Epidemiology of rotavirus diarrhea in Yogyakarta, Indonesia, as revealed by electrophoresis of genome RNA

Significance of continuous rotavirus and norovirus surveillance in Indonesia

BACKGROUND

Diarrhea significantly contributes to the global burden of diseases, particularly in developing countries. Rotavirus and norovirus are the most dominant viral agents responsible for diarrheal disease globally. The aim of this review was to conduct a comprehensive assessment of rotavirus and norovirus study in Indonesia.

DATA SOURCES

Articles about rotavirus and norovirus surveillance in Indonesia were collected from databases, including PubMed and Google Scholar. Manual searching was performed to identify additional studies. Furthermore, relevant articles about norovirus diseases were included.

RESULTS

A national surveillance of rotavirus-associated gastroenteritis has been conducted for years, resulting in substantial evidence about the high burden of the diseases in Indonesia. In contrast, norovirus infection received relatively lower attention and very limited data are available about the incidence and circulating genotypes. Norovirus causes sporadic and epidemic gastroenteritis globally. It is also emerging as a health problem in immunocompromised individuals. During post-rotavirus vaccination era, norovirus potentially emerges as the most frequent cause of diarrheal diseases.

CONCLUSIONS

Our review identifies knowledge gaps in Indonesia about the burden of norovirus diseases and the circulating genotypes. Therefore, there is a pressing need to conduct national surveillance to raise awareness of the community and national health authority about the actual burden of norovirus disease in Indonesia. Continuing rotavirus surveillance is also important to assess vaccine effectiveness and to continue tracking any substantial changes of circulating rotavirus genotypes.

Genomic diversity among group A rotaviruses from diarrheic children, piglets, buffalo and cow calves of Madhya Pradesh

Diarrheal disease continues to be a global health problem, particularly among young ones in developing nations. Amongst several viral and non-viral agents associated with diarrhea, group A rotavirus has been recognized as the major etiological agent of childhood gastroenteritis in human infants as well as several animal species throughout the world. During this study, a total of 181 diarrheic stool samples collected from children, piglets, buffalo and cow calves of Madhya Pradesh, central India were analyzed by electrophoretic mobilities of the 11 segments of dsRNA by polyacrylamide gel electrophoresis (PAGE). This technique revealed prevalence of rotavirus among different species (human-26.09%, pig-25.71%, buffalo-23.61% and cattle-21.43%). Prevalence of existence of circulating 8 different electropherotypes of group A rotaviruses indicated high genomic diversity among rotaviruses in this geographical region. Majority of the electropherotypes from humans and animals were of long pattern (75%) than short electropherotypes (9.09%). Same electropherotype was found to exist either only in a single species or in more than one species implicating the possibility of cross species transmission of the rotavirus strains. As it was found that certain animal rotavirus strains had electropherotypic similarities to some human strains, speculation increased about whether animals play a role as a source of rotavirus infection in humans or vice-versa. There is a need for further detailed study on the molecular characterization of rotaviruses which would have important implication in vaccine evaluation program.

Detection of human rotavirus in hospitalized diarrheic children in central India

During the present study, group A human rotaviruses were detected among diarrheic children using polyacrylamide gel electrophoresis (PAGE) technique, with a typical RNA migration pattern of 4:2:3:2, suggestive of group A rotavirus. During the study, a total of 46 fecal samples collected from hospitalized children with acute diarrhea as well as children inhabiting nearby animal farms with history of presence of animal rotaviruses on the farms were processed for detection of human rotavirus. Out of 33 diarrheic children, 12 showed presence of rotavirus infection (36.36%), however, none of the children from animal farm areas showed presence of rotavirus. Female children were more susceptible to rotavirus infection (46.15%) than males (30%). Majority of the cases of rotavirus gastroenteritis belonged up to one year of the age, with an incidence of 40.91%. RNA profile of rotaviruses suggested circulation of 5 different electropherotypes in this geographical locale of the country, indicating existence of genomic diversity among human rotaviruses. Majority of the isolates were of long pattern (66.67%), whereas short pattern was detected only in one third of the viruses. This preliminary study emphasizes for further detailed studies on the molecular characterization of rotaviruses circulating in this part of country and their relationship with other human rotavirus strains and animal strains in the country.

Human rotavirus genomic RNA electropherotypes in Jeddah, Saudi Arabia from 1988 to 1992

Polyacrylamide gel electrophoresis was used to analyze the double-stranded RNA of rotavirus recovered from stool specimens collected between March 1988 and December 1992 from children with acute diarrhoea admitted to the central hospital in Jeddah, Saudi Arabia. Rotavirus was detected by ELISA in 523 specimens of the 1242 collected during the study, giving an overall prevalence of 42.2% for the 5 years of investigation. Out of 523 rotavirus-positive specimens, 263 (50.3%) were successfully electropherotyped. Eighteen different electropherotypes were observed, 12 long patterns and six short patterns. Eighty-seven per cent of the electropherotypes were of the long RNA pattern. The remaining were short electropherotypes. The predominant electropherotypes were two long patterns and maintained dominance over 5 years of the study. The third most predominant pattern was a short electropherotype. The remaining electropherotypes made minor contributions every year. These predominant electropherotypes were different from the predominant patterns detected in many countries. Temporal distribution was observed for 5 successive years for the predominant electropherotypes, with an increase in the incidence during the cooler months of the year.

Rotavirus e adenovirus em crianças de 0-5 anos hospitalizadas com ou sem gastrenterite em Goiânia - GO., Brasil

De junho/1987 a julho/1990 foram estudadas 557 amostras fecais de crianças hospitalizadas de 0-5 anos de idade, na cidade de Goiânia-GO., para detecção de rotavírus e adenovírus. Destas, 291 provinham de crianças diarréicas e 266 de não diarréicas. Das amostras não diarréicas, 64 eram provenientes de crianças de berçário. Das 557 amostras, 261 foram analisadas pela imunomicroscopia eletrônica (IME), eletroforese em gel de poliacrilamida (EGPA-SDS) e ensaio imunoenzimático para rotavírus e adenovírus (EIARA) e as demais apenas pela EGPA e EIARA. Rotavírus e adenovírus mostraram positividade de 17,2% e 2,1% respectivamente, e na condição de diarréia ou não, observou-se percentuais de 29,2% e 4,1% respectivamente para rotavírus (p<0,05) e 2,4% e 1,5% para adenovírus. Rotavírus foram mais prevalentes entre as crianças de 1-11 meses de idade e não foram vistos em nenhum recém-nato de berçário. Os adenovírus ocorreram na faixa de 1-3 anos. Rotavírus apresentaram maior circulação entre os meses de maio a agosto (p<0,05), não sendo encontrados de dezembro a fevereiro.

Rotavirus serotypes causing acute diarrhoea in hospitalized children in Yogyakarta, Indonesia during 1978-1979

Rotavirus strains in stool specimens from 111 children aged 3-24 months admitted to hospital in Yogyakarta, Indonesia for treatment of acute diarrhoea were serotyped using VP7 serotype specific monoclonal antibodies in a double sandwich enzyme immunoassay. A serotype could be assigned to 59 of 111 specimens (53%). Inability to assign a serotype to 47% of specimens was probably due to loss of the outer capsid during transport of specimens from Indonesia to Australia. All four major human rotavirus serotypes were detected during the 15 month survey from June 1978 to August 1979, including one serotype 1, 5 serotype 2, 31 serotype 3, and 21 serotype 4 strains. One additional strain reacted with serotype 3 and 4 Mabs. Serotype 3 strains showed intratypic variation. The relative frequency of serotypes 2, 3, and 4 varied during the 15 months and appeared to be influenced by climatic changes associated with dry and wet seasons. Vaccine strategies must take account of comparatively rapid changes of predominant serotypes in a community and are only likely to be successful if comprehensive immunity can be established simultaneously against the four major human serotypes.

Molecular epidemiology and subgroup determination of bovine group A rotaviruses associated with diarrhea in dairy and beef calves

The genome electropherotyping technique was used to examine group A rotaviral infections of diarrheic calves ranging from 1 to 85 days of age in 2 beef and 27 dairy herds. Coelectrophoresis studies demonstrated 38 distinct bovine group A rotavirus genome electropherotypes; all were long genome electropherotypes, and none had extra segments or unusual segment rearrangements. Genome electropherotypes in fecal specimens from diarrheic calves previously inoculated orally with a commercial, modified-live group A rotavirus vaccine differed from the vaccine genome electropherotype. Generally, when fecal specimens for genome electropherotyping were collected from two or more different calves within the same herd over a relatively short time, only one genome electropherotype was detected within a given herd. Different genome electropherotypes were detected in the same herd, however, when fecal specimens were obtained from different diarrheic calves over longer intervals (6 months or more). Twenty-three group A rotavirus strains with distinct genome electropherotypes, from diarrheic calves in 22 herds, were isolated and plaque purified in cell culture, and all were subgroup 1 group A rotaviruses. Non-group A rotavirus genome electropherotypes were not detected in 131 fecal specimens, negative for group A rotavirus, collected from diarrheic calves in 17 dairy herds.

Human viral gastroenteritis

During the last 15 years, several different groups of fastidious viruses that are responsible for a large proportion of acute viral gastroenteritis cases have been discovered by the electron microscopic examination of stool specimens. This disease is one of the most prevalent and serious clinical syndromes seen around the world, especially in children. Rotaviruses, in the family Reoviridae, and fastidious fecal adenoviruses account for much of the viral gastroenteritis in infants and young children, whereas the small caliciviruses and unclassified astroviruses, and possibly enteric coronaviruses, are responsible for significantly fewer cases overall. In addition to electron microscopy, enzyme immunoassays and other rapid antigen detection systems have been developed to detect rotaviruses and fastidious fecal adenoviruses in the stool specimens of both nonhospitalized patients and those hospitalized for dehydration and electrolyte imbalance. Experimental rotavirus vaccines have also been developed, due to the prevalence and seriousness of rotavirus infection. The small, unclassified Norwalk virus and morphologically similar viruses are responsible for large and small outbreaks of acute gastroenteritis in older children, adolescents, and adults. Hospitalization of older patients infected with these viruses is usually not required, and their laboratory diagnoses have been limited primarily to research laboratories.

Rapid and accurate viral diagnosis

In recent years, there has been increased recognition of the importance of viral infections. In addition, new antiviral agents have become available. These factors have led to a marked increase in utilization of viral diagnostic services. In this review, both conventional and rapid methods for viral diagnosis are presented, with emphasis on recent advances. The antiviral agents currently available and the major drugs under investigation are also briefly discussed. It is hoped that this review will serve as a useful adjunct for the management of patients with virus infections.

Electropherotyping of human rotaviruses: an epidemiological survey of rotavirus infections in Sicily

An electrophoretic analysis of rotavirus RNA segments was carried out on 522 faecal specimens, obtained from children hospitalized in Sicily in the period 1981/85. One hundred and one viral isolates could be characterized with respect to the electrophoretic pattern of their genomic RNAs. This analysis revealed that in 1981/82 different electropherotypes cocirculated in the infant population. In 1983 one of the patterns became prevalent; in 1984/85 only one electropherotype was detected, both in Palermo and Catania specimens. The serotyping showed that all viral strains with the prevalent electropherotype were subgroup II and serotype 1. These results contrast with the extensive genome variability of rotavirus strains observed in urban areas.

Molecular epidemiology of human rotavirus infection in children in Hong Kong

Rotavirus was identified in 256 (28.5%) of 899 hospitalized children with diarrhea during a 12-month period in Hong Kong. Fourteen electropherotypes were identified, and the appearance of each occurred in a sequential manner during the study period. One patient was shown to be mixedly infected with two prevalent electropherotypes. Sequential stool specimens from another case showed the appearance of an extra RNA band during the course of the diarrheal episode.

Epidemiology of rotavirus electropherotypes determined by a simplified diagnostic technique with RNA analysis

The incidence and RNA electropherotypes of rotavirus in stools or rectal swabs of children with diarrhea were studied for three rotavirus seasons (1981 through 1984) in Philadelphia, Pa. We used a simplified RNA analysis method involving polyacrylamide gel electrophoresis followed by silver staining. Phosphate-buffered saline suspensions of the stools and swab eluates were examined directly by polyacrylamide gel electrophoresis-silver staining analysis and enzyme-linked immunoadsorbent assay (Rotazyme; Abbott Laboratories); electron microscopy was performed on solid stool specimens. The RNA analysis results were compared with electron microscopy and enzyme-linked immunosorbent assay results and exhibited a sensitivity and specificity greater than or equal to that of electron microscopy or the enzyme-linked immunosorbent assay. Ten different electropherotypes were detected among the 68 rotavirus RNA-positive specimens examined over the 3-year study. The predominant electropherotype was different in each season. Our results indicate that the polyacrylamide gel electrophoresis-silver nitrate strain RNA analysis of simple unextracted stool suspensions is a uniquely useful diagnostic technique; it rapidly provides both a definitive positive result and immediate determination of the RNA electropherotype, which is of value for epidemiological study.

Molecular epidemiology of human rotavirus infections

Recognition of rotaviruses as a major aetiological agent of acute gastroenteritis in infants and young children has prompted the investigation of their epidemiology by molecular techniques. Genome analysis by electrophoretic separation of the RNA segments has been widely used to distinguish virus isolates and to monitor patterns of virus transmission. Examination of virus isolates from different epidemics has clearly demonstrated the existance of extensive genomic variation in viruses circulating in large communities; with the co-circulation of a number of viruses of differing electrophoretype. Preliminary studies using the more advanced techniques of oligonucleotide mapping and hybridization analysis have suggested that variation among the viruses may occur by processes involving both "drift" and "shift". Because of their ease and specificity the new hybridization analysis techniques should greatly facilitate both the rapid diagnosis of rotavirus infections, and the solution of many epidemiological and evolutionary questions. Continued and expanded use of molecular techniques for the study of the epidemiology of rotavirus infections will be required to manage future outbreaks and to effect long term control measures.

Epidemiology of rotavirus gastroenteritis in infants from the area of Bochum as revealed by electrophoresis of genome RNA

Rotaviruses were detected by enzyme-linked immunosorbent assay (ELISA) in stool samples from 504 infants admitted with gastroenteritis to the children's hospital of the University Bochum in the period from 1979 to 1984. In most infants rotaviruses persisted in the stools for 6-8 days. Rotavirus RNA was extracted from stool samples from 203 infants. By acrylamide gel electrophoresis, bands characteristic of rotavirus double-stranded RNA were detected in 172 (85%) of these 203 samples in which the presence of rotavirus had been demonstrated by ELISA. Of the RNA-positive samples 87% had a "long" RNA pattern. Six different electropherotypes co-circulated and one electropherotype predominated for more than 4 years. In stool samples of one infant 12 genome segments were found, suggesting the possibility of simultaneous infection by more than one electropherotype or the occurrence of modification in the length of RNA segments during infection. In another infant the sequential infection by two different electropherotypes was observed.

Serotype determination of human rotavirus isolates and antibody prevalence in pediatric population in Hokkaido, Japan

Three different serotypes of human rotavirus isolates defined in our laboratory were compared by cross neutralization tests with human rotavirus serotypes established in the NIH, U.S.A. The results clearly demonstrated that our three serotypes correspond well to their serotypes Wa, DS-1 and M (or P). Using the three serotype-specific rabbit antisera, all of the 16 strains isolated to date could be assigned to one of those three serotypes. The prevalence of human rotavirus serotypes 1, 2 and 3 among inhabitants of Sapporo and its outskirts was investigated based on the results of neutralizing antibody distribution patterns by age using sera of non-infectious disease patients examined at the Sapporo Medical College Hospital. Neutralizing antibody titers were measured against four strains, KU and K8 (serotype 1), S2 (serotype 2) and YO (serotype 3). The results revealed that serum antibody titers against KU, K8 and YO strains rose with time after birth, reaching the highest antibody distribution levels in either the 3-5-year-old or 6-9-year-old age group, while antibody against S2 strain tended to be lower than that against the other three strains throughout all age ranges examined, with the highest level being shown in the adult group.

Cultivation of human rotaviruses in cell culture

Sixteen specimens of faeces from children with acute diarrhoea due to rotavirus were inoculated into MA-104 cells. Rotaviruses present in six of the specimens were successfully adapted to growth after serial passage. Two of these strains had "short RNA" patterns and had caused epidemics of diarrhoea in children in Melbourne, Australia from 1977 to 1979, or in children in the Highlands of Papua New Guinea in 1979. The remaining four strains had "long RNA" patterns. One of these four strains was of major epidemiological importance as a cause of childhood diarrhoea in Melbourne during 1981. The other three strains appeared identical and were isolated from babies born in a Melbourne obstetric hospital during 1977. All six strains were successfully adapted to stationary culture, but only four strains could be plaqued . Selection of strains of rotavirus for culture on the basis of their known epidemiological importance in different communities will increase information about clinically important strains throughout the world.