Impacto poblacional a 10 años de la vacunación contra rotavirus en México / Population impact of rotavirus vaccination in Mexico after 10 years

Resumen: Objetivo: Evaluar el impacto de la vacunación contra rotavirus (RV) a 10 años de su universalización sobre la morbimortalidad por enfermedad diarreica aguda (EDA) en niños mexicanos menores de cinco años. Material y métodos: Se compararon las medianas anuales de casos nuevos, defunciones y hospitalizaciones por EDA del periodo pre y posuniversalización; se calcularon reducciones absolutas y relativas, considerando significativos valores de p<0.05. Resultados: La mortalidad, hospitalizaciones y casos nuevos por EDA en menores de cinco años disminuyeron 52.6, 46 y 15.5% respectivamente, en el periodo posuniversalización. Durante la temporada de RV las reducciones en la mortalidad, hospitalizaciones y casos nuevos fueron de 66.9, 64.7 y 28.7%, respectivamente. Conclusiones: A partir de la universalización de la vacuna de RV en México, se aprecian reducciones importantes y sostenidas en la mortalidad, hospitalizaciones e incidencia por EDA, con menor impacto en esta última. El mayor impacto se observa durante la temporada de RV.

Abstract: Objective: To evaluate the impact of rotavirus (RV) vaccination after 10 years of it´s universalization on morbidity and mortality from Acute Diarrheal Disease (ADD) in mexican children under five years of age. Materials and methods: Annual median numbers for ADD new cases, hospitalizations and deaths were compared between pre and post universalization periods; absolute and relative reductions were calculated, considering p<0.05 values as significant. Results: Mortality, hospitalizations and new cases from ADD in children under five decreased 52.6, 46, and 15.5% respectively, in the posuniversalization period. During rotavirus seasons, reduction in mortality, hospitalizations and new cases was 66.9, 64.7, and 28.7% respectively. Conclusions: As of the universal introduction of RV vaccination in Mexico, significant and sustained reductions are appreciated for mortality and hospitalizations from ADD, less so for incidence. A most prominent effect is observed during the winter season.

Genómica de rotavirus. Impacto en salud pública / Rotavirus genomics. Public health impact

Resumen: Con la introducción de las vacunas de rotavirus Rotarix (RV1) o RotaTeq (RV5) en programas nacionales de vacunación de diversos países, surgió la preocupación de que la presión inmune generada condujera al aumento en la prevalencia de genotipos virales no incluidos en las vacunas, o bien del surgimiento de nuevas cepas que pudieran escapar a la respuesta inmune protectora inducida por la vacunación. La variación natural de los rotavirus ha hecho que sea muy difícil distinguir si el cambio en las cepas circulantes se debe a la presión selectiva impuesta por las vacunas o bien a la fluctuación natural de las cepas. Si acaso ha habido una presión selectiva, ésta ha sido hasta ahora baja. Sin embargo, es importante mantener la vigilancia epidemiólogica y poner atención al surgimiento de cepas resistentes a la inmunidad, en particular en países en desarrollo en los que se ha descrito una mayor diversidad viral.

Abstract: With the introduction of rotavirus vaccines Rotarix (RV1) or RotaTeq (RV5) in the immunization programs of an increasing number of countries, there is concern that the immune selection pressure induced will cause an increase in the prevalence of virus genotypes not included in the vaccine formulation, or to the appearance of novel rotavirus strains that could evade the protective immune response. The natural fluctuation of rotaviruses makes it difficult to distinguish if the change in the circulating strains is due to the vaccine selective pressure or to the natural diversity fluctuation of viruses. If there has been a selective pressure, it has been low so far. However, it is important to keep an epidemiological surveillance and pay attention to the emergence of strains that are resistant to the vaccine, in particular in those countries where the viral diversity has been shown to be higher.

COVID-19 gastrointestinal manifestations: a systematic review

Abstract INTRODUCTION: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has greatly challenged public health worldwide. A growing number of studies have reported gastrointestinal (GI) symptoms. We performed a systematic review of GI symptoms associated with coronavirus disease 2019 (COVID-19) as well as of the serum levels of biomarkers related to liver function and lesion in SARS-CoV-2-infected individuals. METHODS: We surveyed relevant articles published in English, Spanish, and Portuguese up to July, 2020 in the PubMed, MEDLINE, SciELO, LILACS, and BVS databases. Moreover, we surveyed potentially important articles in journals such as the NEJM, JAMA, BMJ, Gut, and AJG. RESULTS: This systematic review included 43 studies, including 18,246 patients. Diarrhea was the most common GI symptom, affecting 11.5% of the patients, followed by nausea and vomiting (6.3%) and abdominal pain (2.3%). With regard to clinical severity, 17.5% of the patients were classified as severely ill, whereas 9.8% of them were considered to have a non-severe disease. Some studies showed increased aspartate transaminase and alanine aminotransferase levels in a portion of the 209 analyzed patients and two studies. CONCLUSIONS: Our results suggest that digestive symptoms are common in COVID-19 patients. In addition, alterations in cytolysis biomarkers could also be observed in a lesser proportion, calling attention to the possibility of hepatic involvement in SARS-CoV-2-infected individuals.

Norovírus no município de São Paulo, 2010-2016: estudo transversal sobre a principal causa de gastroenterite infantil / Norovirus en el Municipio de São Paulo, Brasil, 2010-2016: estudio transversal sobre la principal causa de gastroenteritis infantil / Norovirus in São Paulo city, Brazil, 2010-2016: a cross-sectional study of the leading cause of gastroenteritis in children

Objetivo: descrever casos de doença diarreica aguda por norovírus em crianças menores de 5 anos do município de São Paulo, Brasil. Métodos: estudo transversal com dados provenientes da Vigilância Epidemiológica das Gastroenterites Causadas por Rotavírus; foi definido como caso o paciente internado em unidade sentinela por doença diarreica aguda e identificação laboratorial do norovírus como agente etiológico, entre os anos de 2010 e 2016. Resultados: durante o período estudado, a proporção de casos de norovírus em menores de 5 anos de idade ultrapassou a proporção de casos de rotavírus, agente considerado predominante na infância; o norovírus foi associado a 28,4% do total de casos notificados, ocorrendo o ano todo, principalmente nos meses mais quentes. Conclusão: norovírus foi o principal agente etiológico identificado em crianças menores de 5 anos com doença diarreica aguda no município de São Paulo.

Objetivo: describir casos de enfermedad diarreica aguda por Norovirus en niños menores de 5 años provenientes del Municipio de São Paulo, Brasil. Métodos: Estudio transversal con datos de la Vigilancia Epidemiológica de las Gastroenteritis causadas por Rotavirus. Se definió como caso el paciente internado en unidad centinela por enfermedad diarreica aguda e identificación de laboratorio del Norovirus como agente etiológico entre los años de 2010 y 2016. Resultados: Durante el período estudiado, la proporción de casos de Norovirus en menores de 5 años superó la proporción de casos de Rotavirus, agente considerado predominante en la infancia. El Norovirus fue asociado al 28,4% del total de los casos notificados, ocurriendo todo el año, principalmente en los meses más cálidos. Conclusión: el Norovirus fue el principal agente etiológico identificado en niños menores de 5 años con enfermedad diarreica aguda en el Municipio de São Paulo.

Objective: to describe cases of acute diarrheal disease caused by norovirus in children under 5 years old in São Paulo city, Brazil. Methods: this was a cross-sectional study using data from Epidemiological Surveillance of Gastroenteritis due to Rotavirus; cases were defined as patients hospitalized in a sentinel unit because of acute diarrheal disease and laboratory identification of norovirus as the etiological agent between 2010 and 2016. Results: during the study period, the proportion of norovirus cases in children under 5 years old exceeded the proportion of Rotavirus, an agent considered predominant in childhood; norovirus was associated with 28.4% of total reported cases, occurring all year round, especially in warmer months. Conclusion: norovirus was the leading etiological agent identified in children under 5 years old with acute diarrheal disease in São Paulo city.

Costos de hospitalización por diarrea en niños durante el período de circulación de rotavirus en el Noroeste Argentino / Hospitalization costs associated with diarrhea among children during the period of rotavirus circulation in the Northwest region of Argentina

Objetivo. Evaluar los costos médicos directos, gastos de bolsillo y costos indirectos en casos de diarrea aguda hospitalizada en <5 años, en el Hospital de Niños Héctor Quintana de la provincia de Jujuy, durante el período de circulación de rotavirus en la región Noroeste de Argentina. Métodos. Estudio de corte trasversal de costos de enfermedad. Fueron incluidos todos los niños hospitalizados <5 años con diagnóstico de diarrea aguda y deshidratación durante el período de circulación de rotavirus, entre el 1/5/2013 y el 31/10/2013. La evaluación de costos médicos directos se realizó mediante la revisión de historias clínicas, y los gastos de bolsillo y costos indirectos, mediante una encuesta. Para el intervalo de confianza del 95% del costo promedio por paciente, se realizó un análisis probabilístico de 10 000 simulaciones por remuestreo (boostraping). Resultados. Fueron enrolados 105 casos. La edad promedio fue de 18 meses (desvío estándar 12); 62 (59%) fueron varones. El costo médico directo, gasto de bolsillo y pérdida de dinero por lucro cesante promedio por caso fue de AR$ 3413, 6 (2856, 35-3970, 93) (USD 577, 59), AR$ 134, 92 (85, 95-213, 57) (USD 22, 82) y de AR$ 301 (223, 28380, 02) (USD 50, 93), respectivamente. El total del costo por evento hospitalizado fue de AR$ 3849, 52 (3298-4402, 25) (USD 651, 35). Conclusiones. El valor de costo total por evento hospitalizado se encuentra dentro de lo esperado para Latinoamérica. La distribución de costos presenta una proporción importante de costos médicos directos en relación con los gastos de bolsillo (3, 5%) y costos indirectos (7, 8%).

Objective. To assess direct medical costs, out-of-pocket expenses, and indirect costs in cases of hospitalizations for acute diarrhea among children <5 years of age at Hospital de Niños "Héctor Quintana" in the province of Jujuy during the period of rotavirus circulation in the Northwest region of Argentina. Methods. Cross-sectional study on disease-related costs. All children <5 years of age, hospitalized with the diagnosis of acute diarrhea and dehydration during the period of rotavirus circulation between May 1st and October 31st of 2013, were included. The assessment of direct medical costs was done by reviewing medical records whereas out-of-pocket expenses and indirect costs were determined using a survey. For the 95% confidence interval of the average cost per patient, a probabilistic bootstrapping analysis of 10 000 simulations by resampling was done. Results. One hundred and five patients were enrolled. Their average age was 18 months (standard deviation: 12); 62 (59%) were boys. The average direct medical cost, out-of-pocket expense, and lost income per case was ARS 3413.6 (2856.35-3970.93) (USD 577.59), ARS 134.92 (85.95-213.57) (USD 22.82), and ARS 301 (223.28380.02) (USD 50.93), respectively. The total cost per hospitalization event was ARS 3849.52 (32984402.25) (USD 651.35). Conclusions. The total cost per hospitalization event was within what is expected for Latin America. Costs are broken down into direct medical costs (significant share), compared to out-of-pocket expenses (3.5%) and indirect costs (7.8%).

The impact of rotavirus vaccination on emergency department visits and hospital admissions for acute diarrhea in children under 5 years / Impacto da vacinação contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade

Summary Introduction: Acute diarrheal disease is the second cause of death in children under 5 years. In Brazil, from 2003 to 2009, acute diarrhea was responsible for nearly 100,000 hospital admissions per year and 4% of the deaths in children under 5 years. Rotavirus is the leading cause of severe acute diarrhea worldwide. In 2006, the rotavirus monovalent vaccine (RV1) was added to the Brazilian National Immunization Program. Objectives: To analyze the impact of the RV1 on emergency department (ED) visits and hospital admissions for acute diarrhea. Method: A retrospective ecologic study at the University Hospital, University of São Paulo. The study analyzed the pre-vaccine (2003–2005) and the post-vaccine (2007–2009) periods. We screened the main diagnosis of all ED attendances and hospital admissions of children under 5 years in an electronic registry system database and calculated the rates of ED visits and hospital admissions. The reduction rate was analyzed according to the following formula: reduction (%) = (1 - odds ratio) x 100. Results: The rates of ED visits for acute diarrhea was 85.8 and 80.9 per 1,000 total ED visits in the pre and post vaccination periods, respectively, resulting in 6% reduction (95CI 4 to 9%, p<0.001). The rates of hospital admissions for acute diarrhea was 40.8 per 1,000 in the pre-vaccine period and dropped to 24.9 per 1,000 hospitalizations, resulting in 40% reduction (95CI 22 to 54%, p<0.001). Conclusion: The introduction of the RV1 vaccine resulted in 6% reduction in the ED visits and 40% reduction in hospital admissions for acute diarrhea.

Resumo Introdução: a doença diarreica aguda é a segunda causa de morte em crianças abaixo de 5 anos de idade. No Brasil, entre 2003 e 2009, a diarreia aguda foi responsável por cerca de 100 mil internações por ano e por 4% das mortes em crianças abaixo de 5 anos de idade. O rotavírus é a principal etiologia de diarreia aguda grave. A vacina monovalente (RV1) contra o rotavírus foi introduzida em 2006. Objetivos: verificar o impacto da vacina monovalente contra rotavírus nas consultas de pronto-socorro e internações por doença diarreica aguda em crianças menores de 5 anos de idade. Método: foi realizado um estudo ecológico retrospectivo no Hospital Universitário da Universidade de São Paulo. O período foi dividido em pré-vacina (2003 a 2005) e pós-vacina (2007 a 2009). Foram incluídas todas as crianças abaixo de 5 anos que passaram em consulta no pronto-socorro. Foram obtidas as taxas de consultas no pronto-socorro e internações por doença diarreica aguda. A redução nas taxas foi obtida através da fórmula: redução (%) = (1 - odds ratio) x 100. Resultados: no período pré-vacina, a taxa de consultas por diarreia aguda foi de 85,8 consultas por 1.000 consultas gerais, enquanto no período pós-vacina a taxa de consultas por diarreia aguda foi 80,9 por 1.000, uma redução de 6% (IC95% 4-9, p<0,001). A taxa de internação por diarreia aguda era 40,8 internações por 1.000 e caiu para 24,9 por 1.000, redução de 40% (IC95% 22-54, p<0,001). Conclusão: após a introdução da vacina contra rotavírus houve uma redução de 6% nas consultas por diarreia aguda no pronto-socorro e de 40% nas internações por diarreia aguda.

Mecanismos de virulencia de Escherichia coli enteropatógena / Virulence mechanisms of enteropathogenic Escherichia coli

Acute diarrheal disease (ADD) is a global public health problem, especially in developing countries and is one of the causes of mortality in children under five. ADD etiologic agents include viruses, bacteria and parasites in that order. Escherichia coli bacteria it is classified as a major diarrheagenic agent and transmitted by consuming contaminated water or undercooked foods. This review compiled updates on information virulence factors and pathogenic mechanisms involved in adhesion and colonization of seven pathotypes of E. coli called enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC), shigatoxigenic E. coli (STEC), enteroaggregative E. coli (EAEC) and diffusely-adherent E. coli (DAEC). A final pathotype, adherent-invasive E. coli (AIEC) associated with Crohn's disease was also reviewed. The diarrheagenic pathotypes of E. coli affect different population groups and knowledge of the molecular mechanisms involved in the interaction with the human is important to guide research towards the development of vaccines and new tools for diagnosis and control.

La enfermedad diarreica aguda (EDA) es un problema de salud pública mundial, especialmente en los países en vía de desarrollo y es una de las causas de mortalidad en niños bajo cinco años de edad. Los agentes etiológicos de EDA incluyen virus, bacterias y parásitos, en ese orden. Dentro de las bacterias, Escherichia coli está clasificada como uno de los principales agentes diarreagénicos y se trasmite por el consumo de agua y alimentos contaminados o mal cocidos. Esta revisión recopiló información actualizada sobre los factores de virulencia y los mecanismos de patogenicidad implicados en la adhesión y colonización de siete patotipos de E. coli denominados, E. coli enteropatógena (ECEP), E. coli enterotoxigénica (ECET), E. coli enteroinvasora (ECEI), E. coli shigatoxigénica (ECST), E. coli enteroagregativa (ECEA) y E. coli de adherencia difusa (ECAD). Un último patotipo, E. coli adherente invasor (ECAI) asociado a la enfermedad de Crohn también fue revisado. Los patotipos diarreagénicos de E. coli afectan a diferentes grupos poblacionales y el conocimiento de los mecanismos moleculares implicados en la interacción con el humano es importante para orientar las investigaciones hacia el desarrollo de vacunas o nuevas herramientas para su diagnóstico y control.

A non-enteric adenovirus A12 gastroenteritis outbreak in Rio de Janeiro, Brazil

A gastroenteritis outbreak that occurred in 2013 in a low-income community in Rio de Janeiro was investigated for the presence of enteric viruses, including species A rotavirus (RVA), norovirus (NoV), astrovirus (HAstV), bocavirus (HBoV), aichivirus (AiV), and adenovirus (HAdV). Five of nine stool samples (83%) from patients were positive for HAdV, and no other enteric viruses were detected. Polymerase chain reaction products were sequenced and subjected to phylogenetic analysis, which revealed four strains and one strain of non-enteric HAdV-A12 and HAdV-F41, respectively. The HAdV-A12 nucleotide sequences shared 100% nucleotide similarity. Viral load was assessed using a TaqMan real-time PCR assay. Stool samples that were positive for HAdV-A12 had high viral loads (mean 1.9 X 107 DNA copies/g stool). All four patients with HAdV-A12 were < 25 months of age and had symptoms of fever and diarrhoea. Evaluation of enteric virus outbreaks allows the characterisation of novel or unique diarrhoea-associated viruses in regions where RVA vaccination is routinely performed.

Group A rotavirus gastroenteritis: post-vaccine era, genotypes and zoonotic transmission / Gastroenterite por rotavírus do grupo A: era pós-vacinal, genótipos e transmissão zoonótica

ABSTRACT This article provides a review of immunity, diagnosis, and clinical aspects of rotavirus disease. It also informs about the changes in epidemiology of diarrheal disease and genetic diversity of circulating group A rotavirus strains following the introduction of vaccines. Group A rotavirus is the major pathogen causing gastroenteritis in animals. Its segmented RNA genome can lead to the emergence of new or unusual strains in human populations via interspecies transmission and/or reassortment events.

RESUMO Este artigo fornece uma revisão sobre imunidade, diagnóstico e aspectos clínicos da doença causada por rotavírus. Também aponta as principais mudanças no perfil epidemiológico da doença diarreica e na diversidade genética das cepas circulantes de rotavírus do grupo A, após a introdução vacinal. O rotavírus do grupo A é o principal patógeno associado à gastroenterite em animais. Seu genoma RNA segmentado pode levar ao surgimento de cepas novas ou incomuns na população humana, por meio de transmissão entre espécies e eventos de rearranjo.

The effectiveness of a rotavirus vaccine in preventing hospitalizations and deaths presumably due to acute infectious diarrhea in Brazilian children: a quasi-experimental study

INTRODUCTION: Rotavirus is the main etiologic agent of acute infectious diarrhea in children worldwide. Considering that a rotavirus vaccine (G1P8, strain RIX4414) was added to the Brazilian vaccination schedule in 2006, we aimed to study its effectiveness and safety regarding intestinal intussusception. METHODS: A quasi-experimental trial was performed in which the primary outcome was the number of hospitalizations that were presumably due to acute infectious diarrhea per 100,000 children at risk (0-4 years old). The secondary outcomes included mortality due to acute infectious diarrhea and the intestinal intussusception rates in children in the same age range. We analyzed three scenarios: Health Division XIII of the State of São Paulo (DRS XIII) from 2002 to 2008, the State of São Paulo, and Brazil from 2002 to 2012. RESULTS: The averages of the hospitalization rates for 100,000 children in the pre- and post-vaccination periods were 1,413 and 959, respectively, for DRS XIII (RR=0.67), 312 and 249, respectively, for the State of São Paulo (RR=0.79), and 718 and 576, respectively, for Brazil (RR=0.8). The mortality rate per 100,000 children in the pre- and post-vaccination periods was 2.0 and 1.3, respectively, for DRS XIII (RR=0.66), 5.5 and 2.5, respectively, for the State of São Paulo (RR=0.47), and 15.0 and 8.0, respectively, for Brazil (RR=0.53). The average annual rates of intussusception for 100,000 children in DRS XIII were 28.0 and 22.0 (RR=0.77) in the pre- and post-vaccination periods, respectively. CONCLUSIONS: A monovalent rotavirus vaccine was demonstrated to be effective in preventing the hospitalizations and deaths of children that were presumably due to acute infectious diarrhea, without increasing the risk of intestinal intussusception. .

Intervention analysis of introduction of rotavirus vaccine on hospital admissions rates due to acute diarrhea / Análise de intervenção da introdução da vacina do rotavirus nas taxas de internação hospitalar por diarreia aguda / Análisis de intervención en la introducción de la vacuna contra el rotavirus en las tasas de hospitalización por diarrea aguda

The aim of this study is to investigate the impact of rotavirus vaccine on hospitalization rates for acute diarrhea in children younger than 5 years old after the introduction of the vaccine in 2006. A descriptive analytical observational study was carried out of the hospitalization rates occurred between 2000 and 2011 in 22 Regional Health Centers of Paraná State, Brazil. The effect of the vaccine was assessed by applying the SARIMA/Box-Jenkins time series methodology of intervention analysis, which allows verifying the slopes of the series are different after the introduction of the vaccine and estimating the magnitude of these effects for children younger than five years of age, by age group, for each region center. It was verified a statistically significant reduction by center/month on hospitalization rates for children 1 year old and younger, with averages of 47% and 58%, respectively, in December 2011.

O objetivo desse estudo é investigar o impacto da vacina do rotavírus nas taxas de internação por diarreia aguda em crianças menores de cinco anos após a introdução da vacina em 2006. Foi realizado um estudo analítico observacional descritivo das taxas de hospitalização ocorridas entre 2000 e 2011, em 22 Centros Regionais de Saúde do Estado do Paraná, Brasil. O efeito da vacina foi avaliado por séries temporais aplicando a metodologia SARIMA/Box-Jenkins com análise da intervenção, a qual permite verificar que os declives das séries são diferentes após a introdução da vacina, bem como estimar a magnitude desses efeitos para crianças menores de cinco anos de idade, por faixa etária, para cada região. Verificou-se redução estatisticamente significativa por centro/mês nas taxas de internação por diarreia aguda para as crianças menores de 1 ano de idade e de 1 ano de idade, com médias de 47% e 58%, respectivamente, em dezembro de 2011.

El objetivo de este estudio es investigar el impacto de la vacuna contra el rotavirus en las tasas de hospitalización, relacionadas con diarrea aguda en niños menores de 5 años, después de que se introdujese la vacuna en 2006. Se trata de un estudio observacional, analítico descriptivo de las tasas de hospitalización acaecidas entre 2000 y 2011 en 22 centros regionales de salud del estado de Paraná, Brasil. El efecto de la vacuna se evaluó mediante la aplicación de la serie de tiempo SARIMA/metodología de Box-Jenkins de análisis de intervención, lo que demuestra que los declives de las series son diferentes después de la introducción de la vacuna, con el fin de estimar la magnitud de estos efectos en los niños menores 5 años de edad, por grupos de edad para cada región. Se ha encontrado una reducción estadísticamente significativa de centro/mes en las tasas de hospitalización para niños menores de 1 año de edad y de 1 año de edad, con un promedio de 47% y 58%, respectivamente, en diciembre de 2011.

Detección de norovirus en niños con diarrea adquirida en la comunidad o nosocomial en el Hospital Guillermo Grant Benavente de Concepción, Chile / Norovirus detection in children with community-acquired or nosocomial diarrhea at Guillermo Grant Benavente Hospital in Concepción, Chile

Introduction: Norovirus (NoV) are RNA viruses highly contagious, stable in the environment, genetically variable, and the most common cause of viral sporadic acute gastroenteritis worldwide. This is the first study carried out in Concepcion, Chile, to investigate the presence of NoV as an etiologic agent of viral diarrheas in hospitalized children. Objective. To detect the presence and genogroup of NoV in children with diarrhea and to compare it with rotavirus (RV) and adenovirus (AdV). Material and Methods: A one year descriptive, prospective study in children 0-14 years old. A single diarrheic stool sample per patient was analyzed for the presence of NoV, RV and AdV. Clinical data were unknown at the moment of sampling. Real time RT-PCR with Taqman™ probes for NoV and the immunocromatography VIKIA™ kit for RoV /AV detection were used. Results: Infection for NoV (25.5%) was significantly higher than for RV (15.9%) and AdV (6.2%). It was even greater in infants younger than 2yr. old (n: 103): NoV 34%, RV 17.5%, AdV 7.8%. Children 2-4 yr. old had 11.8% infection of NoV and RV. Children older than 4, only had 12% RV and 4% AdV. Children hospitalized for diarrhea (n: 92) had: 21.7% of both NoV and RV, and 7.6% AdV; whereas children hospitalized for other causes (n: 53) had 32.1% NoV,5.7% RV and 3.8% AV. The proportion of infection due to NoV was significantly higher in males (31.5%) than in females (19.4%). The average frequency during the year was higher for NoV (30.3%) than for RV (14.7%) except in summer. Conclusion: The presence of NoV was higher than RV in children with diarrhea. NoV infection showed defined characteristics regarding age, gender, seasonal occurrence and nosocomial transmission that are important epidemiological features.

Introducción: Los norovirus (NoV) son virus ARN altamente contagiosos, resistentes, variables genéticamente y una de las etiologías más frecuente de gastroenteritis viral esporádica mundial. Este es el primer trabajo en Concepción, Chile, de búsqueda de NoV como etiología viral de diarreas en niños hospitalizados. Objetivo: Determinar la presencia y genogrupo de NoV en niños con diarrea y compararla con la frecuencia de rotavirus (RV) y adenovirus (AdV). Material y Método: Estudio descriptivo, prospectivo de un año, en niños de 0-14 años ingresados por diarrea aguda o que la adquirieron dentro del hospital. La muestra de deposiciones diarreica se tomó una sola vez por paciente. Las fichas clínicas se analizaron al finalizar el estudio etiológico. Para la detección de NoV se utilizó RPC-TR a en tiempo real con sondas Taqman® y para detección de RV/AdV, el kit VIKIA® de inmunocromatografia. Resultados: La infección por NoV (25,5%) fue significativamente más frecuente que por RV (15,9%) y AdV (6,2%). La mayor presencia de infección fue en pacientes bajo2 años de edad (n: 103): NoV 34,0%, RV 17,5%, AdV 7,8%. La detección en niños hospitalizados por diarrea fue: NoV y RV 21,7% cada uno; AdV 7,6%. En niños con diarrea nosocomial hospitalizados por otras causas se detectó NoV en 32,1%, RV en 5,7% y AdV en 3,8%. La presencia de NoV fue significativamente mayor en varones (31,5%) que en niñas (19,4%). El promedio de diarreas durante el año fue mayor para NoV (30,3%) que para RV(14,7%), excepto en verano. Discusión y Conclusión: La presencia de NoV fue mayor que la de RoV en niños con diarrea y con una tendencia nosocomial que podría deberse a las características del virus que favorece infecciones de ambiente confinado, como hospitales, asilos y cruceros. La infección por NoV presentó características definidas, en edad, género, ocurrencia estacional y relevancia nosocomial, que aportan datos epidemiológicos importantes.

Inhibition of rotavirus ECwt infection in ICR suckling mice by N-acetylcysteine, peroxisome proliferator-activated receptor gamma agonists and cyclooxygenase-2 inhibitors

Live attenuated vaccines have recently been introduced for preventing rotavirus disease in children. However, alternative strategies for prevention and treatment of rotavirus infection are needed mainly in developing countries where low vaccine coverage occurs. In the present work, N-acetylcysteine (NAC), ascorbic acid (AA), some nonsteroidal anti-inflammatory drugs (NSAIDs) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists were tested for their ability to interfere with rotavirus ECwt infectivity as detected by the percentage of viral antigen-positive cells of small intestinal villi isolated from ECwt-infected ICR mice. Administration of 6 mg NAC/kg every 8 h for three days following the first diarrhoeal episode reduced viral infectivity by about 90%. Administration of AA, ibuprofen, diclofenac, pioglitazone or rosiglitazone decreased viral infectivity by about 55%, 90%, 35%, 32% and 25%, respectively. ECwt infection of mice increased expression of cyclooxygenase-2, ERp57, Hsc70, NF-κB, Hsp70, protein disulphide isomerase (PDI) and PPARγ in intestinal villus cells. NAC treatment of ECwt-infected mice reduced Hsc70 and PDI expression to levels similar to those observed in villi from uninfected control mice. The present results suggest that the drugs tested in the present work could be assayed in preventing or treating rotaviral diarrhoea in children and young animals.

Diversidad genotípica de rotavirus grupo A: correlación entre el tipo G3 y severidad de la infección. Valencia, Venezuela / Genetic diversity of rotavirus group A: correlation between G3 type and severity of the infection. Valencia, Venezuela

La variabilidad genética y antigénica de los rotavirus (RV) parece tener implicaciones en la severidad de la infección, pero los estudios no son concluyentes. Por este motivo, en el presente trabajo se compararon las medias de severidad entre los episodios de diarrea causados por RV tipo G1 y G3, durante el período 2001-2005, en la Ciudad Hospitalaria “Dr. Enrique Tejera” de Valencia, Venezuela. RV se detectó por ELISA, los tipos G y P por RT-PCR. La severidad de la infección se estimó utilizando el sistema de Ruuska-Vesikari, las medias de severidad se compararon mediante la prueba t de Student (2 colas, 95%IC). RV se detectó en 24,5% (3.193/13.026) de los pacientes. G3 fue más frecuente (50,3%), seguido por G1 (39,2%), G9 (6,2%), G2 (0,6%), G4 (0,6%) y 3,1% mixtos (G1+G3). El 87,3% de las muestras resultaron P[8], 10,9% P[4] y 1,8% P[6]. Al comparar los episodios G1 y G3, no se observaron diferencias significativas (P>0,05) entre los grupos etarios, frecuencia de desnutridos, deshidratación y lactancia materna. Sin embargo, el grupo G3 se caracterizó por presencia significativa (P< 0,05) de fiebre, episodios con una duración ≥ 6 días, 6 o más evacuaciones en 24 horas y 3 o más días con vómitos. La media de severidad para los episodios G3 (11,1) fue mayor significativamente (P<0,05) a la G1 (7,8). Estos resultados muestran la asociación de G3 con diarreas severas y apoyan la importancia de conocer la variabilidad y frecuencia de los tipos virales para medir el impacto de las vacunas antirotavirus.

Genetic and antigenic rotavirus (RV) variabilities may have implications in the severity of the infection caused by these agents; however the studies are not conclusive. For that purpose, the mean severity scores of diarrhea episodes caused by RV types G1 and G3 were compared, at Ciudad Hospitalaria “Dr. Enrique Tejera” in Valencia, Venezuela, between 2001- 2005. RV were identified by ELISA, G and P types by RT-PCR. The severity of infection was determined using the Ruuska-Vesikari system and the mean severity values were compared using the Student’s t-test (two-tailed, 95%CI). RV were detected in 24.5% of patients (3193/13026), being G3 the most common (50.3%), followed by G1 (39.2%), G9 (6.2%), G2 (0.6%), G4 (0.6%) and of mixed infection 3.1% (G1+G3). Type P[8] was present in 87.3% of samples, 10.9% P[4] and 1.8% P[6]. There were not statistically significant differences (P≥0.05) observed between the episodes caused by G1 and G3 when age, breast feeding, and degrees of malnutrition and dehydration were considered. Nevertheless, in the G3 positive group, fever, episodes of more than 6 days, 6 or more evacuations in 24 hours and 3 or more days with vomit, were observed. The mean severity score for the G3 episodes (11.1) was significantly higher (P< 0.05) than for G1 (7.8). These results show that G3 was associated with severe diarrhea, supporting the hypothesis that the knowledge of the variability and frequency of viral types is essential to measure the impact of an anti-rotavirus vaccine.

Agentes patógenos responsables de trastornos gastrointestinales en sujetos infectados con VIH / Enteropathogens responsible of gastrointestinal disorders in HIV patients

Los trastornos gastrointestinales o TGI son afecciones debilitantes muy comunes en individuos infectados con el virus de inmunodeficiencia humana (VIH), que pueden conducir a muerte. Numerosos agentes etiológicos y mecanismos patofisiológicos han sido propuestos causar esta afección. A pesar del uso de terapia antirretroviral, que ha reducido enormemente la prevalencia de TGI en estos pacientes, patógenos entéricos como virus, bacterias, parásitos y hongos logran actuar todavía como agentes oportunistas. Citomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus y algunos más recientemente descritos, como bocavirus y Aichi virus han sido detectados en pacientes con VIH. Sin embargo, a excepción del citomegalovirus, hay muy poca certeza acerca del papel que juegan algunos de ellos en estas afecciones. Varias especies de Criptosporidium, microsporidos, Salmonella, micobacterias atípicas y Campylobacter jejuni han sido reconocidos también como una importante causa de TGI en estos pacientes. La progresiva incorporación de técnicas inmunoenzimáticas y moleculares, cada vez más sensibles para la detección de antígenos, anticuerpos y agentes patógenos en heces ha mejorado el diagnóstico de las diarreas y contribuido a esclarecer la importancia etiológica de algunos microorganismos en los pacientes inmunocompetentes. En Venezuela existen algunos datos acerca de la prevalencia de patógenos entéricos en pacientes inmunodeficientes infectados con VIH. La identificación del agente etiológico responsable de TGI podría ser de gran utilidad para el manejo y tratamiento de estos pacientes, para quienes la enteritis viral es una manifestación morbosa que reduce la calidad de vida y ocasiona un elevado gasto en salud pública.

Gastrointestinal disorders or GID are debilitating conditions common in individuals infected by the human immunodeficiency virus (HIV), capable of leading to death. Numerous etiological agents and pathophysiological mechanisms have been involved in this status. Although the use of highly active antiretroviral therapy (HAART) in many countries has greatly reduced the prevalence of gastrointestinal infections, enteric pathogens such as bacteria, parasites, fungi and viruses may still act as opportunist agents in these patients. Cytomegalovirus, adenovirus, calicivirus, astrovirus, rotavirus, enterovirus, picobirnavirus and some more recently described, like bocavirus and Aichi virus, have been detected in HIV patients. However, except for cytomegalovirus, which is an established etiological agent of GID in these patients, the role of the other viruses remains unclear. Several species of Cryptosporidium, microsporidia, Salmonella, atipical mycobacteria and Campylobacter jejuni, have also been recognized as important causes of GID in HIV patients. The progressive incorporation of increasingly sensitive immunological and molecular assays for antigen, antibody and pathogens detection from faeces, has improved the diagnosis of diarrhea and contributed to clarify the etiological significance of some microorganisms in immunocompetent patients. In Venezuela, some information is available about the prevalence of enteric pathogens in immunocompromised patients infected with HIV. The identification of the etiologic agent responsible for this condition may be useful for the management and treatment of these patients, for whom viral enteritis is a disease, which reduces their quality of life and causes a high public health spending.

Evaluation of a rapid immunochromatographic assay for the detection of rotavirus, norovirus and adenovirus from children hospitalized with acute watery diarrhoea

We evaluated the IP-Triple I immunochromatographic rapid test for the detection of rotavirus, norovirus and adenovirus using stool samples from children with diarrhoea. The detection of norovirus and adenovirus was poor compared to polymerase chain reaction assays. However, high sensitivity (92%) and specificity (99%) were obtained for the detection of rotavirus.

Frequency of Rotavirus infection among children with diarrhea in Omdurman pediatric hospital, Sudan

Rotaviruses are the major cause of gastroenteritis and diarrhea in infants and young children worldwide. Basic epidemiological data concerning rotaviruses among infants and children are necessary for health planners and care providers in Sudan. Cross-sectional study was conducted at Omdurman Pediatric Hospital, Sudan to investigate the frequency of rotavirus infection and associated possible risk factors among children. The solid-phase sandwich enzyme-linked immunosorbent assay [ELISA] was used to detect rotavirus antigens. Structured questionnaire was used to gather socio-demographic data. Out of 92 diarrheal cases, 23 were rotavirus-antigen positive [25%]. Most of the positive subjects [91.3%] were in children less than 3 years of age and the infection rate decreased with the increasing age [p>.05]. Children infected with rotaviruses were more likely to have vomiting [82.6%] [p > 0.05] and fairly low frequency of fever [60.9%] [p > 0.05]. Out of the 23 rotavirus positive subjects, 13 [30.2%] were breast-fed, 6 [25%] were both breast and bottle-fed and 4 [16.6%] were neither breast nor bottle-fed [p > 0.05]. Furthermore, the antibiotic treated children revealed the highest percentage of rotavirus antigen [26.9%] compared to the non-treated children [14.3%]. Rotavirus frequency was 25% among children less than 5 years. Rotavirus vaccine, routine and proper diagnosis of rotavirus infection in children with acute diarrhea help to determine appropriate treatment, prevents the unnecessary use of antibiotics and minimizes the spread of the disease among susceptible children in Sudan

Rotavirus genotyping in gastroenteritis cases of an infantile population from Western Brazilian Amazonia / Genotipagem de rotavírus em casos de gastrenterites de uma população infantil do oeste da Amazônia brasileira

INTRODUCTION: During the period from 2000 to 2002, 79 rotavirus-positive stool samples were collected from children presenting diarrhea in the Western Brazilian Amazon. METHODS: Molecular characterization of the G and P genotypes was performed using RT-PCR and electropherotyping analysis by polyacrylamide gel electrophoresis. RESULTS: A total of 59 samples were confirmed as group A rotavirus. A long electrophoretic profile was exhibited by the G1P[8], G3P[8], and G4P[8] genotypes. The G1P[8] genotype was found in greater proportion. The short electropherotype was exhibited only by G2 genotype strains. CONCLUSIONS: The proportion of the rotavirus genotypes observed was not different from that in other areas of Brazil. This study is the first genotyping of rotavirus in the Western Brazilian Amazon.

INTRODUÇÃO: Entre 2000 e 2002, 79 amostras positivas para rotavírus foram coletadas de crianças com diarreia na Amazônia ocidental brasileira. MÉTODOS: Para a caracterização molecular dos genótipos G e P foram realizadas as reações de RT-PCR e a análise dos eletroferotipos por eletroforese em gel de poliacrilamida (PAGE). RESULTADOS: 59 amostras foram confirmadas como pertencentes ao rotavírus grupo A. Os genótipos G1P[8], G3P[8] e G4P[8] apresentaram perfis eletroforéticos longos. O genótipo G1P[8] foi encontrado em maior proporção. O eletroferotipo curto ocorreu apenas em genótipos G2. CONCLUSÕES: A proporção dos genótipos de rotavírus observada não foi diferente de outras áreas do Brasil. Este estudo é a primeira genotipagem de rotavírus na Amazônia ocidental brasileira.

Viral acute gastroenteritis: clinical and epidemiological features of co-infected patients

BACKGROUND: Acute gastroenteritis (AGE) is a common disorder that affects children worldwide. It is usually caused by viral agents, including rotavirus, enteric adenovirus, norovirus, and astrovirus groups. Currently, there are few reports about co-infection among these viruses, mainly in Brazil. METHODS: This is a retrospective study in which 84 rotavirus-positive samples from hospitalized patients at a teaching hospital in Southern Brazil, collected in the 2001-2010 period, were analyzed by polymerase chain reaction (PCR) and reverse transcription - polymerase chain reaction (RT-PCR), for the investigation of enteric adenovirus, astrovirus, and norovirus. RESULTS: In total, 12 of the 84 (14%) samples were positive to enteric adenovirus or norovirus. Clinical, laboratory, and demographic data showed statistically significant differences between mono and co-infected patients, including age and depletion rate. CONCLUSIONS: These findings highlight the need for implementation of other enteric virus detection assays in clinical diagnosis for a complete laboratory investigation of hospitalized pediatric patients with AGE, in order to understand the impact of these pathogens on disease severity, spread within hospital, and consequently, prevent the dissemination of nosocomial infections.