Molecular epidemiology and clinical characterization of group A rotavirus infections in Tunisian children with acute gastroenteritis

Systematic review of the rotavirus infection burden in the WHO-EMRO region

Rotavirus gastroenteritis imposes a heavy burden on low- and middle-income countries. The World Health Organization defines the Eastern Mediterranean region (WHO-EMRO) as a diverse area in terms of socioeconomic status and health indicators. Rotavirus vaccination has been introduced, at least partially, in 19 out of the 22 EM countries; however, vaccine coverage remains low, and data on rotavirus disease burden is scarce.Available data on rotavirus prevalence, seasonality, vaccination status, and genotype evolution was systematically compiled following a literature review that identified 165 relevant WHO-EMRO epidemiology studies published between 1990 and 2017.Although the infectious agents responsible for acute gastroenteritis vary over time, rotavirus remained the leading cause of acute gastroenteritis in children, as seen in 76.3% of reviewed publications. Younger children (<2 years old) were at higher risk and thus increased vaccination coverage and surveillance systems are required to reduce the rotavirus gastroenteritis burden in WHO-EMRO countries.

Update on the epidemiology of rotavirus in the Middle East and North Africa

Rotavirus (RV) is the leading cause of severe acute gastroenteritis (AGE) worldwide. Consequently, we conducted a systematic literature review on articles studying RV in the 25 countries of the MENA region during the past 15years (2000-2015). The methods and reporting were set according to the 2015 preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and based on the elements from the international prospective register of systematic reviews (PROSPERO). Our literature search identified 169 studies meeting our predefined inclusion criteria. Studies reporting on RV were conducted in 19 out of the 24 countries of the MENA region. The largest number of studies was reported in Turkey (n=32), Iran (n=31), Saudi Arabia (n=19) and Egypt (n=17). The majority of studies reporting on RV gastroenteritis rates were clinical observational studies. In 115 studies out of 169, RV was reported among in-patients whereas 35 studies reported RV among outpatients. The predominantly reported RV genotype in the region was G1[P8] followed by G2[P4] and G9[P8]. The majority of studies (n=108) were conducted among children less than 5years of age whereas the remaining studies reported on AGE among other age groups and rarely adults. In MENA countries, RV infection was reported all year round with peaks described in cold as well as hot months. This systematic review provides a current update on the epidemiology of RV-associated gastroenteritis in countries of the MENA region and draws attention to the major gaps existing in the continuous monitoring of RV.

Detection and genotyping of group A rotaviruses isolated from sewage samples in Monastir, Tunisia between April 2007 and April 2010

AIMS

To ascertain the viral load, the distribution of G and P types of group A rotaviruses (RV-A) in sewage samples and to compare strains in clinical, animal and environmental samples.

METHODS AND RESULTS

During our study from April 2007 to April 2010, 518 samples of raw and treated sewage were collected from two biological sewage treatment plants (STPs) located in the Monastir region, Tunisia. RV-A was detected by real-time RT-PCR in 375 (72·4%) sewage samples. According to the quantification results of RV-A, it appears that the viral load in raw and treated sewage of the two STPs was quite similar (P = 0·735). The genotyping of RV-A strains detected in sewage samples showed a great diversity with 10 G types and 8 P types. Most of them were described as common in humans, but we also detected genotypes commonly found in animals. All the genotypes detected in two previous studies performed in our laboratory on clinical and bovine samples were also found in environmental samples. However, some genotypes commonly found in animal were only found in sewage samples.

CONCLUSION

The comparison of environmental, clinical and animal data suggests that STPs may convey not only human sewage but also animal wastes, both of them contaminated with numerous RV-A strains which are not efficiently eliminated by the sewage treatment process and may spread to surface waters.

SIGNIFICANCE AND IMPACT OF THE STUDY

This work demonstrates the potential release of human and animal RV-A into water sources, representing a public health risk, by inducing gastroenteritis in population, but also by increasing the risk of zoonotic transmission and formation of reassortant viruses which could get a higher infectious potential. Our findings also suggest that monitoring of sewage may provide an additional tool to determine the epidemiology of RV-A circulating in a given community.

Removal of Rotavirus and Bacteriophages by Membrane Bioreactor Technology from Sewage

Human enteric viruses constitute a public health concern due to their low infectious dose and their resistance to environmental factors and to inactivation processes. We aimed at assessing the performance of a laboratory scale Submerged membrane bioreactor (SMBR) treating abattoir wastewaters for Rotavirus (RV) and total coliphages removal. We also aimed at evaluating removal efficiency of enteric viruses through conventional activated sludge treatment by measuring concentrations of total coliphages, considered as fecal and viral contamination indicators, with double-layer agar technique. The Log10 reduction values of bacteriophages ranged from 1.06 to 1.47. Effluents were analyzed to investigate and quantify RV, hepatitis A virus (HAV), Hepatitis E virus (HEV), Noroviruses genogroup I (NoV GI) and genogroup II (NoVGII), and Enterovirus (EV) by real-time PCR, using standardized detection kits (ceeramTools detection kits(®)). All effluent samples were positive for RV; concentrations ranged from 5.2 × 10(5) to 1.3 × 10(7) genome copies/L. These results highlight the inefficiency of conventional biological process for viral removal. A complete removal of RV during Membrane Bioreactor treatment was obtained. To the best of our knowledge, this is the first study providing an evidence of removal of RV simultaneously with total coliphages by SMBR.

Prevalence and genetic diversity of norovirus infection in Tunisian children (2007-2010)

Viral gastroenteritis can be a life-threatening disease in infants and young children, especially in developing countries. The aim of this study was to continue the epidemiological surveillance of norovirus (NoV) infections in Tunisian children suffering from acute gastroenteritis. Surveillance was initiated in January 2003, to monitor potential variations in strains over time, in terms of frequency and diversity of NoV genotypes, and more particularly the potential emergence of new GII.4 variants following the 2004 Hunter variant. From April 2007 to April 2010, a total of 407 stool specimens were collected from sporadic cases (238 inpatients and 169 outpatients). Furthermore, 28 stool samples were collected from children involved in 3 gastroenteritis outbreaks. Stool specimens were screened for NoV genogroup I (GI) and II (GII) by RT-PCR. NoV strains were genotyped, and variants identified, based on sequence and phylogenetic analyses of the polymerase and capsid genes. NoVs were detected in 38 sporadic cases (9.3%) and 21 epidemic cases (75%). Great diversity was observed throughout the period, with seven distinct NoV genotypes characterized in sporadic cases, and three in outbreaks. GIIb/II.3 and GII.4 were predominant globally, with fluctuations of their prevalence over time. Interestingly, the Hunter variant, which was the unique GII.4 variant observed from 2003 to April 2007 in the region of Monastir, was replaced by the 2006b variant. NoV is an important enteropathogen responsible for viral gastroenteritis among infants and children in Tunisia, and the infecting strains between 2007 and 2010 were different from those in previous years.

Importance of viral pathogens in children with acute gastroenteritis in the south of Iran

BACKGROUND AND OBJECTIVES

Different types of viruses are the leading cause of acute diarrhea among infants and young children worldwide. Epidemiological surveillance of viral agents is critical for the develop.ment of effective preventive measures, including vaccines. This study aimed to determine the prevalence of the four major enteropathogenic viruses-rotavirus, norovirus, adenovirus and astrovirus-in children over 7 years of age.

DESIGN AND SETTING

A cross-sectional descriptive study conducted on stool specimens of children with acute gastroenteritis admitted to the Pediatrics Unit of 17 Shahrivar Hospital in Borazjan, Iran from October 2008 to September 2010.

PATIENTS AND METHODS

Acute gastroenteritis was defined as >=3 loose watery stools per 24 hours. A total of 375 stool samples were collected from hospitalized children aged < 7 years old with acute gastroenteritis. All samples were investigated by using enzyme-linked immunosorbent assay for the presence of viral antigens.

RESULTS

Rotavirus was detected in 91 (24.3%) of the patients whereas the prevalence of norovirus, adenovirus and astrovirus was 12.5%, 5.1% and 2.4%, respectively. On average, 75.9% of children with viral diarrhea were younger than 2 years old (P=.023). All the strains of viral gastroenteritis studied peaked in the autumn, except for adenovirus which peaked in spring (P=.015). The most common clinical symptoms included diarrhea (92.2%), vomiting (68.7%), abdominal cramp (60.8%) and moderate dehydration (57.2%).

CONCLUSION

Since nearly half of gastroenteritis cases (44.3%) were due to viral agents, testing for the viral antigens may guide the clinical approach to those patients with acute diarrhea particularly in the case of children less than 2 years old, and during cold seasons.