Rotavirus Positive Cases Research Articles

Observational Study of Rotavirus Related Gastrointestinal Tract Infection in Pediatric Age Group in Kut City Hospitals

In this study, the prevalence and impact of rotavirus infections on pediatric patients under six years old were investigated. Rotaviruses emerged as a predominant cause of severe diarrheal illness in newborns and young children globally. A comprehensive observational study in Al Kut city from May to September 2022 included 99 cases, revealing a 46.5 % positive rate for rotavirus. Statistical analysis indicated a significant association between rotavirus infection and increased frequency of diarrhea episodes (P=0.004) and severe dehydration (P=0.001). Moreover, rotavirus-positive cases were more likely to require intravenous fluid therapy (P=0.02). These findings underscore the substantial burden of rotavirus on both the healthcare system and society, emphasizing its role as a major contributor to infant gastroenteritis, often leading to severe complications and hospitalization

Which one is more dangerous in childhood Rotavirus or Adenovirus?

Objective: Determination of the frequency of Rotavirus and Adenovirus in patients diagnosed with gastroenteritis in the Pediatric Polyclinic of our hospital by immunochromatographic method and retrospective evaluation of the change in the distribution of the agent according to age, gender and vaccination status. Method: Those patients with complaints of diarrhea, vomiting, dehydration, and fever as well as those diagnosed with acute gastroenteritis were evaluated by taking fresh stool samples between January 2015 and November 2020. The data were presented using descriptive statistics. Results: The number of acute gastroenteritis patients included in the study was 1,192. The mean age of the patients was 18±SD months (min: 1 month, max: 180 months). Adenovirus and Rotavirus antigens were detected in 10% of all cases (n=119). Rotavirus antigen was positive in 6.6% (n=78) and Adenovirus antigen was positive in 3.1% (n=38) of all cases. The hospitalization rate was 5.1 times higher in Rotavirus positive cases (p

Effectiveness of Pentavalent Rotavirus Vaccine in Shanghai, China: A Test-Negative Design Study

To evaluate vaccine effectiveness (VE) of a live oral pentavalent rotavirus vaccine (RotaTeq, RV5) among young children in Shanghai, China, via a test-negative design study. We consecutively recruited children visiting a tertiary children's hospital for acute diarrhea from November 2021 to February 2022. Information on clinical data and rotavirus vaccination was collected. Fresh fecal samples were obtained for rotavirus detection and genotyping. To evaluate VE of RV5 against rotavirus gastroenteritis among young children, unconditional logistic regression models were conducted to compare ORs for vaccination between rotavirus-positive cases and test-negative controls. A total of 390 eligible children with acute diarrhea were enrolled, including 45 (11.54%) rotavirus-positive cases and 345 (88.46%) test-negative controls. After excluding 4 cases (8.89%) and 55 controls (15.94%) who had received the Lanzhou lamb rotavirus vaccine, 41 cases (12.39%) and 290 controls (87.61%) were included for the evaluation of RV5 VE. After adjustment for potential confounders, the 3-dose RV5 vaccination showed 85% (95% CI, 50%-95%) VE against mild to moderate rotavirus gastroenteritis among children aged 14 weeks to≤4years and 97% (95% CI, 83%-100%) VE among children aged 14 weeks to≤2years with genotypes G8P8, G9P8, and G2P4 represented 78.95%, 18.42%, and 2.63% of circulation strains, respectively. A 3-dose vaccination of RV5 is highly protective against rotavirus gastroenteritis among young children in Shanghai. The G8P8 genotype prevailled in Shanghai after RV5 introduction.

Histo-Blood Group Antigen Null Phenotypes Associated With a Decreased Risk of Clinical Rotavirus Vaccine Failure Among Children <2 Years of Age Participating in the Vaccine Impact on Diarrhea in Africa (VIDA) Study in Kenya, Mali, and the Gambia

Previously studied risk factors for rotavirus vaccine failure have not fully explained reduced rotavirus vaccine effectiveness in low-income settings. We assessed the relationship between histo-blood group antigen (HBGA) phenotypes and clinical rotavirus vaccine failure among children <2 years of age participating in the Vaccine Impact on Diarrhea in Africa Study in 3 sub-Saharan African countries. Saliva was collected and tested for HBGA phenotype in children who received rotavirus vaccine. The association between secretor and Lewis phenotypes and rotavirus vaccine failure was examined overall and by infecting rotavirus genotype using conditional logistic regression in 218 rotavirus-positive cases with moderate-to-severe diarrhea and 297 matched healthy controls. Both nonsecretor and Lewis-negative phenotypes (null phenotypes) were associated with decreased rotavirus vaccine failure across all sites (matched odds ratio, 0.30 [95% confidence interval: 0.16-0.56] or 0.39 [0.25-0.62], respectively]. A similar decrease in risk against rotavirus vaccine failure among null HBGA phenotypes was observed for cases with P[8] and P[4] infection and their matched controls. While we found no statistically significant association between null HBGA phenotypes and vaccine failure among P[6] infections, the matched odds ratio point estimate for Lewis-negative individuals was >4. Our study demonstrated a significant relationship between null HBGA phenotypes and decreased rotavirus vaccine failure in a population with P[8] as the most common infecting genotype. Further studies are needed in populations with a large burden of P[6] rotavirus diarrhea to understand the role of host genetics in reduced rotavirus vaccine effectiveness.

Regional hospitalisation and seasonal variations of Pediatric rotavirus gastroenteritis pre- and post-RV vaccination: a prospective and retrospective study.

Rotavirus is the primary cause of gastroenteritis in children worldwide and is a leading cause of gastroenteritis in children, with a significant burden. Rotavirus vaccine became available in Ireland in 2016. This study aimed to investigate hospital admissions and seasonal characteristics of rotavirus gastroenteritis in a pre- and post-vaccination period in a single district general hospital. In the post-vaccination year, from November 18th 2016 to November 18th 2017, all children up to 3years of age who presented to Mayo University Hospital with vomiting and diarrhea, were recruited and had their stool tested for rotavirus. Retrospective analysis of hospital data of children of the same age during pre-vaccination years (2014-2016) were used for comparison. Compared with the pre-vaccination years (2014-2016), the median percentages of reduction of rotavirus positive stool requests and hospital admissions were high, 48.5% and 73%, respectively. In the post-vaccination year, the median percentage of reduction of emergency department presentation (stool requests) with gastroenteritis was 9%. No delay in the onset of RV season or reduction of the peak of RV infection was noted in the post-vaccination year. The duration of rotavirus season in 2016/2017 was short. Compared with 3 pre-vaccination years, the total number of gastroenteritis presentations, gastroenteritis hospital admissions, and rotavirus positive gastroenteritis cases were all reduced, and the duration of the rotavirus season was shorter.

Role of routine laboratory markers in the diagnosis of rotavirus and adenovirus gastroenteritis

Purpose: The present study aimed to evaluate and estimate the additional and auxiliary diagnostic value of routine laboratory parameters in patients with acute diarrhea caused by rotavirus and adenovirus. Methods/ patients: A total of 6784 patients diagnosed with acute gastroenteritis were evaluated. Rotavirus and adenovirus infection was diagnosed via a Qualitative immunochromatographic combo rapid cassette antigen test. Complete blood count and biochemical blood tests were performed in all the patients and were compared between the groups according to the positivity or negativity of the virus. Results: Rotavirus diarrhea was diagnosed in 16.8% and adenovirus diarrhea in 3.2% of patients. Hemoglobin, hematocrit, and mean cell volume (MCV) levels were lower, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly higher in rotavirus positive cases. Neutrophil to lymphocyte ratio was significantly higher, and lymphocyte to monocyte ratio was significantly lower in positive rotavirus cases than negative ones 2.96 and 2.56, respectively (p&lt;0.001). Conclusions: Hematological and biochemical parameters may assist in diagnosing and distinguishing rotaviral and adenoviral gastroenteritis, especially in low-resource environments. Keywords: adenovirus; children; diarrhea; laboratory markers; rotavirus

Effectiveness of Monovalent Rotavirus Vaccine in Mozambique, a Country with a High Burden of Chronic Malnutrition.

Mozambique introduced monovalent rotavirus vaccine (Rotarix®) in September 2015. We evaluated the effectiveness of Rotarix® under conditions of routine use in Mozambican children hospitalized with acute gastroenteritis (AGE). A test negative case-control analysis was performed on data collected during 2017–2019 from children <5 years old, admitted with AGE in seven sentinel hospital sites in Mozambique. Adjusted VE was calculated for ≥1 dose of vaccine vs. zero doses using unconditional logistic regression, where VE = (1 − aOR) × 100%. VE estimates were stratified by age group, AGE severity, malnutrition, and genotype. Among 689 children eligible for analysis, 23.7% were rotavirus positive (cases) and 76.3% were negative (controls). The adjusted VE of ≥1 dose in children aged 6–11 months was 52.0% (95% CI, −11, 79), and −24.0% (95% CI, −459, 62) among children aged 12–23 months. Estimated VE was lower in stunted than non-stunted children (14% (95% CI, −138, 66) vs. 59% (95% CI, −125, 91)). Rotavirus vaccination appeared moderately effective against rotavirus gastroenteritis hospitalization in young Mozambican children. VE point estimates were lower in older and stunted children, although confidence intervals were wide and overlapped across strata. These findings provide additional evidence for other high-mortality countries considering rotavirus vaccine introduction.

Acute Gastroenteritis in Children Below 5Years of Age at Tirupati, Andhra Pradesh, India Post Introduction of Rotavirus Vaccine into National Immunization Programme.

To identify the burden of rotavirus acute gastroenteritis (AGE) and the genotypes presenting in the authors' area in the period after introduction of rotavirus vaccine in Universal Immunization Programme (UIP). Children aged less than 5 y and presenting to hospital for the treatment of AGE were enrolled into the study from January 2016 to June 2019. Clinical details including age, gender, extent of illness, number of stools, concomitant vomiting and fever, grade of dehydration, and associated illness were recorded. Stool samples were tested for rotavirus using a commercially available ELISA Kit. Genotyping was performed for the rotavirus antigen-positive samples. Rotavirus positive AGE was seen in 14.2% of the children. High burden of rotavirus gastroenteritis was seen in the age group of 6-23 mo and more cases were observed from December to February months. In our region the prevalent rotavirus genotypes in positive samples are G3 and G1 in G-typing, P[8] and P[4] in P-typing, respectively. G3P[8] and G1P[8] are the most prevalent genotypes identified in our area with a frequency of 35.1% and 25.9%, respectively. Almost all the cases (97.7%) got discharged and only one patient has died. The findings conclude a declining trend in the rotavirus positive AGE cases in the authors' area after introduction of Rotavac vaccine in the UIP.

Rotavirus Diarrhea and its Determinants Among Under-Five Children Admitted in a Tertiary Care Hospital of Southern Haryana, India.

To estimate the prevalence of rotavirus diarrhea and its demographic, social, and clinical characteristics among children less than five years of age admitted in a rural tertiary care institute. This prospective hospital-based observational study was carried out during February 2016 to June 2019. Diarrheal admissions of children aged 0-59 mo were screened and those who met the inclusion criteria were included in the study. Sociodemographic and clinical information was collected using a case report form. Stool samples were collected within 48h of admission and transported in cold chain every month to the referral laboratory situated at Christian Medical College for testing. Among the children admitted with acute diarrhea, 148 (11.02%) were positive for rotavirus in the study. As per Vesikari scoring system, around three fourth (76.2%) of children were having severe or very severe diarrhea. Severity of diarrhea was more among rotavirus positive cases as assessed by the Vesikari scoring system. The rotavirus diarrhea showed a peak during November to February. Rotavirus diarrhea is an issue of public health importance, particularly due to its association with the severe diarrhea. As evidenced from similar settings in the world, rotavirus vaccine introduction and increased coverage is the most important strategy towards prevention and control of rotavirus diarrhea.

FUT2 Secretor Status Influences Susceptibility to VP4 Strain-Specific Rotavirus Infections in South African Children.

Gastroenteritis is a preventable cause of morbidity and mortality worldwide. Rotavirus vaccination has significantly reduced the disease burden, but the sub-optimal vaccine efficacy observed in low-income regions needs improvement. Rotavirus VP4 ‘spike’ proteins interact with FUT2-defined, human histo-blood group antigens on mucosal surfaces, potentially influencing strain circulation and the efficacy of P[8]-based rotavirus vaccines. Secretor status was investigated in 500 children <5 years-old hospitalised with diarrhoea, including 250 previously genotyped rotavirus-positive cases (P[8] = 124, P[4] = 86, and P[6] = 40), and 250 rotavirus-negative controls. Secretor status genotyping detected the globally prevalent G428A single nucleotide polymorphism (SNP) and was confirmed by Sanger sequencing in 10% of participants. The proportions of secretors in rotavirus-positive cases (74%) were significantly higher than in the rotavirus-negative controls (58%; p < 0.001). The rotavirus genotypes P[8] and P[4] were observed at significantly higher proportions in secretors (78%) than in non-secretors (22%), contrasting with P[6] genotypes with similar proportions amongst secretors (53%) and non-secretors (47%; p = 0.001). This suggests that rotavirus interacts with secretors and non-secretors in a VP4 strain-specific manner; thus, secretor status may partially influence rotavirus VP4 wild-type circulation and P[8] rotavirus vaccine efficacy. The study detected a mutation (rs1800025) ~50 bp downstream of the G428A SNP that would overestimate non-secretors in African populations when using the TaqMan® SNP Genotyping Assay.

Alpha Glutathione S-transferase – A Potential Biomarker for Intestinal Epithelial Damage in Infants with Acute Gastroenteritis

BACKGROUND: Acute gastroenteritis is a leading cause of morbidity and mortality in children under 3 years of age worldwide and mostly can be dangerous in the first 12 months of life especially in infants who are not exclusively breastfed. Intestinal pathogens cause enterocyte infection which leads to cell death, lumen extrusion, and intestinal villous atrophy.&#x0D; AIM: The aim of this study was to assess whether alpha glutathione S-transferase (α-GST) can be a biomarker for early intestinal epithelial damage in infants with acute gastroenteritis and the degree of correlation of its serum values with the degree of intestinal epithelial damage associated with infant nutrition.&#x0D; MATERIALS AND METHODS: A total of 23 infants with acute gastroenteritis divided into two groups based on the feeding patterns (type of milk) were included in the study. The values of α-GST in serum between exclusively breastfed and non-exclusively breastfed infants were examined.&#x0D; RESULTS: It was found a statistically significant association between group affiliation and the α-GST levels in serum between the first and the second group (p = 0.002260). It was revealed that Rotavirus can cause erosion of the intestinal epithelium through the positive values of α-GST in Rotavirus positive cases.&#x0D; CONCLUSION: In this study, it was found that α-GST is a biomarker for early intestinal epithelial damage in infants primarily with Rotavirus acute gastroenteritis. α-GST serum values were significantly lower in infants who were exclusively breastfed compared with infants who were not exclusively breastfed.

Long-term effectiveness of pentavalent and monovalent rotavirus vaccines against hospitalization in Taiwan children

BackgroundTwo rotavirus vaccines (RV1 and RV5) are available on the private market in Taiwan, not included in national immunization program. Scanty reports evaluated the rotavirus vaccine effectiveness (VE) in Asian countries. MethodsFrom February 2014-July 2017, we conducted a prospective case-control study in ten hospitals in Taiwan. Case-patients included children aged 8–59 months, and hospitalized with laboratory-confirmed rotavirus acute gastroenteritis (AGE). For each case patient, up to four controls, rotavirus-negative AGE or non-AGE illnesses, respectively, were matched by gender, age and enrolled date. Vaccination history was confirmed through vaccination card or hospital record. VE was calculated as (1 − odds ratio of vaccination) × 100%. ResultsTotally 4248 AGE patients and 2242 non-AGE controls were enrolled. A total of 330 case-patients with rotavirus AGE, 1226 rotavirus-negative AGE controls and 1122 non-AGE controls were included for analysis. Unvaccinated rate was 85.15% for rotavirus-positive cases, 42.9% for rotavirus-negative controls, and 34.31% for non-AGE controls. VE of two-dose RV1 was 84.9% (95% confidence interval [CI]:77.7%, 90.1%) for rotavirus-negative AGE and 88.9% (95% CI: 83.4%, 92.8%) for non-AGE controls, while VE of three-dose RV5 was 92.5% (95% CI: 85.1%, 96.7%) and 96.4% (95% CI: 91.9%, 98.6%), respectively. For respective vaccine, VEs were not significantly different in term of rotavirus genotypes. VEs of both vaccines declined <80% in children aged three years by combined controls. ConclusionsBoth vaccines provided excellent and sustained protection against rotavirus AGE hospitalization in children in Taiwan, but the effectiveness declined slightly in children aged three years.

Prevalence and severity of rotavirus infection in children vaccinated against rotavirus in a tertiary care hospital, Chidambaram

Background: Diarrhoea is the most important reason for illness and death in developing nations. This cross sectional study was conducted to estimate the prevalence and severity of Rotavirus infection among vaccinated and unvaccinated children admitted with acute watery diarrhoea in a tertiary care hospital, Chidambaram. Methods: Clinical assessment of dehydration and rapid immunochromatographic test was performed in stool specimens collected from children under 30 months of age visiting Rajah Muthiah Medical College Hospital, Chidambaram due to acute watery diarrhoea. Results: During one year study, among 115 children admitted with acute watery diarrhoea, 31(27%) children were found to be rotavirus positive. Rotavirus positivity was significantly higher (41%) in unvaccinated than in vaccinated group (p< 0.01). Severity of dehydration in rotavirus positive cases were significantly more (79%) in unvaccinated group (p< 0.01). Conclusion: This study suggests decline in rotavirus positivity and severity in rotavirus vaccinated children hospitalised for acute gastroenteritis.

Identifying signatures of the impact of rotavirus vaccines on hospitalizations using sentinel surveillance data from Latin American countries

BackgroundPassive surveillance data are often the only available source of data that can be used to evaluate the population-level impact of vaccination, but such data often suffer from important limitations such as changes in surveillance efforts. This study provides an example of how to identify important signatures of rotavirus vaccine impact, including evaluating the overall effectiveness and changes in rotavirus seasonal dynamics. MethodsWe used data from a standardized sentinel rotavirus surveillance network in six Latin American countries (Bolivia, El Salvador, Guatemala, Honduras, Paraguay, and Venezuela) from 2004 to 2017. A random-effects model was used to evaluate changes in the proportion of rotavirus-associated hospitalizations following vaccine introduction. Harmonic regression models were used to estimate vaccine impact on the number of rotavirus hospitalizations, controlling for trends in rotavirus-negative cases. Changes to rotavirus seasonality were evaluated using center of gravity analysis, wavelet analysis, and harmonic regression. ResultsAll countries observed declines in the proportion of rotavirus-positive acute diarrhea samples with a mean reduction of 16% (95% confidence interval: 10–22%). We estimate that each 10% increase in vaccine coverage was associated with declines in the number of rotavirus-positive cases, ranging from 4.3% (1.3–7.2%) in Honduras to 21.4% (16.8–25.9%) in Venezuela. The strength of the seasonal peak in rotavirus incidence became smaller after vaccine introduction in Guatemala, Honduras, and Venezuela. Seasonal peaks also shifted later in the surveillance year, especially in higher-mortality countries. ConclusionsThe combination of methods we applied have different strengths that allow us to identify common signatures of rotavirus vaccine impact.

Association of Rotavirus Vaccination With Inpatient and Emergency Department Visits Among Children Seeking Care for Acute Gastroenteritis, 2010-2016

Rotavirus vaccines have been recommended for universal US infant immunization for more than 10 years, and understanding their effectiveness is key to the continued success of the US rotavirus vaccine immunization program. To assess the association of RotaTeq (RV5) and Rotarix (RV1) with inpatient and emergency department (ED) visits for rotavirus infection. This case-control vaccine effectiveness study was performed at inpatient and ED clinical settings in 7 US pediatric medical institutions from November 1, 2009, through June 30, 2016. Children younger than 5 years seeking medical care for acute gastroenteritis were enrolled. Clinical and epidemiologic data, vaccination verification, and results of stool sample tests for laboratory-confirmed rotavirus were collected. Data were analyzed from November 1, 2009, through June 30, 2016. Rotavirus vaccine effectiveness for preventing rotavirus-associated inpatient and ED visits over time for each licensed vaccine, stratified by clinical severity and age. Among the 10 813 children included (5927 boys [54.8%] and 4886 girls [45.2%]; median [range] age, 21 [8-59] months), RV5 and RV1 analyses found that compared with controls, rotavirus-positive cases were more often white (RV5, 535 [62.2%] vs 3310 [57.7%]; RV1, 163 [43.1%] vs 864 [35.1%]), privately insured (RV5, 620 [72.1%] vs 4388 [76.5%]; RV1, 305 [80.7%] vs 2140 [87.0%]), and older (median [range] age for RV5, 26 [8-59] months vs 21 [8-59] months; median [range] age for RV1, 22 [8-59] months vs 19 [8-59] months) but did not differ by sex. Among 1193 rotavirus-positive cases and 9620 rotavirus-negative controls, at least 1 dose of any rotavirus vaccine was 82% (95% CI, 77%-86%) protective against rotavirus-associated inpatient visits and 75% (95% CI, 71%-79%) protective against rotavirus-associated ED visits. No statistically significant difference during this 7-year period was observed for either rotavirus vaccine. Vaccine effectiveness against inpatient and ED visits was 81% (95% CI, 78%-84%) for RV5 (3 doses) and 78% (95% CI, 72%-82%) for RV1 (2 doses) among the study population. A mixed course of both vaccines provided 86% (95% CI, 74%-93%) protection. Rotavirus patients who were not vaccinated had severe infections 4 times more often than those who were vaccinated (74 of 426 [17.4%] vs 28 of 605 [4.6%]; P < .001), and any dose of rotavirus vaccine was 65% (95% CI, 56%-73%) effective against mild infections, 81% (95% CI, 76%-84%) against moderate infections, and 91% (95% CI, 85%-95%) against severe infections. Evidence from this large postlicensure study of rotavirus vaccine performance in the United States from 2010 to 2016 suggests that RV5 and RV1 rotavirus vaccines continue to perform well, particularly in preventing inpatient visits and severe infections and among younger children.

Effectiveness of Monovalent Rotavirus Vaccine Against Hospitalization With Acute Rotavirus Gastroenteritis in Kenyan Children.

BackgroundRotavirus remains a leading cause of pediatric diarrheal illness and death worldwide. Data on rotavirus vaccine effectiveness in sub-Saharan Africa are limited. Kenya introduced monovalent rotavirus vaccine (RV1) in July 2014. We assessed RV1 effectiveness against rotavirus-associated hospitalization in Kenyan children.MethodsBetween July 2014 and December 2017, we conducted surveillance for acute gastroenteritis (AGE) in 3 Kenyan hospitals. From children age-eligible for ≥1 RV1 dose, with stool tested for rotavirus and confirmed vaccination history we compared RV1 coverage among rotavirus positive (cases) vs rotavirus negative (controls) using multivariable logistic regression and calculated effectiveness based on adjusted odds ratio.ResultsAmong 677 eligible children, 110 (16%) were rotavirus positive. Vaccination data were available for 91 (83%) cases; 51 (56%) had 2 RV1 doses and 33 (36%) 0 doses. Among 567 controls, 418 (74%) had vaccination data; 308 (74%) had 2 doses and 69 (16%) 0 doses. Overall 2-dose effectiveness was 64% (95% confidence interval [CI], 35%–80%); effectiveness was 67% (95% CI, 30%–84%) for children aged <12 months and 72% (95% CI, 10%–91%) for children aged ≥12 months. Significant effectiveness was seen in children with normal weight for age, length/height for age and weight for length/height; however, no protection was found among underweight, stunted, or wasted children.ConclusionsRV1 in the Kenyan immunization program provides significant protection against rotavirus-associated hospitalization which persisted beyond infancy. Malnutrition appears to diminish vaccine effectiveness. Efforts to improve rotavirus uptake and nutritional status are important to maximize vaccine benefit.

The molecular epidemiology of human group A rotavirus infections in children in Hangzhou in 2017

Objective To analyze the infectious status and genotype characteristics of group A rotavirus (RV) in children with diarrhea in Hangzhou city in 2017, and to provide information for the disease surveillance, epidemic control as well as vaccine development. Methods Fecal samples from children with acute diarrhea at Children′s Hospital of Zhejiang University were collected from Jan to Dec in 2017. All samples were tested for RV antigen by emulsion technique. The antigen-positive samples were further detected by reverse transcription polymerase chain reaction (RT-PCR) and sequencing to determine the G and P genotypes. The RV positive rates in different genders, ages and months were compared by chi-square test. Results A total of 20 895 fecal samples were collected from 12 389 male patients and 8 506 female patients. The gender ratio was 1.46∶1. In 5 012 (23.99%) RV antigen positive samples, 2 964 (23.92%) were from male patients and 2 048 (24.08%) were from female patients. There was no gender difference in RV positive rate (χ2=0.049, P>0.05). In the study, RV could be detected in the whole year. January, February and December were peak months, and the RV positive rates were significantly different in different months (χ2=2 654.681, P<0.05). The highest RV positive rate was in 18-24 months age group and the lowest in<6 months age group, respectively. Children under 2 years old accounted for 76.56% RV positive cases, and those under 5 years old accounted for 98.72% RV positive cases. The RV positive rates were also significantly different in all age groups (χ2=1 013.832, P<0.05). A total of 116 samples were selected from each month, following the random stratified sampling principle, for PCR amplification, sequencing, and genotyping according to VP7 (G genotype) and VP4 (P genotype). A total of 4 G genotypes were detected and G9 (85.3%) was the predominant one. In the two detected P genotypes, P[8] (96.6%) was predominant. The 4 G/P combination genotypes were G9P[8] (85.3%), G3P[8] (9.5%), G2P[4] (3.5%), and G1P[8](1.7%). Conclusions RV was a common pathogen in pediatric patients with acute diarrhea in Hangzhou city in 2017. Children under 5 years old, especially 18 months to 2 years old infants was the main infected population. The study showed RV infection had obvious seasonality and winter was the peak period. The G9 genotype was predominant in G genotypes, P[8] genotype was predominant in P genotypes, and G9P[8] genotype was predominant in G/P combination genotypes, respectively. Key words: Rotavirus infections; Diarrhea; Genotype; Epidemiologic studies; Child

Global impact of rotavirus vaccine introduction on rotavirus hospitalisations among children under 5 years of age, 2008–16: findings from the Global Rotavirus Surveillance Network

SummaryBackgroundRotavirus vaccine use in national immunisation programmes has led to declines in hospital admissions for rotavirus gastroenteritis among children; however, the global impact of rotavirus vaccine introduction has not been described using primary data. We describe the impact of rotavirus vaccine introduction on admissions for acute rotavirus gastroenteritis in primarily low-income and middle-income countries, using 9 years of data from the WHO-coordinated Global Rotavirus Surveillance Network (GRSN).MethodsBetween Jan 1, 2008, and Dec 31, 2016, children younger than 5 years of age who were admitted to hospital with acute gastroenteritis were prospectively enrolled in GRSN sites. We included sites that enrolled children and collected stool specimens monthly and tested at least 100 specimens annually in the impact analysis, with a separate analysis taking into account site continuity. We compared proportions of acute gastroenteritis cases positive for rotavirus in the pre-vaccine and post-vaccine periods and calculated mean proportion changes for WHO regions, with 95% CIs; these findings were then compared with interrupted time series analyses. We did further sensitivity analyses to account for rotavirus vaccination coverage levels and sites that collected specimens for at least 11 months per year and tested at least 80 specimens per year. We also analysed the age distribution of rotavirus-positive cases before and after vaccine introduction.Findings403 140 children younger than 5 years of age admitted to hospital with acute gastroenteritis from 349 sites in 82 countries were enrolled over the study period, of whom 132 736 (32.9%) were positive for rotavirus. We included 305 789 children from 198 sites in 69 countries in the impact analysis. In countries that had not introduced rotavirus vaccine in their national immunisation programmes, rotavirus was detected in 38.0% (95% CI 4.8–73.4) of admissions for acute gastroenteritis annually whereas in those that have introduced the vaccine, rotavirus was detected in 23.0% (0.7–57.7) of admissions for acute gastroenteritis, showing a 39.6% (35.4–43.8) relative decline following introduction. Interrupted time series analyses confirmed these findings. Reductions by WHO regions ranged from 26.4% (15.0–37.8) in the Eastern Mediterranean Region to 55.2% (43.0–67.4) in the European Region and were sustained in nine countries (contributing up to 31 sites) for 6–10 years. The age distribution of children with rotavirus gastroenteritis shifted towards older children after rotavirus vaccine introduction.InterpretationA significant and sustained reduction in the proportion of hospital admissions for acute gastroenteritis due to rotavirus was seen among children younger than 5 years in GRSN sites following rotavirus vaccine introduction. These findings highlight the need to incorporate rotavirus vaccines into immunisation programmes in countries that have not yet introduced them and underline the importance of high-quality surveillance.

Adenovirus and Rotavirus Associated Diarrhoea in under 5 Children from Enugu Rural Communities, South East Nigeria

Globally, diarrhoea is the second commonest infectious cause of death in children less than 5 years old. It is estimated that more than one billion diarrhoea episodes occur every year causing up to 700,000 deaths among children younger than 5 years of age. Seventy-two percent of these deaths occur in children below two years and enteric viruses have been recognized as a major cause of childhood diarrhoea. This study was undertaken to determine the prevalence of enteric Adenoviruses and Rotaviruses in children with diarrhoea in rural Enugu communities of Enugu State South East Nigeria. Methods: Stool samples were collected from children less than 5 years with diarrhoea seen in any of the participating hospitals in Enugu State. Samples were collected between June 2015 and May 2017. Detection of rotavirus and enteric adenovirus antigens were performed using commercially available ELISA kit (Oxoid-ProspecT®). Demographic data of the children were also collected. Results: Of the 290 stool samples that had sufficient materials for adenovirus and rotavirus ELISA, 14 (4.8%) and 89 (30.7%) were positive for enteric adenovirus and rotavirus respectively. 3 (1%) were co-infected with adenovirus and rotavirus. Rotavirus positive cases were more among hospitalized patients while enteric adenovirus was more among outpatients. Marked peaks of rotavirus positivity were seen in January of each year but no peak was seen among adenovirus positive cases. Higher vomiting frequencies and severe dehydration were more among rotavirus positive cases compared to adenovirus positive cases (p = 0.030 and 0.001 respectively). Conclusion: Many diarrhoea cases among children aged <5 in the population studied were associated with enteric adenoviruses and rotavirus. This finding suggests that enteric viral agents (adenovirus and rotavirus) are important aetiologies for childhood diarrhoea in Enugu state Nigeria. Appropriate preventive, diagnostic and treatment interventions should be instituted so as to reduce the mortality and morbidity associated with these viruses.

Monovalent Rotavirus Vaccine Effectiveness Against Rotavirus Hospitalizations Among Children in Zimbabwe.

Rotavirus is a leading cause of mortality among children <5 years old. We evaluated monovalent rotavirus vaccine effectiveness (VE) under conditions of routine use at 2 surveillance sites in Harare, Zimbabwe, after vaccine introduction in May 2014. Children aged <5 years hospitalized or treated in the accident and emergency department (A&E) for acute watery diarrhea were enrolled for routine surveillance. Copies of vaccination cards were collected to document vaccination status. Among children age-eligible to receive rotavirus vaccine, we estimated VE, calculated as 1 - odds ratio, using a test-negative case-control design. We included 903 rotavirus-positive cases and 2685 rotavirus-negative controls in the analysis; 99% had verified vaccination status. Rotavirus-positive children had more severe diarrhea than rotavirus-negative children; 61% of cases and 46% of controls had a Vesikari score ≥11 (P < .01). Among cases and controls, 31% and 37%, respectively, were stunted for their age (P < .01). Among children 6-11 months old, adjusted 2-dose VE against hospitalization or treatment in A&E due to rotavirus of any severity was 61% (95% confidence interval [CI], 21%-81%) and 68% (95% CI, 13%-88%) against severe rotavirus disease. Stratified by nutritional status, adjusted VE was 45% (95% CI, -148% to 88%) among stunted infants and 71% (95% CI, 29%-88%) among infants with a normal height for age. Monovalent rotavirus vaccine is effective in preventing hospitalizations due to severe rotavirus diarrhea among infants in Zimbabwe, providing additional evidence for countries considering rotavirus vaccine introduction that live, oral rotavirus vaccines are effective in high-child-mortality settings.