Paediatric rotavirus diarrhoea in Sri Lanka: a preliminary report

Abstract

BACKGROUND: Group A rotavirus is the leading cause of acute gastroenteritis in children. Serotypes Gl, G2, G3 and G4 are mainly responsible for human infections. Strain characterization and serotype distribution of rotavirus in a country is an importaa determinant of future vaccine strategy. Information in this regard is scarce in Sri Lanka. OBJECTIVES: To determine the prevalence, severity and molecular epidemiology of rotavirus diarrhoea among children hospitalized with diarrhoea in Sri Lanka. DESIGN, SETTING AND METHOD: A prospective hospital-based study was conducted in the paediatric units of the North Colombo Teaching Hospital from April 2005-February 2006. Stool samples of children admitted with diarrhoea were analyzed for Group A rotavirus antigen by enzyme linked immunosorbent assay (EL1SA) (Rotaclone). Samples positive for rotavirus were characterized electropherotyping (PAGE) and serotyping (reverse transcription-poiymerase 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 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 (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 patients respectively (p=0.05). Presence frequency and duration of vomiting and duration of diarrhoea were significantly higher in rotavirus diarrhoea (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 in Sri Lanka. This study reports for the first time of G9 type rotavirus infection in Sri Lanka.