Skip to main content
SpringerLink
Log in

Rotavirus Gastroenteritis Hospitalizations Among Under-5 Children in Northern India

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

To study epidemiological profile, prevalence, and molecular epidemiology of RVGE in hospitalized under-5 children at a tertiary care teaching rural hospital located in sub-Himalayan belt of Northern India.

Methods

This was a hospital-based surveillance study done over 4 y (2016–2019) including under-5 children hospitalized with acute gastroenteritis (AGE). Demographic and clinical parameters were recorded in a pre-designed performa. After consent, stool samples were collected and sent to Christian Medical College (CMC), Vellore for RV screening by enzyme immunoassay (EIA). Each EIA-positive sample was further subjected to G and P typing using published methods.

Results

Out of total 851 included children, rotavirus gastroenteritis (RVGE) was detected in 23.03% (196/851) cases by EIA. The highest incidence for RVGE-positive cases (40.43%) was observed in 2016 with gradual decline over next 3 y. Maximum cases of diarrhea were observed in 12–23 mo age group along with highest rotavirus detection. G3P[8] was most common genotype (46.94%) found, followed by G1P[8] (13.78%), G2P[4] (4.59%), G1P[6] (8.16%) and G9P[4] (3.57%). Mixed genotype was seen in 13.78% of total cases.

Conclusion

This study summarizes the changing trends in the epidemiology of RVGE in Northern India along with the major circulating genotypes postvaccine introduction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Troeger C, Khalil IA, Rao PC, et al. Rotavirus vaccination and the global burden of rotavirus diarrhea among children younger than 5 years. JAMA Pediatr [Internet]. 2018;172:958–65. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233802/. Accessed 24 June 2019.

  2. Troeger C, Forouzanfar M, Rao PC, et al. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the global burden of disease study 2015. Lancet Infect Dis [internet] Elsevier. 2017;17:909–48. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30276-1/abstract. Accessed 6 Oct 2020.

    Article  Google Scholar 

  3. Liu L, Johnson HL, Cousens S, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet (London, England). 2012;379:2151–61.

    Article  Google Scholar 

  4. Akoua-Koffi C, Akran V, Peenze I, et al. Epidemiological and virological aspects rotavirus diarrhoea in Abidjan, Côte d’Ivoire (1997-2000). Bull Soc Pathol Exot. 2007;100:246–9.

  5. Clark A, Black R, Tate J, et al. Estimating global, regional and national rotavirus deaths in children aged <5 years: current approaches, new analyses and proposed improvements. PLoS One [Internet]. 2017;12. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593200/. Accessed 15 Sep 2020.

  6. John J, Sarkar R, Muliyil J, Bhandari N, Bhan MK, Kang G. Rotavirus gastroenteritis in India, 2011-2013: revised estimates of disease burden and potential impact of vaccines. Vaccine. 2014;32(Suppl 1):A5–9.

    Article  Google Scholar 

  7. Dhirar N, Dudeja S, Khandekar J, Bachani D. Childhood morbidity and mortality in India — analysis of national family health survey 4 (NFHS-4) findings. Indian Pediatr [internet]. 2018;55:335–8. https://doi.org/10.1007/s13312-018-1276-6 Available at: Accessed 9 Oct 2020.

    Article  Google Scholar 

  8. Malik A, Haldar P, Ray A, et al. Introducing rotavirus vaccine in the universal immunization Programme in India: from evidence to policy to implementation. Vaccine [Internet]. 2019;37:5817–24 Available at: http://www.sciencedirect.com/science/article/pii/S0264410X19310254. Accessed 15 Sep 2020.

  9. Nair NP, Reddy NS, Giri S, et al. Rotavirus vaccine impact assessment surveillance in India: protocol and methods. BMJ Open [Internet]. 2019;9:e024840 Available at: http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2018-024840. Accessed 13 Aug 2019.

    Article  Google Scholar 

  10. Vesikari T, Van Damme P, Giaquinto C, et al. European Society for Paediatric Infectious Diseases consensus recommendations for rotavirus vaccination in Europe: update 2014. Pediatr Infect Dis J. 2015;34:635–43.

    Article  Google Scholar 

  11. Ruuska T, Vesikari T. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis. 1990;22:259–67.

    Article  CAS  Google Scholar 

  12. Kang G, Arora R, Chitambar SD, et al. Multicenter, hospital-based surveillance of rotavirus disease and strains among indian children aged <5 years. J Infect Dis. 2009;200(Suppl 1):S147–53.

  13. Babji S, Arumugam R, Sarvanabhavan A, et al. Multi-center surveillance of rotavirus diarrhea in hospitalized children <5 years of age in India, 2009-2012. Vaccine. 2014;32(Suppl 1):A10–2.

  14. Iturriza-Gomara M, Green J, Brown DW, Desselberger U, Gray JJ. Comparison of specific and random priming in the reverse transcriptase polymerase chain reaction for genotyping group a rotaviruses. J Virol Methods. 1999;78:93–103.

    Article  CAS  Google Scholar 

  15. Giri S, Nair NP, Mathew A, et al. Rotavirus gastroenteritis in Indian children < 5 years hospitalized for diarrhoea, 2012 to 2016. BMC Public Health [internet]. 2019;19:69. https://doi.org/10.1186/s12889-019-6406-0. Accessed 4 Mar 2019.

  16. Mehendale S, Venkatasubramanian S, Girish Kumar CP, Kang G, Gupte MD, Arora R. Expanded Indian national rotavirus surveillance network in the context of rotavirus vaccine introduction. Indian Pediatr [Internet]. 2016;53:575–81. Available at: http://link.springer.com/10.1007/s13312-016-0891-3. Accessed 22 Mar 2019.

    Article  Google Scholar 

  17. Gupta M, Singh MP, Guglani V, Mahajan KS, Pandit S. Hospital-based surveillance of rotavirus diarrhea among under- five children in Chandigarh. Indian Pediatr. 2016;53:651–2.

    Article  Google Scholar 

  18. Salim H, Karyana IPG, Sanjaya-Putra IGN, Budiarsa S, Soenarto Y. Risk factors of rotavirus diarrhea in hospitalized children in Sanglah Hospital, Denpasar: a prospective cohort study. BMC Gastroenterol [Internet]. 2014;14:54. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986934/. Accessed 9 Oct 2020.

    Article  Google Scholar 

  19. National Rotavirus Surveillance Network, Kumar CPG, Venkatasubramanian S, Kang G, Arora R, Mehendale S. Profile and trends of rotavirus gastroenteritis in under 5 children in India, 2012–2014, Preliminary Report of the Indian National Rotavirus Surveillance Network. Indian Pediatr. 2016;53:619–22.

    Article  Google Scholar 

  20. Jagai JS, Sarkar R, Castronovo D, et al. Seasonality of rotavirus in South Asia: a meta-analysis approach assessing associations with temperature, precipitation, and vegetation index. PLoS One [Internet] Public Libr Sci. 2012;7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364973/. Accessed 6 Oct 2020.

  21. Lestari FB, Vongpunsawad S, Wanlapakorn N, Poovorawan Y. Rotavirus infection in children in Southeast Asia 2008–2018: disease burden, genotype distribution, seasonality, and vaccination. J Biomed Sci [Internet]. 2020;27. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239768/. Accessed 27 Aug 2020.

  22. Nag VL, Khare V, Awasthi S, Agrawal SK. Clinical profile and prevalence of rotavirus infection in children presented with acute diarrhea at tertiary care referral hospital at northern part of India. J Commun Disord. 2009;41:183–8.

    CAS  Google Scholar 

  23. Staat MA, Azimi PH, Berke T, et al. Clinical presentations of rotavirus infection among hospitalized children. Pediatr Infect Dis J [Internet]. 2002;21:221–7. Available at: https://europepmc.org/article/med/12005086. Accessed 9 Oct 2020.

    Article  Google Scholar 

  24. Azemi M, Berisha M, Ismaili-Jaha V, et al. Socio-demographic, clinical and laboratory features of rotavirus gastroenteritis in children treated in pediatric clinic. Mater Soc. 2013;25:9–13.

    Google Scholar 

  25. Kang G, Desai R, Arora R, et al. Diversity of circulating rotavirus strains in children hospitalized with diarrhea in India, 2005-2009. Vaccine. 2013;31:2879–83.

  26. Kang G, Green J, Gallimore CI, Brown DWG. Molecular epidemiology of rotaviral infection in South Indian children with acute diarrhea from 1995–1996 to 1998–1999. J Med Virol [Internet]. 2002;67:101–5. Available at: http://doi.wiley.com/10.1002/jmv.2197. Accessed 6 Oct 2020.

    Article  Google Scholar 

  27. Santos N, Hoshino Y. Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine. Rev Med Virol. 2005;15:29–56.

    Article  Google Scholar 

  28. Leshem E, Lopman B, Glass R, et al. Distribution of rotavirus strains and strain-specific effectiveness of the rotavirus vaccine after its introduction: a systematic review and meta-analysis. Lancet Infect Dis [Internet]. 2014;14:847–56. Available at: http://www.sciencedirect.com/science/article/pii/S1473309914708321. Accessed 5 Aug 2020.

  29. Ghosh S, Varghese V, Samajdar S, Sinha M, Naik TN, Kobayashi N. Evidence for bovine origin of VP4 and VP7 genes of human group a rotavirus G6P[14] and G10P[14] strains. J Clin Microbiol [Internet]. 2007;45:2751–3. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1951218/. Accessed 6 Oct 2020.

    Article  CAS  Google Scholar 

  30. Ramani S, Kang G. Burden of disease & molecular epidemiology of group A rotavirus infections in India. Indian J Med Res [Internet]. 2007;125:619–32. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474761/. Accessed 9 Sep 2015.

    CAS  Google Scholar 

  31. Shrivastava AK, Reddy NS, Giri S, et al. Burden and molecular epidemiology of Rotavirus causing diarrhea among under-five children: a hospital-based study from Eastern India. J Glob Infect Dis [Internet]. 2019;11:147. Available at: http://www.jgid.org/article.asp?issn=0974-777X;year=2019;volume=11;issue=4;spage=147;epage=152;aulast=Shrivastava;type=0. Accessed 6 Oct 2020.

    Article  Google Scholar 

  32. Mullick S, Mandal P, Nayak MK, et al. Hospital based surveillance and genetic characterization of rotavirus strains in children (<5 years) with acute gastroenteritis in Kolkata, India, revealed resurgence of G9 and G2 genotypes during 2011-2013. Vaccine. 2014;32(Suppl 1):A20–8.

  33. da Silva MFM, Rose TL, Gómez MM, et al. G1P[8] species a rotavirus over 27 years--pre- and post-vaccination eras--in Brazil: full genomic constellation analysis and no evidence for selection pressure by Rotarix® vaccine. Infect Genet Evol. 2015;30:206–18.

  34. Kirkwood CD, Boniface K, Barnes GL, Bishop RF. Distribution of rotavirus genotypes after introduction of rotavirus vaccines, Rotarix® and RotaTeq®, into the National Immunization Program of Australia. Pediatr Infect Dis J. 2011;30:S48–53.

    Article  Google Scholar 

  35. Chakravarti A, Chauhan MS, Sharma A, Verma V. Distribution of human rotavirus G and P genotypes in a hospital setting from northern India. Southeast Asian J Trop Med Public Health. 2010;41:1145–52.

    CAS  PubMed  Google Scholar 

  36. Jain S, Vashistt J, Changotra H. Rotaviruses: is their surveillance needed? Vaccine. 2014;32:3367–78.

    Article  Google Scholar 

  37. Gupta S, Chaudhary S, Bubber P, Ray P. Epidemiology and genetic diversity of group a rotavirus in acute diarrhea patients in pre-vaccination era in Himachal Pradesh, India. Vaccine. 2019;37:5350–6.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful for the co-operation by all participants, parents/guardians, project medical officers, lab assistants and field workers who helped in smooth conduction of the study. This work was supported by grants from the Bill and Melinda Gates Foundation to the Centers for Disease Control and Prevention, Atlanta, GA, USA (subcontract to Christian Medical College, Vellore grant no MOA#871-15SC) and the Translational Health Science and Technology Institute (grant no OPP1165083).

The study was supported by the Indian Council of Medical Research, New Delhi; Ministry of Health and Family Welfare, Govt. of India and the State government of the participating institution.

The authors thank the team at Christian Medical College, Vellore for support.

Funding

This work was supported by grants from the Bill and Melinda Gates Foundation to the Centers for Disease Control and Prevention, Atlanta, GA, USA (subcontract to Christian Medical College, Vellore grant no MOA#871-15SC) and the Translational Health Science and Technology Institute (grant no OPP1165083).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Dr Rajendra Prasad Govt Medical College, Distt Kangra, Tanda, Himachal Pradesh, 176001, India

    Jyoti Sharma, Sanjiv Chaudhary & Mohit Bajaj

  2. The Wellcome Trust Research Laboratory, Christian Medical College, Vellore, Tamil Nadu, India

    Nayana P. Nair & Varunkumar Thiyagarajan

Authors
  1. Jyoti Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjiv Chaudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohit Bajaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nayana P. Nair
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Varunkumar Thiyagarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of the study – JS & SC; Acquisition of data – JS, SC & NPN in coordination with project medical officers; Analysis of data – JS, SC, VT & NPN; Interpretation of data and drafting of article – JS & MB; Critically revising drafts of article – JS, NPN & MB; Final approval of submitted version – All the authors. SC will act as guarantor for this paper.

Corresponding author

Correspondence to Jyoti Sharma.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sharma, J., Chaudhary, S., Bajaj, M. et al. Rotavirus Gastroenteritis Hospitalizations Among Under-5 Children in Northern India. Indian J Pediatr 88 (Suppl 1), 28–34 (2021). https://doi.org/10.1007/s12098-020-03621-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-020-03621-4

Keywords

Search

Navigation