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Miranda S, Tonin FS, Pinto-Sousa C, Fortes-Gabriel E, Brito M. Genetic Profile of Rotavirus Type A in Children under 5 Years Old in Africa: A Systematic Review of Prevalence. Viruses 2024; 16:243. [PMID: 38400019 PMCID: PMC10893345 DOI: 10.3390/v16020243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 02/25/2024] Open
Abstract
Human type A rotavirus (RV-A) is world-recognized as the major pathogen causing viral gastroenteritis in children under 5 years of age. The literature indicates a substantial increase in the diversity of rotavirus strains across continents, especially in Africa, which can pose significant challenges including an increase of disease burden and a reduction of vaccines' effectiveness. However, few studies have mapped the variety of circulating virus strains in different regions, which may hamper decisions on epidemiological surveillance and preventive public health measures. Thus, our aim was to compile the most updated available evidence on the genetic profile of RV-A among children in Africa and determine the prevalence of different genotypes according to the geographical regions by means of a broad systematic review. Systematic searches were performed in PubMed, Scopus, Web of Science, and Scielo without language, time limits, or geographical restrictions within the African continent. We selected full-text peer-reviewed articles assessing the genetic profile (i.e., genotyping) of RV-A in children up to 5 years old in Africa. Overall, 682 records were retrieved, resulting in 75 studies included for evidence synthesis. These studies were published between 1999 and 2022, were conducted in 28 countries from the five African regions, and 48% of the studies were carried out for 24 months or more. Most studies (n = 55; 73.3%) evaluated RV-A cases before the introduction of the vaccines, while around 20% of studies (n = 13) presented data after the vaccine approval in each country. Only seven (9.3%) studies compared evidence from both periods (pre- and post-vaccine introduction). Genotyping methods to assess RV-A varied between RT-PCR, nested or multiplex RT-PCR, testing only the most common P and G-types. We observed G1 and P[8] to be the most prevalent strains in Africa, with values around 31% and 43%, respectively. Yet if all the genotypes with the following highest prevalence were added ((G1 + G2, G3, G9) and (P[8] + P[6], P[4])), these figures would represent 80% and 99% of the total prevalence. The combination G1P[8] was the most reported in the studies (around 22%). This review study demonstrated an increased strain diversity in the past two decades, which could represent a challenge to the efficacy of the current vaccine.
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Affiliation(s)
- Sandra Miranda
- Faculdade de Medicine, Universidade Agostinho Neto, Luanda, Angola; (S.M.); (C.P.-S.)
- CISA-Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola;
- Clínica Girassol, Luanda, Angola
| | - Fernanda S. Tonin
- ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Carlos Pinto-Sousa
- Faculdade de Medicine, Universidade Agostinho Neto, Luanda, Angola; (S.M.); (C.P.-S.)
- UPRA-Universidade Privada de Angola, Luanda, Angola
| | - Elsa Fortes-Gabriel
- CISA-Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola;
- ISTM- Instituto Superior Técnico Militar, Luanda, Angola
| | - Miguel Brito
- CISA-Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola;
- ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisboa, Portugal;
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Elbashir I, Aldoos NF, Mathew S, Al Thani AA, Emara MM, Yassine HM. Molecular epidemiology, genetic diversity, and vaccine availability of viral acute gastroenteritis in the middle East and North Africa (MENA) region. J Infect Public Health 2022; 15:1193-1211. [PMID: 36240530 DOI: 10.1016/j.jiph.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 11/18/2022] Open
Abstract
Acute gastroenteritis is the cause of considerable mortality and morbidity worldwide, particularly among children under five years in underdeveloped countries. Most acute gastroenteritis (AGE) cases are attributed to viral etiologies, including rotavirus, norovirus, adenovirus, astrovirus, and sapovirus. This paper aimed to determine the prevalence rate of different viral etiologies of AGE in the Middle East and North Africa (MENA) region. Moreover, this paper explored rotavirus phylogenetic relatedness, compared VP7 and VP4 antigenic regions of rotavirus with vaccine strains, and explored the availability of vaccines in the MENA region. The literature search identified 160 studies from 18 countries from 1980 to 2019. The overall prevalence of rotavirus, norovirus, adenovirus, astrovirus, and sapovirus were 29.8 %, 13.9 %, 6.3 %, 3.5 %, and 3.2 % of tested samples, respectively. The most common rotavirus genotype combinations in the MENA region were G1P[8], G9P[9], and G2P[4], whereas GII.4 was the predominant norovirus genotype all of which were reported in almost all the studies with genotyping data. The comparison of VP7 and VP4 between circulating rotavirus in the MENA region and vaccine strains has revealed discrete divergent regions, including the neutralizing epitopes. Rotavirus vaccine was introduced to most of the countries of the MENA region; however, only a few studies have assessed the effectiveness of vaccine introduction. This paper provides a comprehensive update on the prevalence of the different viral agents of AGE in the MENA region.
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Affiliation(s)
- Israa Elbashir
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Noor F Aldoos
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
| | - Shilu Mathew
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
| | - Asmaa A Al Thani
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar; Department of Biomedical Sciences, College of Health Science-QU Health, Qatar University, Doha 2713, Qatar
| | - Mohamed M Emara
- Basic Medical Sciences Department, College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar.
| | - Hadi M Yassine
- Biomedical Research Center, Qatar University, 2713 Doha, Qatar.
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Epidemiological, molecular, and clinical features of rotavirus infections among pediatrics in Qatar. Eur J Clin Microbiol Infect Dis 2021; 40:1177-1190. [PMID: 33411172 DOI: 10.1007/s10096-020-04108-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022]
Abstract
Acute gastroenteritis (AGE) remains a major cause of diarrhea in developing and developed countries. Rotavirus (RV) is a leading cause of severe pediatric diarrhea worldwide. Here we report on the prevalence of circulating genotypes in association with demographics and clinical manifestations outcomes in Qatar. A total of 231 RV-positive fecal samples were collected from children suffering from AGE during 3 years study period between June 2016 and June 2019. The age of the subjects ranged between 2 months and 14 years (median of 16 months). The VP4 and VP7 were amplified and sequenced. Phylogenetic analyses were performed using MEGA7.0. Pearson's chi-squared test was used to determine significant differences for comparisons of general categorical variables. RV infections were most common in children between 1 and 3 years of age (49%), followed by those < 1 year and > 3 years of age (33% and 28%, respectively). RV infections were more frequent in males than females, with a ratio of 1.4:1. RV infections occurred throughout the year, with a noticeable increase in summer (42.8%) and a drop in winter (20.1%). RV genotypes G3P[8] (30.8%), G2P[8] (12.3%), G4P[8] (11.7%), and G1P[8] (10.4%) were the common genotypes during the study period. The G3P[8] strain detected in our study revealed similarities to the equine-like G3P[8] (10.3%; 24/231) (KT988229.1), Wa-like genomic constellation (9%; 21/231) (MF563894.1), and DS-1-like strains (6.4%; 15/231) (LC386081.1). Based on the Vesikari score system, severe clinical illness including diarrhea and vomiting (average frequency: 4 to 5 times/day) was recorded for G3P[8] group, followed by G9P[8], G4P[8], and G1P[8]. Higher incidence for G3P[8], G2P[8], G4P[8], and G1P[8] were reported in Qatari subjects compared to other nationalities. The multinational status of a small country explains the wide diversity of circulating RV genotypes in Qatar. The highest prevalence and severe illnesses were recorded to G3P[8], which is different from other surrounding countries/global levels.
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Islam A, Hossain ME, Rostal MK, Ferdous J, Islam A, Hasan R, Miah M, Rahman M, Rahman MZ, Daszak P, Epstein JH. Epidemiology and Molecular Characterization of Rotavirus A in Fruit Bats in Bangladesh. ECOHEALTH 2020; 17:398-405. [PMID: 32876756 PMCID: PMC7464061 DOI: 10.1007/s10393-020-01488-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 05/06/2023]
Abstract
Rotavirus A (RVA) is the primary cause of acute dehydrating diarrhea in human and numerous animal species. Animal-to-human interspecies transmission is one of the evolutionary mechanisms driving rotavirus strain diversity in humans. We screened fresh feces from 416 bats (201 Pteropus medius, 165 Rousettus leschenaultii and 50 Taphozous melanopogon) for RVA using rRT-PCR. We detected a prevalence of 7% (95% CI 3.5-10.8) and 2% (95% CI 0.4-5.2) in P. medius and R. leschenaultii, respectively. We did not detect RVA in the insectivorous bat (T. melanopogon). We identified RVA strains similar to the human strains of G1 and G8 based on sequence-based genotyping, which underscores the importance of including wildlife species in surveillance for zoonotic pathogens to understand pathogen transmission and evolution better.
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Affiliation(s)
- Ariful Islam
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Geelong, VIC, Australia
| | - Mohammad Enayet Hossain
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Melinda K Rostal
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
| | - Jinnat Ferdous
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
- Institute of Epidemiology, Disease Control and Research (IEDCR), Mohakhali, Dhaka, 1212, Bangladesh
| | - Ausraful Islam
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rashedul Hasan
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mojnu Miah
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter Daszak
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA
| | - Jonathan H Epstein
- EcoHealth Alliance, 460 West 34th Street, Suite 17, New York, NY, 10001, USA.
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El-Senousy WM, Abu Senna ASM, Mohsen NA, Hasan SF, Sidkey NM. Clinical and Environmental Surveillance of Rotavirus Common Genotypes Showed High Prevalence of Common P Genotypes in Egypt. FOOD AND ENVIRONMENTAL VIROLOGY 2020; 12:99-117. [PMID: 32279222 PMCID: PMC7224034 DOI: 10.1007/s12560-020-09426-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 05/18/2023]
Abstract
The objective of this study was to compare the prevalence of human rotavirus group A common G and P genotypes in human Egyptian stool specimens and raw sewage samples to determine the most common genotypes for future vaccine development. From 1026 stool specimens of children with acute diarrhea and using nested RT-PCR, 250 samples (24.37%) were positive for human rotavirus group A. Using multiplex RT-PCR, rotavirus common P and G genotypes were detected as 89.20% and 46.40% of the positive clinical specimens respectively. This low percentage of common G genotypes frequency may affect the efficiency of the available live attenuated oral rotavirus vaccines [Rotarix® (human rotavirus G1P[8]) and RotaTeq® (reassortant bovine-human rotavirus G1-4P[5] and G6P[8])], however the percentage of clinical specimens which were negative for common G genotypes but positive for P[8] genotype was 12.00%. From 24 positive raw sewage samples for rotavirus group A VP6 collected from Zenin and El-Gabal El-Asfar wastewater treatment plants (WWTPs), 21 samples (87.50%) were typeable for common P genotypes while 13 samples (54.17%) were typeable for common G genotypes. Phylogenetic analysis of a VP8 partial gene of 45 P-typeable clinical isolates and 20 P-typeable raw sewage samples showed high similarity to reference strains and the majority of mutations were silent and showed lower to non-significant similarity with the two vaccine strains. This finding is useful for determining the most common antigens required for future vaccine development.
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Affiliation(s)
- Waled M El-Senousy
- Environmental Virology Lab., Water Pollution Research Department, Environmental Research Division and Food-Borne Viruses Group, Centre of Excellence for Advanced Sciences, National Research Centre (NRC), 33 El-Buhouth st., Dokki, P.O. 12622, Giza, Egypt.
| | - Amel S M Abu Senna
- Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University, Yossuf Abbas st., Nasr city, P.O. 11754, Cairo, Egypt
| | - Nabil A Mohsen
- Pediatrics Department, Kasr Al Ainy School of Medicine, Cairo University, Kasr Al Ainy st, P.O. 11562, Cairo, Egypt
| | - Seham F Hasan
- Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University, Yossuf Abbas st., Nasr city, P.O. 11754, Cairo, Egypt
| | - Nagwa M Sidkey
- Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University, Yossuf Abbas st., Nasr city, P.O. 11754, Cairo, Egypt
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Islam A, Hossain ME, Haider N, Rostal MK, Mukharjee SK, Ferdous J, Miah M, Rahman M, Daszak P, Rahman MZ, Epstein JH. Molecular characterization of group A rotavirus from rhesus macaques (Macaca mulatta) at human-wildlife interfaces in Bangladesh. Transbound Emerg Dis 2019; 67:956-966. [PMID: 31765042 DOI: 10.1111/tbed.13431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 01/29/2023]
Abstract
Group A rotavirus (RVA) is an important cause of diarrhoea in people, especially children, and animals globally. Due to the segmented nature of the RVA genome, animal RVA strains have the potential to adapt to the human host through reassortment with other co-infecting human viruses. Macaques share food and habitat with people, resulting in close interaction between these two species. This study aimed to detect and characterize RVA in rhesus macaques (Macaca mulatta) in Bangladesh. Faecal samples (N = 454) were collected from apparently healthy rhesus macaques from nine different sites in Bangladesh between February and March 2013. The samples were tested by one-step, real-time, reverse transcriptase-polymerase chain reaction (PCR). Four percent of samples (n = 20; 95% CI 2.7%-6.7%) were positive for RVA. RVA positive samples were further characterized by nucleotide sequence analysis of two structural protein gene fragments, VP4 (P genotype) and VP7 (G genotype). G3, G10, P[3] and P[15] genotypes were identified and were associated as G3P[3], G3P[15] and G10P[15]. The phylogenetic relationship between macaque RVA strains from this study and previously reported human strains indicates possible transmission between humans and macaques in Bangladesh. To our knowledge, this is the first report of detection and characterization of rotaviruses in rhesus macaques in Bangladesh. These data will not only aid in identifying viral sharing between macaques, human and other animals, but will also improve the development of mitigation measures for the prevention of future rotavirus outbreaks.
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Affiliation(s)
- Ariful Islam
- EcoHealth Alliance, New York, NY, USA.,Centre for Integrative Ecology, School of Life and Environmental Science, Deakin University, Geelong, Vic., Australia
| | - Mohammad Enayet Hossain
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Najmul Haider
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Department of Pathobiology and Population Sciences, Royal Veterinary College, London, UK
| | | | - Sanjoy Kumar Mukharjee
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jinnat Ferdous
- EcoHealth Alliance, New York, NY, USA.,Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Mojnu Miah
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mohammed Ziaur Rahman
- International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Sadiq A, Bokhari H, Noreen Z, Asghar RM, Bostan N. Magnitude of Rotavirus A and Campylobacter jejuni infections in children with diarrhea in Twin cities of Rawalpindi and Islamabad, Pakistan. BMC Infect Dis 2019; 19:978. [PMID: 31752744 PMCID: PMC6868847 DOI: 10.1186/s12879-019-4575-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/16/2019] [Indexed: 03/10/2023] Open
Abstract
Background Acute diarrhea is a leading cause of morbidity and mortality in children particularly in developing countries of Asia and Africa. The present study was conducted to detect the two most important pathogens, rotavirus and Campylobacter Jejuni in children suffering with diarrhea in Rawalpindi and Islamabad, Pakistan in 2014. The clinical and epidemiological aspects of the disease were also investigated. Methods A total of 500 stool samples were collected from children presented with clinical signs and symptoms of acute diarrhea. The samples were initially screened for the presence of rotavirus A (RVA) via ELISA (Enzyme-linked immunosorbent assay) and RT-PCR (Reverse Transcriptase PCR) and then were analysed for C. jejuni by using species specific PCR assay. Results The detection rate of RVA was 26.4% (132/500) while, Campylobacter was detected in 52% (260/500) of samples with C. jejuni accounted for 48.2% (241/500) of all study cases. Co-infection of C. jejuni with RVA was identified in 21.8% of all cases. Children with RVA and C. jejuni co-infection showed a higher probability (p = 0.01) to be dehydrated. A significant association (p = 0.02) was found between C. jejuni positive status and fever in children. The median age of children with both RVA and C. jejuni infection was 6–11 months. The RVA detection rate was high in winter months of the year while, C. jejuni infections were documented high in summer over 1 year study period. Conclusions The overall results have demonstrated the high prevalence of C. jejuni in Rawalpindi, Islamabad, Pakistan in 2014. The results of present study will not only help to calculate disease burden caused by C. jejuni and rotavirus but also will provide critical information to health authorities in planning public health care strategies against these pathogens.
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Affiliation(s)
- Asma Sadiq
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan
| | - Habib Bokhari
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan.
| | - Zobia Noreen
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan
| | | | - Nazish Bostan
- Department of Biosciences, COMSATS University (CUI), Tarlai Kalan, Chak Shahzad, Islamabad, 45550, Pakistan.
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Badur S, Öztürk S, Pereira P, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Systematic review of the rotavirus infection burden in the WHO-EMRO region. Hum Vaccin Immunother 2019; 15:2754-2768. [PMID: 30964372 PMCID: PMC6930073 DOI: 10.1080/21645515.2019.1603984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Selim Badur
- MENA, Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Serdar Öztürk
- MENA, Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Priya Pereira
- Global Medical Affairs Rota/MMRV, GSK, Wavre, Belgium
| | | | - Mansour Khalaf
- EM Central Vaccines Medical/Clinical, GSK, Jeddah, Saudi Arabia
| | - Youness Lagoubi
- EM Central Vaccines Medical/Clinical, GSK, Casablanca, Morocco
| | - Onur Ozudogru
- EM Central Vaccines Medical/Clinical, GSK, Dubai, United Arab Emirates
| | - Kashif Hanif
- EM Central Vaccines Medical/Clinical, GSK, Karachi, Pakistan
| | - Debasish Saha
- Epidemiology/Health Economics EM, GSK, Wavre, Belgium
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Detection and Genotyping of Viral Gastroenteritis in Hospitalized Children Below Five Years Old in Cairo, Egypt. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.60288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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