ABSTRACT
Objective: To characterize rotavirus infections detected in rotavirus vaccinated children hospitalized for acute gastroenteritis. Design: Observational, hospital-based study. Setting: Three hospitals in Pune, Western India. Participants: Children aged <5 years hospitalized for acute gastroenteritis during 2013-14. Methods: Rotavirus capture ELISA was performed on all stool samples that were collected from patients following informed consent from parents. VP7 and VP4 genes of rotavirus strains were genotyped by multiplex RT-PCR. Stool samples from vaccinated children were tested for other enteric viruses. Results: Among the 529 children, 53 were vaccinated with at least one dose of the rotavirus vaccine. There was no difference in the mean (SD) (months) age of vaccinated [14.8 (10.6)] and unvaccinated [14.4 (10.5)] children. Rotavirus positivity was significantly higher (47%) in unvaccinated than in vaccinated (28.3%) children (P=0.01). Mean Vesikari score and severe cases were significantly more in rotavirus positive than in negative children within unvaccinated group (P<0.001), while these did not differ within the vaccinated group. Rotavirus strain G1P[8] was identified as the most prevalent strain in both, vaccinated (60%) and unvaccinated (72.8%) groups. No association was found between mean Vesikari score and viral coinfections. Conclusions: This study suggests decline in rotavirus positivity in rotavirus-vaccinated children hospitalized for acute gastroenteritis and high prevalence of G1P[8] and non-rotaviral co-infections in Pune, Western India.
ABSTRACT
Background & objectives: Diarrhoeal disease is the fifth leading cause of all mortality globally. To this burden, rotavirus contributes over half a million deaths annually. This pilot study was conducted to determine the economic burden of diarrhoeal episodes on families from different geographical regions accessing medical facilities in India. Methods: Participants were enrolled from four study sites with eight reporting hospitals, categorized as non-profit and low cost, private and government facilities between November 2008 and February 2009. Questionnaires detailing healthcare utilization, medical and non-medical expenditure and lost income were completed by families of children < 5 yr of age hospitalized for gastroenteritis. All available faecal samples were tested for rotavirus. Results: A total of 211 patients were enrolled. The mean total cost of a hospitalized diarrhoeal episode was 3633 (US$ 66.05) for all facilities, with a marked difference in direct costs between governmental and non-governmental facilities. Costs for rotavirus positive hospitalizations were slightly lower, at 2956 (US$ 53.75). The median cost of a diarrhoeal episode based on annual household expenditure was 6.4 per cent for all-cause diarrhoea and 7.6 per cent for rotavirus diarrhoea. Of the 124 samples collected, 66 (53%) were positive for rotavirus. Interpretation & conclusions: Data on direct costs alone from multiple facilities show that diarrhoeal disease constitutes a large economic burden on Indian families. Affordable, effective vaccines would greatly reduce the economic burden of severe gastroenteritis on patients, families and the government.