Evidence of rotavirus AU32 like G9 strains from nontypeable fecal specimens of Indian children hospitalized during 1993-1994

Burden of Rotavirus Diarrhea in Under five Indian Children

NEED AND PURPOSE

Rotavirus is the most common cause of severe diarrhea in infants and young children worldwide. The burden of rotavirus diarrhea in Indian children is not well established. The present study reviewed the epidemiology of rotavirus diarrhea in hospitalized children and in the community, molecular serotyping and under-five mortality caused by rotavirus diarrhea.

METHODS

Publications, reporting rotavirus diarrhea in Indian children, were retrieved through a systematic search of databases including Medline, PubMed, IndMed, websites of WHO, UNICEF, National Family Health Survey, Ministry of Health and Family Welfare, and Government of India. Human studies in English language were included. Age group selected was 0 month to 5 years. No restrictions were applied in terms of study design and time frame.

CONCLUSIONS

Stool sample positivity varied from 4.6% in Kolkata to 89.8% in Manipur, among hospitalized children, and from 4% in Delhi to 33.7% in Manipur in community. Most cases of rotavirus diarrhea in India are caused by G1, G2, and G untypeable strains with distinct regional variations. Rotavirus was identified as an etiological agent in 5.2 to 80.5% cases of nosocomial diarrhea. Data are lacking for rotavirus mortality.

Characterization ofVP7andVP4genes of rotavirus strains: 1990–1994 and 2000–2002

A total of 90 rotavirus-positive faecal specimens collected from patients hospitalized with diarrhoea in 1990–1994 (n=77) and 2000–2002 (n=13) were investigated for VP7 and VP4 genotypes. The specimens included 21 typable and 69 non-reactive or multireactive rotavirus strains as monitored by monoclonal antibody-based serotyping ELISA. Genotyping was carried out by multiplex PCR/sequencing using primers specific for bothVP7andVP4genes. The contribution of common genotypes (G1P[8], G2P[4], G3P[8], G4P[8]) in causing rotavirus diarrhoea was 79·2% and 92·3% in the years 1990–1994 and 2000–2002, respectively, while G9P[8] infections were detected at lower levels (1·3% and 7·7%) at both time-points. There was a predominance of G1P[8] in 1990–1994 and of G2P[4] in 2000–2002. The detection of unusual rotavirus strains (G1P[6], G1P[4], G1P[19], G2P[8], G3P[4], G4P[6]) in 19·5% of the patients indicated a significant contribution of reassortants in causing diarrhoea in western India.

Dual infection due to simian G3—human reassortant and human G9 strains of rotavirus in a child and subsequent spread of serotype G9, leading to diarrhea among grandparents

Cultivation of rotavirus from day 1 and 3 fecal specimens of a child yielded simian SA11-human reassortant, G3P[8] and AU32 like G9P[8] rotavirus strains, respectively. Diarrhea developed in the grandfather by sheer hospital visits, and in the grandmother, after wiping the vomit of the grandfather. AU32 like G9 strains were isolated from the grandparents also. Rotavirus specific IgM developed in all the three patients. A fourfold rise in G9 neutralizing antibodies was observed in the child and grandmother. The child's mother had asymptomatic rotavirus infection. The study highlights the potential of G9 serotype to spread from children to adults.