Association of rotavirus strains and severity of gastroenteritis in Indian children

ABSTRACT

Rotavirus is the leading cause of severe and dehydrating diarrhea in children aged under 5 years. We undertook this hospital-based surveillance study to examine the possible relationship between the severity of diarrhea and the various G-group rotaviruses circulating in India. Stool samples (n = 2,051) were systematically collected from 4,711 children aged <5 years admitted with severe acute gastroenteritis to 12 medical school centers from April 2011 to July 2012. Rotavirus testing was undertaken using a commercially available enzyme immunoassay kit for the rotavirus VP6 antigen (Premier Rotaclone Qualitative ELISA). Rotavirus positive samples were genotyped for VP7 and VP4 antigens by reverse-transcription polymerase chain reaction at a central laboratory. Of the stool samples tested for rotavirus antigen, 541 (26.4%) were positive for VP6 antigen. Single serotype infections from 377 stool samples were compared in terms of gastroenteritis severity. Among those with G1 rotavirus infection, very severe diarrhea (Vesikari score ≥ 16) was reported in 59 (33.9%) children, severe diarrhea (Vesikari score 11–15) in 104 (59.8%), moderate (Vesikari score 6–10) and mild diarrhea (Vesikari score 0–5) in 11 (6.3%). Among those with G2 infection, very severe diarrhea was reported in 26 (27.4%) children, severe diarrhea in 46 (48.4%), and moderate and mild diarrhea in 23 (24.2 %). Among those with G9 infection, very severe diarrhea was reported in 47 (54.5%) children, severe diarrhea in 29 (33.6%), and moderate and mild diarrhea in 10 (11.9%). Among those with G12 infection, very severe diarrhea was reported in 9 (40.9%) children and severe diarrhea in 13 (59.1%). The results of this study indicate some association between rotavirus serotypes and severity of gastroenteritis.

KEYWORDS:

• diarrhea
• rotavirus
• serotypes
• severity
• surveillance

Disclosure of potential conflicts of interest

All the authors except Tarun Saluja, Mandeep S. Dhingra, Rajendra Prasad, Annick Moureau and Badri N. Patnaik were the Principal Investigators of the study at their respective study sites. All the Principal Investigators declared that they had no financial interests in the funder but received research grant to undertake the study. Tarun Saluja and Rajendra Prasad are employed by Shantha Biotechnics Private Limited and were involved in planning, analyzing and interpreting the study. Annick Moureau and Mandeep S. Dhingra are employed by Sanofi Pasteur. Annick Moureau was involved in the interpretation of data. Mandeep S. Dhingra was involved in planning, analyzing and interpreting the study. Badri N. Patnaik is employed by Shantha Biotechnics Private Limited and was involved in analyzing and interpreting the study.

Acknowledgments

We are grateful to the subjects who volunteered to participate in this research study.

Funding

This study was funded by a research grant from Shantha Biotechnics Private Limited (A part of the Sanofi group).