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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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Pediatric Rotavirus Gastroenteritis: A 2 year Analysis to Understand
Current Prevalence in Mumbai |
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Vidya Nerurkar, Senior Microbiologist,
Vipulmati Dhole, Section Technical Coordinator,
Nimmi Kothari, Section Technical Manager,
Simi Bhatia, General Manager-Laboratory
operations Director,
Super Religare
Laboratories Limited, Prime Square Building, Plot No. 1, Gaiwadi Industrial
Estate,
SV Road, Goregaon (W),
Mumbai – 400 062, India. |
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Address for Correspondence |
Super Religare
Laboratories Limited,
Prime Square Building,
Plot No. 1, Gaiwadi Industrial
Estate,
SV Road, Goregaon (W),
Mumbai – 400 062, India.
E-mail:
dr.nerurkar@gmail.com |
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Nerurkar V, Dhole V, Kothari N, Bhatia S. Pediatric Rotavirus Gastroenteritis: A 2 year Analysis to Understand
Current Prevalence in Mumbai. Online J Health Allied Scs.
2011;10(1):15 |
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Submitted: Dec 13,
2010; Suggested revision: Dec 31,
2010; Revised: Dec 31, 2010; Accepted: March 31, 2011; Published:
April 15, 2011 |
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| Abstract: |
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Many studies have established
the high prevalence of paediatric Rotavirus gastroenteritis in India.
The importance of rapid diagnosis of rotavirus infection has also been
stressed upon, to initiate prompt rehydration therapy and prevent unnecessary
use of antibiotics .We undertook a retrospective analysis of 327 paediatric
stool specimens to understand the current prevalence and seasonal distribution
of cases in Mumbai and its surrounding areas. Overall Rotavirus positivity
rate was 37.9 %, with peak positivity in winter seasons. Infections
were more common upto 2 years of age. Incidence of bacterial and parasitic
coinfections was low.
Key Words:
Rotavirus; Paediatric diarrhea;
Antigen detection
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A number of
Indian studies have established the high prevalence of Paediatric Rotavirus
gastroenteritis in India.(1-5)The importance of rapid diagnosis
of rotavirus infection has also been stressed upon, to initiate prompt rehydration therapy and prevent unnecessary use of antibiotics.(1,2,6,7) Nosocomial rotaviral outbreaks in paediatric wards and neonatal
nurseries are known to occur and are difficult to contain.(6) Rotavirus
antigen testing for confirmation of infection, or as an epidemiological
tool is usually not included in the diagnostic protocol for acute pediatric diarrhoea, since a specific diagnosis of rotavirus gastroenteritis does
not change the management significantly and also does not help in case
of other viral etiology. With this background in mind, we undertook
retrospective laboratory data analysis of 327 stool specimens, taken
from children < 7 years of age with acute diarrhoea, collected over
a period of 22 months (August 2008 to May 2010).This was done with an
aim to understand the current prevalence and seasonal distribution of
cases in Mumbai. Tests performed on each specimen included 1) Routine
Stool macroscopic and microscopic examination, 2) Modified acid fast
staining for Cryptosporidia and 3) Rotavirus antigen detection. Rotavirus
antigen was detected by using a commercially available rapid antigen
detection kit, RIDA®QUICK [R-Biopharm AG, Germany]. The
kit uses the principle of Immunochromatography and claims a sensitivity
and specificity of 100% & 94.4% respectively, when compared with
PCR.
Data analysis
showed that 124/327 specimens i.e. 37.9 % tested positive for Rotavirus
antigen. The antigen positivity was as high as 45 % in children up to
2 years of age and declined to 14.3 % in the 5-6 years age group.
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Table 1: Association
of Rotavirus positivity with Key Microscopy findings |
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Microscopy
Findings |
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Mucus |
WBC |
RBC |
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3-10/ High power field |
>10/High power field |
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Specimens
Positive for Rotavirus Antigen (n=124) |
62 |
5 |
0 |
6 |
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Specimens
negative for Rotavirus Antigen (n=203) |
42 |
30 |
3 |
34 |
As seen in
Table 1, WBCs and RBCs were more commonly associated with the Rotavirus
negative specimens (n=203), pointing to a likely bacterial infection.
Since stool cultures had not been performed on these 327 specimens,
we were unable to ascertain the type of bacterial infection. The 10/124 rotavirus positive specimens also showed presence of WBCs
and/or RBCs, may be indicating a possibility of concomitant bacterial
infection. Giardia lamblia and Cryptosporidia were detected in 10 and
6 stools respectively. Giardia-rotavirus co-infection was seen
in 5 specimens, while cryptosporidia-rotavirus coinfection was seen
in 1 case.
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Graph I: Seasonal
Trend in Rotavirus Positivity
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As indicated
in Graph 1, positivity trend analysis indicated
that infections occurred more during the cooler winter months , with
a relative decline in the monsoons.
Indian
studies show a wide range of Rotavirus prevalence rates, ranging from
4 to 62.6%.(1,3,4,6,8) It can be attributed to the differences in
age groups studied, detection methods used, geographical location and
the season.(1,3,4,6,8) The positivity rates also vary between various
settings, i.e. hospitalizations, symptomatic and asymptomatic infections
and nosocomial infections.(5) Though the overall prevalence rate in
our study was similar to other study findings, the peak seasonal positivity
was much higher, i.e. upto 83% .Since our study included patients mainly
from Mumbai and its surrounding areas, it is possible that Rotavirus
prevalence is higher in Mumbai due to the overcrowding and poor sanitation.
A limiting factor of our analysis was the inability to differentiate
between community & nosocomial infections, or ascertain whether
these large numbers of seasonal cases were due to a localized institutional
or community outbreak. However, the data does point to the need of larger
prospective studies to assess the current rotavirus prevalence in Mumbai,
especially in context of inpatient and outpatient settings. The utility
of rotavirus antigen testing as an epidemiologic tool in infection control
and prevention needs to be further evaluated, especially in paediatric set-ups.
- Rajesh PK et al.
A Short-Term study of diarrhoea among children under 5 years of age
in Chennai, Tamil Nadu ,with special reference to Rotavirus. IndMedica.
2005;2(3).
- Naik TN. Commentary;
Rapid Diagnosis of rotavirus infection; key to prevent unnecessary use
of antibiotics for treatment of childhood diarrhoea.
Indian J Med Res. 2004;119:v-vi.
- Saravanan P, Ananthan
S, Ananthasubramanian M. Rotavirus Infection among infants and young
children in Chennai South India. IJMM.
2004;22(4):212-221
- De A et al.
Prevalence of rotaviral diarrhoea in hospitalized children.
IJMM. 2005;23:67.
- Ramani S, Kang G.
Burden of disease & molecular epidemiology of group A rotavirus infections
in India. Indian J Med Res. 2007;25(5):619–632.
- Shariff M, Deb M,
Singh R. A study of diarrhoea among children in eastern Nepal with special
reference to Rotavirus. IJMM. 2003;21(2):87-90.
- Taneja N et al.
Antimicrobial resistance in selected bacterial enteropathogens in North
India. Indian J Med Res. 2004;120:39-43.
- Truant AL, Chonmaitree
T. Incidence of Rotavirus infection in different age groups of pediatric
patients with gastroenteritis. Journal of Clinical Microbiology.
1982;568-569.
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