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 ~  Abstract
 ~ Introduction
 ~ Subjects and Methods
 ~ Results
 ~ Discussion
 ~ Conclusion
 ~  References
 ~  Article Tables

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BRIEF COMMUNICATION
Year : 2019  |  Volume : 37  |  Issue : 3  |  Page : 415-417
 

Occurrence of viral gastroenteritis in children below 5 years: A hospital-based study from Assam, India


Department of Microbiology, Gauhati Medical College, Guwahati, Assam, India

Date of Submission25-Feb-2019
Date of Decision06-Aug-2019
Date of Acceptance13-Nov-2019
Date of Web Publication05-Dec-2019

Correspondence Address:
Dr. Ajanta Sharma
Department of Microbiology, Gauhati Medical College, Guwahati - 781 032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmm.IJMM_19_79

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 ~ Abstract 


Viral gastroenteritis is an important cause of mortality and morbidity in children under 5 years of age. Many a time, these cases go unnoticed causing immense scarcity of data on viral diarrhoea. The study aimed to determine the occurrence of viral gastroenteritis among children below 5 years and the aetiological viral agents. Stool samples were collected from patients suffering from acute gastroenteritis. Real-time polymerase chain reaction was done for detection of rotavirus, adenovirus, norovirus, astrovirus and sapovirus. Viruses were detected in 55% of children. Adenovirus was found to be the most common virus (33.7%), followed by rotavirus infection (28.7%).


Keywords: Adenovirus, astrovirus, norovirus, rotavirus, viral gastroenteritis


How to cite this article:
Goldar S, Rajbongshi G, Chamuah K, Alam ST, Sharma A. Occurrence of viral gastroenteritis in children below 5 years: A hospital-based study from Assam, India. Indian J Med Microbiol 2019;37:415-7

How to cite this URL:
Goldar S, Rajbongshi G, Chamuah K, Alam ST, Sharma A. Occurrence of viral gastroenteritis in children below 5 years: A hospital-based study from Assam, India. Indian J Med Microbiol [serial online] 2019 [cited 2020 Jul 13];37:415-7. Available from: http://www.ijmm.org/text.asp?2019/37/3/415/272352





 ~ Introduction Top


Enteric viruses are the main aetiologic agents of acute gastroenteritis among infants and young children. The acknowledged viral causes of paediatric gastroenteritis are rotavirus, norovirus, adenovirus and astrovirus.[1] The World Health Organization data demonstrated that virtually each child has viral diarrhoea within the first 5 years of life.[2] The National Rotavirus Surveillance Network noted a prevalence of 39.6% of rotavirus in children.[3] Assam, like other states in India, does not have an exclusive surveillance monitoring for viral diarrhoea among children. This study was conducted and is a first of its kind to determine the enteric viruses causing diarrhoeal illness in Assam.


 ~ Subjects and Methods Top


The study was conducted in the Gauhati Medical College and Hospital, Guwahati, Assam, taking approval from the Institutional Ethics Committee. The study included acute gastroenteritis patients, between the ages of >6 months and 5 years.[4] A total of 80 cases were enrolled after calculating sample size taking a prevalence rate of 19.4% as reported by Gupta et al.[5]

For homogenisation, 100 mg of the solid stool or 200 μl of liquid stool was collected into a sterile Eppendorf tube. One millilitre of phosphate-buffered saline was added to the specimen and vortexed for 30 s. The tubes were centrifuged for 5 min at 14,000 rpm and taken out carefully assuring undisturbed transport of the filtrate. 40 μl supernatant was extracted and mixed with 160 μl lysis buffer and eluted.

Real-time multiplex polymerase chain reaction (PCR) was done for qualitative detection of norovirus G1, G2, astrovirus, rotavirus, sapovirus and adenovirus. Nucleic acid purification and real-time PCR were done using commercial kits QIAamp MinElute Virus Spin, Qiagen, and FTlyo Viral gastroenteritis kit, Fast Track Diagnostics, Luxembourg, respectively. PCR targets of the viruses are given in [Table 1]. PCR programme included hold at 50°C for 15 min, 94°C for 1 min, 40 cycles of 94°C for 8 s and 60°C for 1 min, followed by 2 min hold at 4°C. Samples showing CT value <33 were considered positive. For quality control, brome mosaic virus was used as an extraction control, the internal control, which was introduced into each sample. Negative control was used at the lysis buffer stage of the extraction process. The assay also included positive controls GASTRO PC (liquid) containing plasmids for Noro G1/G2, astro, rota and adenovirus.
Table 1: Multiplex polymerase chain reaction target

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The data were summarised and analysed using IBM's Statistical Package for the Social Sciences (SPSS) version 21 (IBM, Armonk, NY, USA).


 ~ Results Top


Of the 80 enrolled patients, viruses were detected in 55%. Single viral infection was seen in 33.7% of patients and mixed viral infections in 21.2%. Adenovirus was the most commonly associated virus (33.7%) followed by rotavirus (28.7%).

The highest co-infection was seen with adenovirus and norovirus (20.4%), followed by adenovirus and rotavirus (13.6%), sapovirus and rotavirus (4.5%) and norovirus, adenovirus and rotavirus (4.5%). Norovirus was present as co-infection in 20.4% of patients. Astrovirus and sapovirus each showed single infections in 1 (2.2%) patient. None of the vaccinated children was found to be positive for rota virus.

Rotavirus infection was the most common in the age group of 1–2 years (42.9%). Adenovirus infection was predominant in the age group of 3–4 years (66.7%). 35% of patients had fever of 2–3 days' duration, vomiting in 88.7% and abdominal pain in 56.8% of patients. Mild dehydration was seen in 65.9%, moderate dehydration in 29.5% and severe dehydration in 4.5% of patients. None of the virus was found to be significantly associated with any of the clinical symptoms.

Viral diarrhoea was mostly seen in April–July.


 ~ Discussion Top


In this study, the occurrence rate of viral diarrhoea was 55%, which corresponds with the findings of Imade and Eghafona, (42.6%) and Colomba et al. (59.1%).[2],[6] 60% of the study population received Rotavac vaccine which contains live 116E strain, a naturally occurring reassortant strain G9P[11], containing one bovine rotavirus gene P[11] and ten human rotavirus genes. It is administered as 3-dose regimen, 4 weeks apart, beginning at 6 weeks of age. All doses of rotavirus vaccine should be completed by the age of 8 months.[7] 116E can cause mild gastroenteritis rarely. Bhandari et al. reported G9P[11] rotavirus gastroenteritis following administrations of ROTAVAC (approximately 1 event in 600 doses); no severe cases were seen.[7] In the present study, all the vaccinated child completed three doses of Rotavac vaccine by 4 months of age. Hence, probably, the rotavirus strains detected in the present study were of wild type. However, the assay that we performed for the detection of rotavirus was not designed to differentiate vaccine G9P[11] from wild G9P[11]; hence, we were not able to rule out contribution of the vaccine strains in causing diarrhoea in our study population.

In this study, overall, viral diarrhoea was more common below 2 years (68.1%), which corresponds with the findings of Carraturo et al. and Donà et al. with detection rate of 32% and 62%, respectively.[8],[9] It is the period of activities for many children. Children usually learn to crawl, walk and sometimes even put their fingers into their mouths, which might be the route of transmission.[2]

In the present study, following diarrhoea, the most common clinical feature was fever (97.7%), followed by vomiting (90.9%) and abdominal pain (43.1%). Anbazhagi et al. noted diarrhoea (92%), followed by vomiting (83%) and fever (67%).[10] This is probably because the stool specimens were collected as early as possible within 2 days of onset of diarrhoea.

In the present study, viral diarrhoea mostly occurred in the summer months, i.e., April–July. It is possible that, over and above climatic changes multiple factors interact in certain geographical regions and oppose climatic influences. The waterborne transmission route may dominate during heavy rainfall, followed by flood during summer season in places like Assam.

In the present study, adenovirus was detected most frequently (33.7%), followed by rotavirus (28.7%). Borkakoty et al. found the adenovirus occurrence rate of 10.9% in Dibrugarh, Assam, which was lower than the present study, but higher than the other reports.[11],[12] This implies that adenovirus burden is increasing in this region.


 ~ Conclusion Top


To conclude, it is only a matter of time that rotavirus-associated mortality and morbidity has steadily declined. It is still important to keep a strict vigilance on the other viruses causing gastrointestinal illness in Assam.

Acknowledgement

We gratefully acknowledge the Department of Health Research, Government of India, Indian Council of Medical Research and State Level VRDL, Gauhati Medical College, Guwahati, Assam, India, for extending financial and technical support in this research work.

Financial support and sponsorship

The Department of Health Research, Government of India, Indian Council of Medical Research and State Level VRDL, Gauhati Medical College, Guwahati, Assam, India (As Intramural project).

Conflicts of interest

There are no conflicts of interest.



 
 ~ References Top

1.
Hart N, Cunliffe A, Nakagomi OD. Diarrhea caused by viruses. In: Cook GC, Zumla AL, editors. Manson's Tropical Diseases. Philadelphia, USA: Saunders Elsevier; 2009. p. 815-24.  Back to cited text no. 1
    
2.
Imade PE, Eghafona NO. Viral agents of Diarrhea in young children in two primary health centres in Edo state, Nigeria. Int J Microbiol 2015;10:1-5.  Back to cited text no. 2
    
3.
Mehendale S, Venkatasubramanian S, Girish Kumar CP, Kang G, Gupte MD, Arora R, et al. Expanded Indian national rotavirus surveillance network in the context of rotavirus vaccine introduction. Indian Pediatr 2016;53:575-81.  Back to cited text no. 3
    
4.
World Health Organization. The Treatment of Diarrhoea – A Manual for Physicians and other Senior Health Workers. 4th Review. Geneva: World Health Organization; 2005.  Back to cited text no. 4
    
5.
Gupta S, Singh KP, Jain A, Srivastava S, Kumar V, Singh M. Aetiology of childhood viral gastroenteritis in Lucknow, North India. Indian J Med Res 2015;141:469-72.  Back to cited text no. 5
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6.
Colomba C, Grazia SD, Giammanco GM, Saporito L, Scarlata F, Titone L, et al. Viral gastroenteritis in children hospitalized in Sicily, Italy. Eur J Clin Microbiol Infect Dis 2006;25:570-5.  Back to cited text no. 6
    
7.
Bhandari N, Rongsen-Chandola T, Bavdekar A, John J, Antony K, Taneja S, et al. Efficacy of a monovalent human-bovine (116E) rotavirus vaccine in Indian infants: A randomised, double-blind, placebo-controlled trial. Lancet 2014;383:2136-43.  Back to cited text no. 7
    
8.
Carraturo A, Catalani V, Tega L. Microbiological and epidemiological aspects of rotavirus and enteric adenovirus infections in hospitalized children in Italy. New Microbiol 2008;31:329-36.  Back to cited text no. 8
    
9.
Donà D, Mozzo E, Scamarcia A, Picelli G, Villa M, Cantarutti L, et al. Community-acquired rotavirus gastroenteritis compared with adenovirus and norovirus gastroenteritis in Italian children: A pedianet study. Int J Pediatr 2016;2016:5236243.  Back to cited text no. 9
    
10.
Anbazhagi S, Kamatchiammal S, Jayakar SS. Norovirus based viral gastroenteritis in Chennai city of southern India – An epidemiological study. J Gen Mol Virol 2011;3:27-34.  Back to cited text no. 10
    
11.
Borkakoty B, Jakharia A, Bhattacharya C, Das M, Biswas D, Mahanta J. Prevalence of Enteric Adenovirus among non-rotavirus diarrhea in Assam, Northeast India. Int J Med Res Professionals 2016;2:124-30.  Back to cited text no. 11
    
12.
Ramani S, Kang G. Burden of disease & molecular epidemiology of group A rotavirus infections in India. Indian J Med Res 2007;125:619-32.  Back to cited text no. 12
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