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Epidemiology of rotavirus in India
V Jain1, U D Parashar, R I Glass
1Viral Gastroenteritis Section, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Rotavirus causes significant childhood diarrhea and deaths globally. Analyzing Indian studies highlights the need for rotavirus vaccines, especially for infants, to combat this disease effectively.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health
Background:
- Rotavirus is a primary cause of severe childhood diarrhea, leading to hundreds of thousands of deaths annually worldwide.
- India faces a substantial burden of rotavirus-related morbidity and mortality, necessitating effective control strategies.
Purpose of the Study:
- To evaluate the potential benefits of a national rotavirus immunization program in India.
- To analyze the prevalence, age distribution, and serotype diversity of rotavirus in Indian children.
Main Methods:
- A meta-analysis of 40 published studies on rotavirus conducted in India between 1976 and 1997.
- Inclusion criteria focused on pediatric studies with over 100 patients, lasting at least 12 months, and all neonatal studies.
Main Results:
- Rotavirus was detected in a median of 18% of pediatric patients and 28% of neonates.
- Hospitalization peaked between 6-9 months of age, with highest prevalence in children aged 7-12 months (31%).
- Commonly isolated genotypes were G1 and G2, with notable strain diversity and specific P[11], G9 strains in neonates.
Conclusions:
- Rotavirus infection poses a significant public health challenge in India, with a high burden on young children.
- The diversity of strains and early age of onset present challenges for immunization programs.
- A neonatal rotavirus vaccine could offer effective coverage and reduce disease burden.
Abstract:
Rotavirus is the leading cause of childhood diarrhea worldwide, causing an estimated 600,000 deaths each year. To assess the potential benefits of a national rotavirus immunization program in India, we analyzed 40 published studies of rotavirus that were conducted between 1976 and 1997 and included a total of approximately 13,000 Indian pediatric inpatients. Pediatric studies featuring 100 or more patients and lasting at least 12 months in duration and all neonatal studies were analyzed. Rotavirus was detected in a median of 18% of pediatric patients and 28% of neonates surveyed. Fifty percent of all children hospitalized with rotavirus by age 5 were hospitalized by the age of 6 months, 75% by the age of 9 months, and almost 100% by the age of 2 years. Rotavirus was most prevalent (31%) in children between 7 and 12 months of age, followed by children between 1 and 2 years of age (20%), and children < 7 months of age (13%). VP7 genotypes G1 and G2 were most commonly isolated although significant heterogeneity of serotypes was observed. P[11], G9 strains were most frequently isolated among neonates. In 1998; approximately 98,000 childhood deaths were caused by rotavirus. These data underscore the urgent need for safe and effective interventions against rotavirus such as vaccines. The significant diversity of rotavirus strains and young age of hospitalization pose unique challenges to the formulation of a rotavirus immunization program in India, but raise the possibility of utilizing a neonatal vaccine to provide effective coverage.