Molecular Epidemiology and Correlates of Protection against Rotaviral Gastroenteritis in Children in Vellore South India

Abstract

Rotavirus is one of the leading causes of diarrhoea and dehydration of infants incurring significant societal costs in the community and large costs to the health sector as a result of hospital admissions. Studies in the community have the distinct advantage of representing the true burden of disease whereas hospital-centric studies have an intrinsic referral bias as they represent only the sick children requiring admission. Our study is the first prospective, community-based cohort study from India designed specifically to look at rotavirus epidemiology in 452 children recruited from an urban slum in Vellore from birth and monitored till three years of age. There were 1955 episodes of diarrhoea in this cohort of children in these three years of intensive follow up, with rotavirus as the causative factor in 14.2% of these episodes. This compares with a previous published estimate of rotavirus causing diarrhoea in 18% of children with diarrhoea, although these were mainly hospital based studies. The annual incidence of rotavirus diarrhoea in this cohort was 0.25 episodes per child year and any rotavirus infection was 0.44 episodes per child year. Other cohort studies from developing countries like Mexico and Guinea-Bissau have reported similar incidence of rotavirus infection. The public health importance of this finding is immense especially if one notes the fact that 72.9% of all episodes of rotavirus diarrhoea required clinic visits and 4.3% required hospitalization. Global estimates suggest that 1 in 5 children with rotavirus infection will require a clinic visit, 1 in 65 will require hospitalization, and approximately 1 in 293 will die. newlineThis is on account of complicating factors like malnutrition and poor access to health care and rehydration therapy. Our mortality rate (0.72%) was twice the global estimate and reflects these intrinsic factors prevalent in the developing world, despite the fact that all children were under frequent surveillance and received medical attention at the earliest. newline