Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Human-porcine reassortant rotavirus generated by multiple reassortment events in a Sri Lankan child with diarrhea(Elsevier Science, 2018) Yahiro, T.; Takaki, M.; Chandrasena, T.G.A.N.; Rajindrajith, S.; Isa, H.; Ahmed, K.A human-porcine reassortant rotavirus, strain R1207, was identified from 74 group A rotaviruses detected in 197 (37.6%) stool samples collected from patients who attended a tertiary care hospital in Ragama, Sri Lanka. This is the first report of a human-porcine reassortant rotavirus in Sri Lanka. The patient was a 12-month-old boy who had been hospitalized with fever and acute diarrhea with a duration of 6 days. The family had pigs at home before the birth of this boy. However, the neighbors still practice pig farming. The genotype constellation of R1207 was G4-P[6]-I1-R1-C1-M1-A1-N1-T1-E1-H1. This is based on the assignment of all the eleven gene segments a full genome-based genotyping system. R1207 showed a 4-2-3-2 genomic electrophoretic migration pattern, which is characteristic of group A rotaviruses. Our analyses revealed that five (NSP2, NSP4, VP1, VP2, and VP7) of the 11 genes were closely related to the respective genes of porcine strains. Although the remaining six genes (NSP1, NSP3, NSP5, VP3, VP4, and VP6) were related to human strains, with the exception of the gene sequence of NSP1, all of these human strains were human-porcine reassortants. With a genogroup 1 genetic backbone, this strain was possibly formed via multiple genetic reassortments. We do not know whether this strain is circulating in pigs, as no data are available on porcine rotaviruses in Sri Lanka. Surveillance should be strengthened to determine the epidemiology of this genotype of rotavirus in Sri Lanka and to assess whether the infection was limited or sustained by ongoing human-to-human transmission.Item Projected cost- effectivenes of rotavirus vaccination in Sri Lanka(The Bulletin of the Sri Lanka College of Microbiologists, 2007) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardane, R.; Adhihetty, D.; Ahmed, K.; Pathmeswaran, A.; Nakagomi, O.OBJECTIVES: The disease and economic burden of rotavirus infection among children hospitalised for gastroenteritis in Sri Lanka was assessed, in anticipation of the availability of new rotavirus vaccines. METHODS: A prospective gastroenteritis case surveillance was conducted between April 2005-October 2006 at the paediatric units of the Colombo North Teaching Hospital. Stool samples of children admitted with diarrhoea were screened for group A rotavirus antigens by enzyme-immuno assay (ElA)(Rotaclone®).Information regarding medical and non- medical costs during the event was obtained among randomly selected rotavirus cases (n=45) through an interviewer administered questionnaire. Cost effectiveness of universal rotavirus vaccination was investigated assuming a cost Of ≤ US$.7 per vaccine dose (two dose regime) in accordance with the World Bank cost effectiveness standard for low-income countries. RESULTS: Total of 606 children (335 males)[ mean age 27.3 months,(range 1-144) were analyzed. 116 (19.1%) had rotavirus antigens. The prevalence among the 0-5 years age group was 20.8. The average cost per episode of rotavirus gastroenteritis was Rs. 3004(US$ 27). Estimated initial and recurrent expenditure of universal vaccination was US$ 23.7 and five million respectively. Costs saved through averting rotavirus diarrhoea hospitaljsations per year (assuming a vaccine of 100% efficacy) were US$ 0.21 million. Deaths averted were eight per year. CONCLUSION: Universal rotavirus vaccination at 5 US$.7 per dose may not be cost-saving in Srilanka. However decisions regarding vaccine use should be based not only on whether the intervention provides cost savings but also on the value of preventing associated morbidity and mortality.Item Surveillance of rotavirus in three hospital settings of Sri Lanka 2007 - 2010(Sri Lanka College of Microbiologists, 2014) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardena, N.K.; Liyanarachchi, N.; Abeysekera, C.K.; Matsomoto, T.; Yahiro, T.; Nishizono, A.; Ahmed, K.INTRODUCTION: Rotavirus is an important aetiological agent of childhood diarrhoeas in Sri Lanka. OBJECTIVES: To study the rotavirus epidemiology and genotypic diversity of cases hospitalized in three geographical locations of Sri Lanka, Ragama, Galle and Kandy. MATERIALS AND METHODS: The study was approved by the ethical review board of the Sri Lanka College of Paediatricians. Stool samples were collected from children < 5 years, hospitalized at the Teaching Hospitals at Ragama (RTH) (November 2007 - October 2010) Galle (GTH) and Kandy (KTH) (mid and late 2008) respectively for acute gastroenteritis. Rotavirus was detected using EIA kit, Rotaclone®. A subset of rotavirus positive samples was genotyped by reverse-transcription(Rt)-PCR and polyacrylamide-gel-electrophoresis (PAGE). RESULTS: Stool samples of 1245 children (69.2%, 23.3% and 7.3% from RTH, GTH and KTH respectively) were screened for rotavirus. Of them, 476 were positive by EIA. The overall rate of prevalence of rotavirus infection was 38.2%. The median age of infection ranged from 13-20 months. Rotavirus genotyping was done on 375 (78.8 %) samples. G1 [P8] was the overall dominant strain (44.8%) followed by G9[P8] (10.1%), G2[P4] (5.3%), G3[P8] (3.2%), G1[P6] (2.1%), G12[P6] (1.3%), G2[P8] (1.06%) and 0.26% of G4[P6], G4[P4] and G4[P8]. The G or P serotype was untypable in 25.6% of samples and 5.6% were of mixed-G and P type. PAGE yeilded 25 electropherotypes (E1-E12 and E16-E29), with E5 and E20 causing 19 and 14 percent of infections respectively. The electropherotype could not be determined in 26%. CONCLUSIONS: Rotavirus continues to be an important cause of childhood diarrhoreas in Sri Lanka. Strain G1P8 predominated in all areas during the surveillance period with a notable percentage of mixed-G and P infections. Multiple E types identified indicate increasing strain diversityItem Paediatric rota-virus diarrhoea in Sri Lanka: a preliminary report(Sri Lanka Medical Association, 2007) Chandrasena, T.G.A.N.; Rajindrajith, S.; Ahmed, K.; Pathmeswaran, A.; Abeyewickreme, W.; Nakagomi, O.OBJECTIVE: To determine the prevalence, severity and molecular epidemiology of group A rotavirus infections among children hospitalized with diarrhoea in Sri Lanka. DESIGN, SETTINGS AND METHODS: A prospective hospital-based study was conducted in the paediatric units of the Colombo North Teaching Hospital from April 2005 to February 2006. Stool samples of children admitted with diarrhoea were analysed for Group A rotavirus antigen by enzyme linked immunosorbent assay (ELISA) (Rotaclone ®). Samples positive for rotavirus were characterised by electropherotyping (PAGE) and serotyping (reverse transcription-polymerase chain reaction (RT-PCR) respectively. Severity of diarrhoea was assessed by the Vesikari severity score. RESULTS: A total of 341 children [(204 males, mean age 25.7 months (range 1-144)] were studied. Sixty seven (19.6%) had rotavirus diarrhoea. RT-PCR and PAGE were done on 58 rotavirus positive samples. Thirty one samples were PAGE positive with 6 different electropherotypes. RT-PCR revealed the presence of serotypes Gl, G2, G3, G4 and G9 in 7 (12.1%), 16 (27.6%), 2 (3.4%), 2 (3.4%) and 11 (19.0%) samples respectively. Twenty samples (34.5%) were untypable. Severity score assessed in 326 patients revealed a mean score of 13.3 and 11.4 in rotavirus positive and negative diarrhoeas respectively (p<0.05). Presence, frequency and duration of vomiting and duration of diarrhoea were significantly higher in rotavirus infections (p<0.05). CONCLUSIONS: Rotavirus is an important agent of severe paediatric diarrhoea in Sri Lanka. Molecular analysis indicates genetic diversity among group A rotavirus. This study reports for the first time G9 type rotavirus infection in Sri Lanka.Item Human bocavirus in patients with encephalitis, Sri Lanka, 2009-2010(Centers for Disease Control and Prevention (CDC), 2013) Mori, D.; Ranawaka, U.; Yamada, K.; Rajindrajith, S.; Miya, K.; Perera, H.K.K.; Matsumoto, T.; Dassanayake, M.; Mitui, M. T.; Mori, H.; Nishizono, A.; Soderlund-Venermo, M.; Ahmed, K.We identified human bocavirus (HBoV) DNA by PCR in cerebrospinal fluid from adults and children with encephalitis in Sri Lanka. HBoV types 1, 2, and 3 were identified among these cases. Phylogenetic analysis of HBoV1 strain sequences found no subclustering with strains previously identified among encephalitis cases in Bangladesh.Item Rotavirus infections with multiple emerging genotypes in Sri Lanka(Springer-Verlag, 2010) Ahmed, K.; Batuwanthudawe, R.; Chandrasena, T.G.A.N.; Mitui, M.T.; Rajindrajith, S.; Galagoda, G.; Pun, S.B.; Uchida, R.; Kunii, O.; Moji, K.; Abeysinghe, N.; Nishizono, A.; Nakagomi, O.Rotavirus diarrhea is an important cause of child mortality in developing countries, but studies on this diarrhea are scarce in Sri Lanka. A prospective study conducted in Sri Lanka on rotavirus infection among children in a hospital setting (n = 611) versus children residing in tsunami camps (n = 52) showed that prevalence of rotavirus infection was comparable, 21.9 and 20%, respectively. The hospital and camps were located in different districts. Analysis of the genotypes of 122 rotaviruses from the hospital and 12 from the camps indicated that G9P[8] was associated with 35 and 33%; G12P[8/nt] with 14.7 and 33%; G3P[8/4/nt] with 17 and 8% and G1P[8/4] with 6.5 and 16.7%. Rotaviruses with G2P[8/4/6] and G4P[8/4] were hospital-associated only, and some rotaviruses (9 and 8% from the hospital and the camps, respectively) were G- and P-nontypable. We conclude from the present study that multiple emerging genotypes were prevalent in Sri Lanka, and children in camps were at risk of developing diarrhea due to rotavirusesItem Hospital-based study of the severity and economic burden associated with rotavirus diarrhea in Sri Lanka(IOS Press, 2009) Chandrasena, N.; Rajindrajith, S.; Ahmed, K.; Pathmeswaran, A.; Nakagomi, O.