Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : December | Volume : 16 | Issue : 12 | Page : SC01 - SC05 Full Version

Clinical Profile and Serotyping of Rotavirus Diarrhoea in the Postvaccination Period: A Single-centre Cross-sectional Study


Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57311.17188
Gunasekaran Sabharritha, Krishnaswami Devi Meenakshi, Dhandapani Prabu

1. Registrar, Department of Paediatrics, Dr. Mehta’s Multispeciality Hospital, Chennai, Tamil Nadu, India. 2. Professor, Department of Paediatrics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India. 3. Assistant Professor, Department of Microbiology, Dr. ALMPGIBMS, University of Madras, Chennai, Tamil Nadu, India.

Correspondence Address :
Gunasekaran Sabharritha,
Royapettah, Chennai, Tamil Nadu, India.
E-mail: sabharrithasekar@gmail.com

Abstract

Introduction: Rotavirus is the leading cause of severe, life threatening gastroenteritis in infants and young children. As rotavirus strains vary between geographic areas, region specific genotyping information is highly vital to study rotavirus epidemiology and to monitor strain variation after vaccine introduction.

Aim: To estimate the prevalence of rotavirus diarrhoea and strains causing the infection among children younger than five years of age and to study the clinical profile of rotavirus diarrhoea to ascertain factors associated with rotavirus infection in them.

Materials and Methods: This hospital-based cross-sectional study was carried out on 150 children under five years with diarrhoea in the Department of Paediatrics, Government Medical College, Chennai, Tamil Nadu, India from November 2017 to August 2018. The clinical severity was assessed by using Vesikari score. By using PremierTM Rotaclone ELISA Kit rotavirus antigen was detected. Positive samples were tested for RNA identification by Reverese Transcriptase-Polymerase Chain Reaction (RT-PCR). The IBM Statistical Package for the Social Sciences (SPSS) version 22 was used for statistical analysis.

Results: The prevalence of rotavirus diarrhoea was 17.3% and positive samples belonged to G3 type. Prevalence of rotavirus diarrhoea among the vaccinated children was less when compared to unvaccinated children (p-value 0.034). Clinical severity score (Vesikari score) indicated that patients infected with rotavirus had severe disease as compared to rotavirus non infected patients (p-value 0.011). The duration of hospital stay was longer in rotavirus-positive children as compared to rotavirus-negative children (p-value <0.001).

Conclusion: This study highlights the serotype specific prevalence of rotavirus diarrhoea in under five children. Rotavirus has been found to have more severe and prolonged illness among unimmunised under five children; thereby, reinforcing the need for routine rotavirus vaccination.

Keywords

Acute diarrhoea, Rotavirus infection, Vesikari score

Diarrhoea is the most important cause of morbidity and mortality in under-five children in developing countries. According to WHO, diarrhoea is the “passage of loose or watery stools atleast three times in a 24 h period”, with emphasis on stool consistency rather than frequency (1). Globally 1.7 billion children are affected by diarrhoea out of that more than half millions of children die every year (2). UNICEF estimates that 480,000 young children die due to diarrhoea across the globe, accounting for 9% of all deaths among children under five years (3). The National Family Health Survey shows that the prevalence of childhood diarrhoea has increased from 9-9.2% from 2016-2020 in India. Diarrhoea is the third most common cause of under five mortality (4).

Rotavirus is the leading cause of acute diarrhoea, and is responsible for about 40% of all hospital admissions due to diarrhoea among children under five years worldwide (5).

Hospitalisation rates are high (40-50%) in rotavirus infection among diarrhoea children under five years in WHO surveillance countries that have not introduced rotavirus vaccine (6). India holds the second place among countries with the greatest number of rotavirus deaths as a proportion of All Global rotavirus Deaths in Children under five years (6). Indian Rotavirus Strain Surveillance Network data has emphasised the need for region specific genotyping information to study rotavirus epidemiology and to monitor strain variation after vaccine introduction (7). Variation has been observed in serotypes and genotypes of rotavirus in different geographical regions during a particular rotavirus infection season and also in different seasons. Serotypes are the classification within each group based on neutralisation assays which measures reaction of antibody against two outer capsid antigens VP7 and VP4. This assay differentiates VP7 as G types, as VP7 is a Glycoprotein and VP4 as P type, as VP4 is a protease sensitive protein. Currently there are 27G serotypes and 35P serotypes in group A rotavirus (8),(9). Reverse transcriptase PCR is the commonly used technique for VP4 and VP7 genotyping. Globally, G1-G4 and P1A (8) and P1B (4) are the most common G and P types that cause disease in humans (10),(11).

India began a phased introduction of the RotavacR vaccine in national immunisation program starting in 2016. Currently, available rotavirus vaccines are effective in reducing the disease burden, but correct understanding of local epidemiology of rotavirus infection is important for rotavirus immunisation. With the advent of rotavirus vaccination there is significant reduction in the prevalence of rotavirus diarrhoea with reduction in hospitalisation of 70 to 80% in the first year after introduction of rotavirus vaccine and reduction in childhood diarrhoea deaths of around 30-55% have been observed (12).

Considering the severity of rotavirus infection and its associated mortality and morbidity in children under five years, this study was undertaken to determine the serotype-specific prevalence of rotavirus causing diarrhoea in children under five years after the advent of rotavirus vaccination programme and to ascertain factors associated with rotavirus infection in them.

Material and Methods

This cross-sectional hospital-based study was conducted in Department of Paediatrics, Government Medical College, Chennai, Tamil Nadu, India from November 2017 to August 2018. The study was commenced after approval from the Institutional ethics Committee, of a tertiary care Medical College hospital (Protocol ID no 02/2017 meeting held on 14.11.2017).

Inclusion criteria: One hundred and fifty children aged less than or equal to five years with primary diagnosis of acute diarrhoea (>three unformed stools in any 24-hour period of fewer than seven days duration) were included in the study.

Exclusion criteria: Children with dysentery, prolonged diarrhoea more than 14 days, diarrhoea developing after hospitalisation due to other causes and children with a previous history of immunosuppressive therapy like steroids, chemotherapy and children with immunodeficiency syndromes were excluded from the study.

Children fulfilling the selection criteria were identified and their legal guardians were briefed about the nature of the study in local language and a written informed consent was obtained (Table/Fig 1).

Sample size calculation: Sample size was calculated using Epi Info software. With a prevalence of rotavirus infection of 39% observed in multicentre surveillance by Kang G et al., (13) and with an error margin of 8% to calculate 95% confidence interval the number of samples estimated was 142. Hence a sample size of 150 was planned.

Study Procedure

After a written informed consent, a detailed history and examination of the child was done and recorded on a predesigned proforma. Vesikari Clinical Severity Scoring System which included parameters like diarrhoea, vomiting, fever, dehydration, duration of diarrhoea and vomiting and treatment status was used to categorise according to severity (14). The parameters were scored based on the severity of the symptoms in each category. This included the number of episodes of diarrhoea, episodes of vomiting, highest body temperature recorded, duration of diarrhoea and severity of dehydration and treatment plan. The seven parameters were subdivided into thirds according to an equally divided severity distribution (i.e., bottom third=one, middle third=two, top third=three). The scores for each of the seven parameters were added to arrive at the final score between 0-20 which was used to classify the severity (14). An episode was considered to be mild for Vesikari scores 0-5, moderate for scores 6-10, severe for scores 11-15, and very severe for scores 16-20 (Table/Fig 2).

Stool sample was collected by placing the child on a non absorbemt sterile sheet and sample was collected using a spatula contained in the sterile leak proof stool collection container. After collecting stool sample it was sent immediately to the hospital laboratory where the sample was placed at -20°C in deep freezer. Enzyme immunoassay was performed by using Premier Rotaclone kit for the detection of rotavirus antigen in faecal samples. Samples which were positive by ELISA were sent for RT-PCR to University of Madras, Taramani. Rotavirus molecular level RNA detection was done by rotavirus-A Real-time PCR assay.

Statistical Analysis

The IBM SPSS version 22 was used for statistical analysis. Categorical data was expressed as rates, ratios and percentages. Continuous data was expressed as mean±standard deviation. For normally distributed parameters the mean values were compared between study groups using Independent sample t-test (2 groups). For non normally distributed parameters, Medians and Interquartile range (IQR) were compared between study groups using Mann Whitney u test (2 groups). Categorical outcomes were compared between study groups using Chi-square test. A p-value <0.05 was considered statistically significant.

Results

In this study, 26 children tested positive for rotavirus, among the 150 children who were evaluated, which accounted for a prevalence of 17.3%. Majority of the rotavirus-positive children (61.53%) were in the 7-12 months age group. In this study, 55.33% of the children with diarrhoea were boys and 44.67% were girls and the boy to girl ratio was 1.2:1. Among the children with rotavirus infection, 13 (50%) were girls and 13 (50%) were boys (Table/Fig 3).

Majority of the children with diarrhoea had a fever (69.3%). Other common complaints were vomiting (64%), increased thirst (26%), perianal excoriation (16%), and lethargy (11.3%). In this study, 88.5% of children with rotavirus infection had fever when compared to 65.3% of the children without rotavirus infection. In this study, 23.07% of rotavirus-positive cases were not breastfed when compared to 16.93% of rotavirus-negative cases. Among the children with rotavirus infection, 6 (23.07%) children had malnutrition. Among rotavirus-negative cases, 18 (14.51%) children had malnutrition (p=0.279).

Among the children with rotavirus infection, 3 (11.53%) children had received rotavirus vaccine while 40 (32.25%) of vaccinated children did not have rotavirus infection (p=0.034). All children had received RotavacR vaccine as per the National immunisation schedule. Among children with rotavirus infection, one child had received single dose, another child had received two doses and one child had received three doses of RotavacR vaccine (Table/Fig 4).

The mean Vesikari score of children with rotavirus infection was 11.81±3.93 and it was 11.81±3.93 in children without rotavirus infection (p=0.001). Among the children with rotavirus infection, 46.15% of children had severe disease and 19.23% had very severe disease; while among children without rotavirus infection only 30.64% were severe, and 4.83% were very severe disease (p=0.011).

The mean duration of diarrhoea in children with rotavirus infection was 3.69±1.26 days and 2.94±1.32 days in children without rotavirus infection (p=0.008). In the study group, 127 children were hospitalised. The duration of hospital stay was >7 days in 48% of cases with rotavirus infection and 12.74% of cases without rotavirus infection (p<0.001) (Table/Fig 5).

Among children who received rotavirus vaccine, the median (IQR) Vesikari score was 5 (5,7) in rotavirus-positive cases and it was 9 (6,11) in rotavirus-negative cases (p=0.115). However in the unvaccinated group, there was a significant difference in the Vesikari score between rotavirus-positive and negative cases (p<0.001) (Table/Fig 6).

Only 12 samples were positive by rotavirus-A Real-time PCR. Remaining samples did not amplify which may be due to degradation of RNA while transportation or low viral load at the time of specimen collection. Also inconsistency between the two tests may result from false positivity of the antigen tests and false negativity of the nucleic acid test. Causes of false positivity of the antigen test may include cross-reactivity with other microorganisms, interference and non specific reactivity. Causes of false negativity of the nucleic acid test may include RNA degradation due to the prolonged storage of specimens and variations of the RNA viruses that could not be detected by the primers that were used.

Polymerase Chain Reaction was done for 12 samples for the G (VP7) genotyping and P (VP4) genotyping detection. All 12 samples were of G3 type (Table/Fig 7). while there was no amplification during P genotyping (Table/Fig 8).

Discussion

In the present study, rotavirus diarrhoea was observed in 17.3% of children. Other studies revealed a prevalence of 22.6% and 24% and a higher proportion was seen among hospitalised patients (15),(16).

Mehendale S et al., observed a rotavirus positivity rate of 39.6% as part of the Expanded Indian National rotavirus Surveillance Network study conducted between 2012 and 2014 (17). The variation in the prevalence rates of rotavirus diarrhoea may be attributed to the methods of detection (latex slide agglutination test is less sensitive to ELISA), difference in climatic conditions and socio-demographic determinants.

In this study, prevalence of rotavirus infection was equal in both the genders, and similar results were obtained by Saravanan P et al., (15). However, contrary findings were reported from Karnataka with a 20% higher prevalence in males (18).

In the present study, a peak infection was observed in 7-12 months old children (61.53%). It is reported that rotavirus diarrhoea occurs at an early age in developing countries with 80% below one year. (19) In contrast, in developed countries prevalence is common in second year of life (20). The National Rotavirus Surveillance Network involving 28 hospital sites across the four geographical regions of India between 2012 and 2016 found highest rotavirus detection rates in children aged 6-23 months (41.8%), and 24.7% in children aged <6 months (21).

Clinical severity score revealed severe disease in rotavirus diarrhoea (p=0.011) and similar findings were observed by Pol SS et al., (22) However, a hospital-based cross-sectional study by Muendo C et al., found similar distribution of severe diarrhoea among all children (rotavirus-positive and negative) (23).

In the present study, 28.7% children were vaccinated and their rotavirus positivity rate was significantly lower (6.9%) as compared to unimmunised (21.49%) (p=0.034). These findings are consistent with study by Jain P et al., which showed that vaccine recipients were less likely to have rotavirus diarrhoea (24). However, Bhatnagar S and Srivastava G, found positivity rate was comparable in rotavirus vaccinated and unvaccinated children (25). In this study similar disease severity scores were recorded in rotavirus-positive and negative children in the vaccinated group. In the unvaccinated group, significantly higher severity score was found in the rotavirus-positive children. This was consistent with the findings by Jain P et al., (24).

Earlier reports from other countries have described rise in the circulation of strains other than the vaccine strains after the introduction of mono (G1P(8)) or pentavalent (G1, G2, G3, G4 and P(1)) vaccines (26). In this study, all the positive samples were G3 strains.

A study conducted in Indian children below five years between 2012 and 2016 by Giri S et al., revealed G1P (8) (49.9%) and G2P (4) (9.8%) were the two most common genotypes. The common genotypes detected in the southern sites were G1P (8) (56.3%), G2P (4) (9.1%), G9P (4) (7.6%), G9P (8) (4.2%), and G12P (6) (3.7%) (27). The National rotavirus Surveillance Network study from September 2012 to August 2016 found genotypes G1P (8) (52.9%), G9P4 (8.7%) and G2P4 (8.4%) (21).

The G3 rotavirus is one of the most common rotavirus strain reported worldwide (28). A variant of G3 referred to as “new variant G3” was reported from Japan during 2003-2004 (29). Ummair M et al., showed that G3P (8) (18.3%) was the most common genotype (30). Similarly in a study by Shaheen M et al., in Egypt from May 2015 to April 2016, G3 was the most circulating rotavirus strain among the 56 characterised G types (31) In this study, positive samples showed no amplification during P typing. In a study by Cunliffe NA et al., (32) 26% of G genotype and 32% of P genotype could not be typed. It has been observed that genotypic prevalence varies from place to place and rotavirus shows rapid strain variations. Hence it is important to know the genotype information pertaining to particular region.

Limitation(s)

The limitations of the study are that it was done in a single centre with limited sample size. Also, as the study was done only a year after introduction of the rotavirus vaccine the vaccine coverage in the study population was low. Though there was a difference in infection rates among vaccinated children, the inclusion of more numbers of vaccinated children in the study population would have facilitated better understanding of the trend of rotavirus infection in the postvaccination period.

Conclusion

Rotavirus is the leading cause of severe, life-threatening gastroenteritis in children even after implementation of vaccination. Rotavirus shows an unusual genomic diversity worldwide. During the rotavirus outbreaks, multiple strains which show combination of several G and P types are seen. This study highlights that rotavirus diarrhoea caused by G3 strain accounts for a significant proportion of diarrhoeal diseases in children less than five years. The main clinical presentation of rotavirus infected patients was diarrhoea associated with vomiting and fever. Rotavirus infected children had severe disease and longer duration of Hospitalisation when compared to rotavirus uninfected children. Immunisation is an important preventive strategy as evidenced by fewer rotavirus infections and less severe disease in immunised children.

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DOI and Others

DOI: 10.7860/JCDR/2022/57311.17188

Date of Submission: Apr 24, 2022
Date of Peer Review: Jun 24, 2022
Date of Acceptance: Sep 12, 2022
Date of Publishing: Dec 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 25, 2022
• Manual Googling: Jul 25, 2022
• iThenticate Software: Sep 10, 2022 (17%)

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