astrovirus (8.5%; n = 48)
Summary
Acute viral gastroenteritis is a major public health problem in children below the age of five [1].Viruses, including the rotavirus (RV), norovirus (NV), and astrovirus (AstV), are established etiological agents associated with acute gastroenteritis [2]. The rotavirus is the leading cause of severe diarrhea worldwide, and accounts for over 600,000 annual deaths among young children [3,4]. The rotavirus has been classified into seven serogroups (A-G) based on antigenicity of the VP6 protein, as well as patterns of the electrophoretic mobility of the 11 RNA segments. 27 G- and 35 P-genotypes have been reported, based on nucleotide variations among VP7 and VP4 gene segments, respectively [6], while the majority of rotavirus infections are caused by G1P [7], G2P [4], G3P [7], G4P [7], and G9P [7] worldwide [7,8]
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