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.

Changes in epidemiology of rotavirus in the Triângulo Mineiro region of Brazil: lack of two consecutive rotavirus seasons

Rotaviruses are the main cause of infantile acute diarrhea, and a monovalent (G1P[8]) vaccine against the virus was introduced into the Brazilian National Immunization Program for all infants in March 2006. The objectives of this study were to determine the rate and genotype distribution of rotavirus causing infantile diarrhea in the Triângulo Mineiro region of Brazil during 2011-2012 and to assess the impact of local vaccination. Fecal specimens were analyzed for detection and characterization of rotavirus using polyacrylamide gel electrophoresis, reverse transcription followed by polymerase chain reaction (PCR), and PCR-genotyping assays. Overall, rotavirus was diagnosed in 1.7% (6/348) of cases. Rotavirus positivity rates decreased 88% [95% confidence intervals (CI)=15.2, 98.3%; P=0.026] in 2011 and 78% (95%CI=30.6, 93.0%; P=0.007) in 2012 when compared with available data for baseline years (2005/2006) in Uberaba. In Uberlândia, reductions of 95.3% (95%CI=66.0, 99.4%; P=0.002) in 2011, and 94.2% (95%CI=56.4, 99.2%; P=0.004) in 2012 were also observed compared with data for 2008. The circulation of rotavirus G2P[4] strains decreased during the period under study, and strains related to the P[8] genotype reemerged in the region. This study showed a marked and sustained reduction of rotavirus-related cases, with a lack of rotavirus in the 2011 and 2012 seasons, suggesting a positive impact of the vaccination program.

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.

Identification of human Norovirus (HNoV) in domestic pig stool samples / Identificación de Norovirus Humano (HNoV) en muestras de estiércol de cerdos domésticos / Identificação de Norovírus Humano (HNoV) em amostras de suínos domésticos

Identificación de Norovirus Humano (HNoV) en muestras de estiércol de cerdos domésticos. Objetivo: determinar la presencia de NoVs como posible agente zoonótico causal de diarrea aguda entre cerdos y humanos. Materiales y métodos: se recolectaron un total de 77 muestras diarreicas provenientes de niños menores de cinco años y de cerdos menores de dos meses de la población La Chamba en el Tolima, Colombia. Estas muestras fueron transportadas al Laboratorio de Virología de la Pontificia Universidad Javeriana en Bogotá, donde inicialmente se les realizó extracción con Trizol-reagent, siguiendo las instrucciones del fabricante. Una vez obtenido el RNA, el siguiente paso fue hacer la RT-PCR para obtener el producto de amplificacion esperado para NoVs de 213 pb. Finalmente, las muestras positivas obtenidas en la RT-PCR fueron secuenciadas y analizadas mediante métodos bioinformáticos. Resultados: se obtuvieron seis muestras positivas de diarrea de niños y una muestra positiva de diarrea de cerdos, las cuales se evidenciaron en una banda de 231 pb. Cinco de las seis muestras positivas en niños y la muestra positiva en cerdos fueron secuenciadas y analizadas. Conclusiones: dada la estrecha relación genética que se evidencia entre las secuencias del cerdo y el humano, este podría ser un indicio de que exista la posibilidad de un animal en común como reservorio para cepas de humano u otras cepas de animales...

Objective. To determine the presence of NoVs as a possible causal zoonotic agent of acute diarrhea in pigs and humans. Materials and methods. We collected a total of 77 samples from diarrheal children under 5 years and pigs under 2 months from La Chamba town in Tolima, Colombia. These samples were transported to the Laboratory of Virology of the Pontificia Universidad Javeriana in Bogotá, and extraction with Trizol-reagent was done following the manufacturer’s instructions. After obtaining the RNA, the next step was to perform RT-PCR for obtaining the expected amplification product of 213- bp NoVs. Finally, the positive samples obtained in the RT-PCR were sequenced and analyzed by bioinformatics methods. Results. Six positive diarrheic samples from children and a positive diarrheic sample from pigs were detected by a band of 231 bp. Five of the six positive samples in children and the positive pig sample were sequenced and analyzed. Conclusion. Given the close genetic relationship between pig and human sequences, this could be an indication of the potential existence of a common animal acting as a reservoir for human or other animal strains...

Identificação de Norovírus Humano (HNoV) em amostras de suínos domésticos. Objetivo. Determinar a presença de NoVs como possível agente zoonótico causal de diarréia aguda entre porcos e seres humanos. Materiais e métodos. Foram coletadas um total de 77 amostras de crianças diarréicas menores de cinco anos e porcos com menos de dois meses da população “La Chamba” Tolima-Colômbia. Estas amostras foram transportadas ao laboratório de virologia da Pontifícia Universidade Javeriana - Bogotá, onde foram inicialmente submetidas à extração com Trizol reagment e seguindo as instruções do fabricante, após a obtenção do RNA o próximo passo foi realizar a RT-PCR para obter o produto de amplificação esperado para NoVs de 213 bp. Finalmente as amostras positivas obtidas no RT-PCR foram seqüenciadas e analisadas por métodos de bioinformática. Resultados. Foram obtidas seis amostras positivas de diarréia nas crianças e uma amostra positiva de diarréia em suínos, as que foram representadas em uma banda de 231 pb. Cinco das seis amostras positivas em crianças e a amostra positiva em suínos foram seqüenciadas e analisadas. Conclusões. Dada a estreita relação genética que se manifesta entre as seqüências de suínos e humanos, isso poderia ser uma indicação de que existe a possibilidade de um animal comum como reservatório para o humano ou outras cepas de animais...

Prevalence of rotavirus in feces of children with acute diarrhea: clinical signs and associated symptoms / Prevalência de rotavírus em fezes de crianças com diarreia aguda: sinais e sintomas clínicos associados

Introduction: Rotavirus is a very common etiologic agent in acute diarrheas in children worldwide, affecting mainly children under five years of age. The overall annual mortality associated with rotavirus infection was estimated at 454000-705000 deaths annually, predominantly in the developing countries. The aim of this study was to describe the prevalence and serotypes of rotavirus in a region of Brazil, as well as to present a clinical evaluation of this diarrheal disorder in children. Methods: Cross-sectional study which selected 124 samples from the same number of children under five years of age with acute gastroenteritis, attended to in a Basic Health Unit. Results: Thirty-one samples were positive for rotavirus A, with higher occurrence from September to March (p <0.05). With respect to genotype G, 16 (80%) samples were rated as G1. P genotype showed that all strains were P[8]. Dehydration was found 2.45 times more often among children infected with rotavirus. Conclusion: It is hoped that determining the prevalence of infection and disease caused by rotavirus and the characterization of the profile of circulating viral strains may contribute to information on the molecular biology and epidemiology of infection by that agent

Introdução: O rotavírus é agente etiológico muito comum em diarreias agudas em crianças, em todo o mundo, afetando principalmente crianças menores de cinco anos de idade. A mortalidade anual global associada a infecções por rotavírus foi estimada em 454.000 a 705.000 mortes por ano, predominantemente nos países em desenvolvimento. Os objetivos deste estudo foi descrever os sorotipos circulantes e a prevalência de rotavírus em uma região do Brasil, bem como, apresentar a caracterização clínica da doença diarréica em crianças. Métodos: Estudo transversal que selecionou 124 amostras de um mesmo número de crianças de até cinco anos de idade, com gastrenterite aguda, atendidas em uma Unidade Básica de Saúde. Resultados: Trinta e uma amostras foram positivas para rotavírus A com maior ocorrência de setembro a março (p < 0,05). Com relação ao genótipo G, 16 (80%) amostras foram classificadas como G1. O genótipo P mostrou que todas as cepas eram P[8]. A desidratação foi encontrada 2,45 vezes mais entre crianças infectadas com rotavírus. Conclusão: Espera-se que a determinação da prevalência da infecção e doença provocada pelo rotavírus e a caracterização do perfil de cepas virais circulantes possa contribuir para informação sobre a biologia molecular e a epidemiologia da infecção pelo referido agente

Estudio epidemiológico y clínico de las diarreas por rotavirus en niños menores de 5 años atendidos en centros asistenciales del estado Miranda-Venezuela / Epidemiological and clinical study of diarrhea by rotavirus in children 5 years of age attended in medical centers of the Miranda State Venezuela

Con el objeto de conocer la epidemiología y clínica de la infección por rotavirus (RV) tratada de forma ambulatoria, se realizó un estudio en 5 centros (un hospital tipo I y 4 ambulatorios) del estado Miranda, entre febrero 2006 y enero 2007. Se evaluaron 194 niños menores de 5 años con diarrea aguda y se analizaron las siguientes variables: género, edad, estrato socioeconómico, alimentación, estado nutricional, clínica, diagnóstico de RV por Ensayo Inmuno Enzimático (ELISA) y su tipificación G por RT-PCR. La población presentó las siguientes características: 53 por ciento de varones, 17,6 ± 14,05 meses de edad (media), 68 por ciento de clase obrera y marginal (Graffar 4 y 5), 59 por ciento de lactancia materna en el primer año de vida, 13 por ciento de desnutrición, 40 por ciento de deshidratación y 19 por ciento de infección por RV. Los episodios RV positivos se asociaron significativamente a vómitos (94 por ciento, P < 0,0001) y a desnutrición (30 por ciento, P = 0,0010) al compararlos con los RV negativos. En los casos deshidratados fue mayor significativamente la desnutrición (21 por ciento, P = 0,00232) y la presencia de RV (28 por ciento, P = 0,0407). Encontramos entre la población del hospital y los ambulatorios diferencias respecto al graffar 4 y 5 (90 por ciento vs 53 por ciento, P < 0,0001), desnutrición (23 por ciento vs 6 por ciento, P = 0,006), deshidratación (63 por ciento vs 24 por ciento, P<0,0001) y RV (27 por ciento vs 13 por ciento, P = 0,027). Se tipificaron 14 cepas RV positivos resultando el 29 por ciento de tipo G1, 21 por ciento de G3 y 14 por ciento de G4. Este estudio sugiere que los RV, en la región estudiada, son causa de diarreas severas asociadas a desnutrición, pobreza y afectan significativamente a la población mayor de un año.

Prevalence of rotavirus causing acute diarrhea in children below two years in Babylon governorate in Iraq

Acute diarrhea is considered as the major cause of morbidity and mortality disease to infants in the world. This research is done to reveal the prevalence of rotavirus that cause diarrhea in children below two years with their spreading according to age, sex, feeding pattern, residence and mother education. 315 children less than two years of age, who were suffering from acute diarrhea, were studied between November 2003 and April 2004 in Babylon governorate including 225 hospitalized patients and 90 outpatients. Rotavirus antigen was detected in their stool by latex agglutination technique.Rotavirus antigen was positive in 22.5% of cases. The frequency of rotavirus infection was significantly higher among patients under one year of age [99%]. Breast-feeding proved to have a protective action against rotavirus infection

G and P rotavirus genotypes in stool samples from children in Teresina, State of Piauí

A total of 123 stool specimens collected in Teresina, Piauí between 1994 and 1996, from 0 to 2-year-old children with diarrhea, were used for this study. Molecular characterization of the G and P rotavirus genotypes was performed using the reverse transcriptase polymerase chain reaction. The following results were obtained for the P genotypes: P[8] (17. 1 percent), P[1] (4. 9 percent), P[4] (3. 3 percent), P[6, M37] (2. 4 percent) and mixtures (27. 6 percent). The P[1]+P[8] mixture was found in 19. 5 percent of the samples. For the G genotypes, the results were: G1 (25. 2 percent), G5 (13. 8 percent), G2 (2. 5 percent), G4 (2. 5 percent), G9 (0. 8 percent) and mixtures (41. 5 percent). G1+G5 was the mixture most frequently found (12. 1 percent). Our results showed unusual combinations such as P[1]G5 and P[1]+P[8]G5. The high percentage of mixtures and unusual combinations containing mixtures of human and animal rotavirus genotypes strongly suggests the possibility of gene reassortment and interspecies transmission.

Um total de 123 amostras fecais de crianças de 0 a 2 anos com diarréia, coletadas em Teresina, Piauí, entre 1994 e 1996 foi utilizada neste estudo. Para a caracterização molecular dos genótipos G e P de rotavírus, foram realizadas as reações de transcriptase reversa e reação em cadeia pela polimerase. Os seguintes resultados foram obtidos para o genótipo P: P[8] (17,1 por cento), P[1] (4,9 por cento), P[4] (3,3 por cento), P[6, M37] (2,4 por cento) e misturas (27,6 por cento). A mistura P[1]+P[8] foi encontrada em 19,5 por cento das amostras. Para o genótipo G os resultados foram: G1 (25,2 por cento), G5 (13,8 por cento), G2 (2,5 por cento), G4 (2,5 por cento), G9 (0,8 por cento) e misturas (41,5 por cento). A mistura G1+G5 foi a mais freqüentemente encontrada (12,1 por cento). Nossos resultados mostram combinações não usuais como P[1]G5 e P[1]+P[8]G5. A alta porcentagem de misturas e as combinações não usuais contendo misturas de genótipos de rotavirus humanos e animais sugerem fortemente a possibilidade de rearranjo genético e transmissão interspecies.

First detection of a human astrovirus type 8 in a child with diarrhea in Belém, Brazil: comparison with other strains worldwide and identification of possible three lineages

This study describes the genetic relationships of the first human astrovirus type-8 (HAstV-8) detected in Belém-Brazil, during a public hospital-based study. This strain was compared with other HAstV-8 strains identified elsewhere which have sequences available at GeneBank. The regions ORF1a (primers Mon348/Mon340) and ORF2 (primers Mon269/Mon270) were analyzed by nucleotide sequencing and a high similarity rate was observed among the Belém strain and other HAstV-8 strains. In ORF1a, homology values of 93-100 por cento were detected, and in ORF2 96-99 por cento. Considering the sequence variation (7 por cento) observed in ORF2 region, it was suggested that HAstV-8 strains could be divided in three different lineages.

La carga de la enfermedad por rotavirus en niños menores de cinco años, Colombia, 2004 / Burden of rotavirus-related disease among children under five, Colombia, 2004

OBJETIVOS: Establecer un sistema de vigilancia intrahospitalaria de la diarrea en niños menores de 5 años, estimar la carga de la enfermedad por rotavirus e identificar los genotipos más frecuentes de rotavirus. MÉTODOS: Se incluyó en este estudio a niños hospitalizados por complicaciones graves de la diarrea en tres centros asistenciales de Santa Fe de Bogotá, Barranquilla y Cali, Colombia. Se utilizó un método de enzimoinmunoanálisis en fase sólida (ELISA) para la detección de rotavirus y un método de reacción en cadena de la polimerasa con transcripción inversa (RT-PCR) para la genotipificación. Se determinaron las frecuencias, la tendencia central y la dispersión de las variables. Se realizó un análisis estratificado y un análisis con dos variables, mediante una prueba de la ji2 o una prueba exacta de Fisher, o una prueba de la ji2 para evaluar la tendencia, según los datos. Se establecieron los riesgos relativos. Para el análisis de la tendencia, se utilizaron la regresión lineal, los coeficientes de correlación y los valores de P. RESULTADOS: Entre diciembre de 2003 y noviembre de 2004 se hospitalizó a 893 niños en los tres centros participantes en el estudio, de los cuales el 68 por ciento tenía entre 6 y 23 meses de edad. Un 2,7 por ciento de los pacientes ingresados presentaba un cuadro de choque hipovolémico y un 1,2 por ciento falleció. Solo un 57 por ciento de las madres había administrado a sus hijos una solución de rehidratación oral antes de la hospitalización. La infección por rotavirus motivó un 50 por ciento de las hospitalizaciones (coeficiente de correlación [r] > 0,8) y se relacionó con intolerancia a la vía oral (riesgo relativo [RR] = 1,45; intervalo de confianza del 95 por ciento [IC95 por ciento]: 1,24 - 1,69; P < 0,0000) y vómito incoercible (RR = 1,47; IC95 por ciento: 1,16 - 1,86; P < 0,01). La infección por rotavirus ocasionó una muerte por cada 2 000 niños; 16 hospitalizaciones por cada 1 000 niños y 631 consultas por cada 1 000 niños. Se identificó estacionalidad en los genotipos G1P[8], G2P[4] y G3P[8] de rotavirus, que no varió a pesar de la distancia geográfica y las diferencias de temperatura, humedad y precipitación entre las tres ciudades.CONCLUSIONES: La infección por rotavirus es una causa importante de morbilidad y mortalidad por diarrea, especialmente en los primeros años de vida, cuando los niños están más expuestos a las complicaciones graves. Es necesario que las estrategias de prevención tengan un alto impacto antes de los 6 meses de edad. La vacunación contra el rotavirus puede ser una buena estrategia complementaria de intervención. No se encontró en la literatura internacional ninguna descripción anterior de la estacionalidad de los genotipos de rotavirus. Es importante hacer estudios de costo-efectividad para favorecer la inversión de recursos según las necesidades de la población y continuar la vigilancia para ampliar el conocimiento del comportamiento de este virus.

OBJECTIVES: To establish an in-hospital surveillance system for diarrhea in children under five, to estimate the burden of rotavirus-related disease, and to identify the most common rotavirus genotypes. METHODS: Included in the study were children who were hospitalized for serious complications of diarrhea in three medical care facilities in Bogotá, Barranquilla, and Cali, Colombia. A solid-phase enzyme-linked immunosorbent assay (ELISA) was used to detect rotavirus, and reverse-transcriptase polymerase chain reaction (RT-PCR) was the genotyping method employed. The frequencies, central tendency, and dispersion of the variables were determined. Stratified analysis and bivariate analysis were performed by applying a chi squared test or Fisher's exact test, or a chi squared test for trends, depending on the type of data analyzed. Relative risks were established. For analyzing trends we performed linear regression and calculated correlation coefficients and P values. RESULTS: Between December 2003 and November 2004, 893 children were hospitalized in the three participating centers included in the study. Of these children, 68 percent were between 6 and 23 months of age; 2.7 percent of hospitalized patients showed clinical signs of hypovolemic shock, and 1.2 percent died. Only 57 percent of the mothers had given their children an oral rehydration solution before hospitalization. Rotavirus infection was the cause of 50 percent of hospitalizations (correlation coefficient [r] > 0.8) and was linked to an inability to hold down orally-ingested fluids (relative risk [RR] = 1.45; 95 percent confidence interval [95 percent CI]: 1.24 to 1.69; P < 0.0000) and to intractable vomiting (RR = 1.47; 95 percent CI: 1.16 to 1.86; P < 0.01). Rotavirus infection led to one death per 2 000 children; 16 hospitalizations per 1 000 children, and 631 medical visits per 1 000 children. A seasonal trend was noted for G1P[8], G2P[4], and G3P[8] rotavirus genotypes, and this did not vary as a result of geographic distance or differences in temperature, humidity, and rainfall among cities.CONCLUSIONS: Rotavirus infection is an important cause of morbidity and mortality from diarrhea, particularly during the first years of life, when children are more susceptible to serious complications. It is important for prevention strategies to have a high impact before 6 months of age, and vaccination against rotavirus can be a good complementary intervention strategy. No description was found in the international scientific literature of the seasonal variations in rotavirus genotypes. It is important to carry out cost-effectiveness studies in order to promote the investment of resources in accordance with population needs, and to continue surveillance activities so as to better understand how the virus behaves.

Agentes causantes de diarrea en niños menores de 5 años en Tunja, Colombia / Diarrhoea-causing agents in children aged less than five in Tunja, Colombia

Objetivos: Determinar la prevalencia y tipo de agentes infecciosos causantes de EDA en una muestra de niños menores de 5 años que consultaron a IPS de Tunja durante el año 2004. Materiales y Métodos Estudio de corte transversal, la información se recogió mediante aplicación de una encuesta a 129 niños menores de 5 años afectados de EDA. Adicionalmente se recogió una muestra de heces, en las consultas externas del Hospital San Rafael y Clínica Saludcoop de Tunja. Resultados Se encontró Rotavirus en 48,1 por ciento, Shigella 0,8 por ciento, E. coli 13,9 por ciento; Campylobacter 2,3 por ciento; Giardia lamblia 12,4 por ciento; E. histolytica 7 por ciento; en 15,5 por ciento de casos no se identificó agente causal. La asociación es creciente con la edad para Rotavirus (p<0,01), E.Coli (p<0,05) y Campylobacter (p<0,001). Conclusión Rotavirus es el mayor agente causal de EDA en menores de 1 año, y en general, en menores de 5 años. Las prevalencias encontradas coinciden con lo reportado en estudios realizados en Facatativá, Bogotá, Santander, Manizales y Chocó; también con estudios adelantados en Venezuela, Perú y México.

Objectives: Determining the prevalence and type of infectious ADD-causing agents in a sample of children aged less than five who consulted the IPS in Tunja during 2004. Material and Methods A cross-sectional study was designed. Data was obtained by surveying 129 children younger than 5 suffering from ADD. Samples of faeces were obtained following outpatient consultation at San Rafael Hospital and SaludCoopÆs clinic in Tunja. Results Rotavirus was found in 48,1 percent of cases, Shigella in 0,8 percent, E. coli in 13,9 percent, Campylobacter in 2,3 percent, Giardia lamblia in 12,4 percent and E. hitolytica in 7 percent. The causative agent could not be identified in 15,5 percent of cases. The statistical association grew with age for Rotavirus (p<0.01), E. coli (p<0.05) and campylobacter (p<0.001). Conclusion Rotavirus is the major causative agent of ADD in children younger than one year and, generally, in children aged less than five. The prevalence found was similar to data reported in studies carried out in Facatatativá, Bogotá, Santander, Manizales and the Chocó in Colombia and studies carried out in Venezuela, Peru and Mexico.

Comportamiento clínico y costos de la gastroenteritis por rotavirus en lactantes: adquisición comunitaria versus nosocomial / Clinical features and costs of rotavirus gastroenteritis in infants: community versus nosocomialy acquired infection

Este estudio observacional prospectivo describe elementos clínicos y costos directos de lactantes hospitalizados (julio 2003 a junio 2004), con diarrea confirmada por rotavirus de adquisición comunitaria (G-1, n = 78) y otros de adquisición nosocomial (G-2, n = 52). Se les aplicó una escala de gravedad de gastroenteritis, según Rennels 1996, de 0 a 17 puntos y asignó costos directos según arancel FONASA. Un 26,9 % de pacientes del G-1 tuvo puntaje > a 14 v/s 9,6 % del G-2 (p < 0,015). Así también los lactantes del G-1 presentaron menor nivel de bicarbonato plasmático (p < 0,001) y mayor frecuencia de shock o requerimiento de expansión de volumen (p < 0,023). El costo promedio total fue de $143.805 (US 277) para un caso de rotavirosis adquirida en la comunidad y $139.423 (US 268) para la de origen nosocomial. Hubo un gasto de $ 7.250.010 (US 13.900) en esta infección nosocomial, lo que amerita la implementación de un programa activo de prevención y control.

Prevalence and genetic diversity of astroviruses in children with and without diarrhea in São Luís, Maranhão, Brazil

Human astroviruses (HAstV) have been increasingly identified as important etiological agents of acute gastroenteritis in children up to five years old. The aim of this study was to determine the prevalence and genotype diversity of HAstV in children with symptomatic and asymptomatic infections in São Luís, Maranhão, Brazil. From June 1997 to July 1999 a total of 183 fecal samples 84 from symptomatic and 99 from asymptomatic children were tested by enzyme immunoassay for HAstV. Prevalence rates were found to be 11 and 3 percent for symptomatic and asymptomatic children, respectively. Reverse transcription-polymerase chain reaction (RT-PCR) was carried out in 46 specimens (26 symptomatic and 20 asymptomatic) including the 12 samples that were positive by enzyme immunoassay (EIA). The overall positivity yielded by both methods was 8 percent (15/184); of these, 11 percent (9/84) for symptomatic and 5 percent (5/99) for those without symptoms or signs. Sequence analysis of amplicons revealed that HAstV-1 genotype was the most prevalent, accounting for 60 percent of isolates. Genotypes 2, 3, 4, and 5 were also detected, as one single isolate (10 percent) for each type. Variations in the sequences were observed when Brazilian isolates were compared to prototype strains identified in the United Kingdom. No seasonal pattern of occurrence was observed during these two years of study, and peak detection rate was observed in children aged between 3 and 6 months in the symptomatic group, and between 18 and 24 months in the controls.

Rotavirus serotypes and electropherotypes identified among hospitalised children in São Luís, Maranhão, Brazil

De junho de 1997 a junho de 1999, pesquisou-se a infecção por rotavírus entre crianças até 2 anos de idade internadas com quadro diarréico agudo em São Luís, nordeste do Brasil. Coletaram-se 128 espécimes fecais oriundos de pacientes diarréicos. Paralelamente, obtiveram-se 122 amostras de um contingente caracterizado como controle, comparável ao anterior no tocante às idades e distribuição temporal. As freqüências de positividade para rotavírus alcançaram 32,0 por cento (41/128) e 9,8 por cento (12/122), respectivamente (p < 0,001). Procedeu-se à determinação dos sorotipos e eletroferotipos dos rotavírus em 42 (79,2 por cento) das 53 amostras reativas para rotavírus. Identificaram-se eletroferotipos longo e curto em freqüências similares - 38,1 por cento e 40,5 por cento, respectivamente. De um modo geral, caracterizou-se o sorotipo G em 35 (83,3 por cento) das amostras positivas, a maioria, revelando especificidade para o tipo G1. Considerando o conjunto dos eletroferotipos e sorotipos, rotavírus classificados como G1 exibiram padrões eletroforéticos longo e curto nas freqüências de 30,9 por cento e 19 por cento, respectivamente. Todos os rotavírus do tipo G2 apresentaram eletroferotipo de configuração curta. No tocante ao perfil temporal, observou-se que as gastroenterites por rotavírus naquela região ocorrem ao longo de todo o ano, denotando-se tendência quanto à mais expressiva concentração no segundo semestre de vida das crianças, se comparado ao primeiro; em síntese, 45,2 por cento e 26,1 por cento (p = 0,13), respectivamente. As infecções por rotavírus configuraram picos quanto à distribuição durante o segundo semestre de vida, com freqüências de 30,1 por cento e 13,5 por cento, respectivamente. Aqueles do tipo G2 circularam durante todo o período de estudo, enquanto o sorotipo G1 (n = 27) emergiu a partir de junho de 1998. Aliás, detectaram-se 20 (74,1 por cento) das amostras virais com essa última especificidade ao longo de 1998. Os dados acima sustentam a importância dos rotavírus na etiologia das gastroenterites graves no nordeste brasileiro e consubstanciam o conceito de que uma futura vacina contra esses enteropatógenos necessariamente deve conferir proteção frente aos múltiplos sorotipos circulantes.

Epidemiological aspects of rotavirus infections in Minas Gerais, Brazil

In order to develop good polices regarding public health measures and vaccine use to prevent rotavirus induced gastrointeritis, the epidemiology of the illness in various regions of Brazil is necessary. Accordingly, this study was to detected the frequency and types of rotavirus in one city in a tropical part of Brazil. This is an epidemiological survey of pediatric gastroenteritis caused by rotavirus conducted in Juiz de Fora, Minas Gerais State, Brazil. We analyzed 656 in-patient (190) and out-patient (466) stool samples from children ages 0 to 5 years during 1998. Rotavirus detection was performed using polyacrylamide gel electrophoresis (PAGE). Rotavirus was isolated from 62/190 stool samples (32.6 percent) from hospitalized childreen and 16/466 (3.4 percent) from out-patients. The overall rotavirus frequency in this population was 11.9 percent. The highest rotavirus detection was found in hospitalized children ages 6 to 24 months. Rotaviruses were detected from march to september, with a peak incidence in june (33.3 percent), the coldest and driest month in the region. Electrophoretic analysis identified 10 different profiles, all long and compatible with group. A rotavirus, termed La through Lj. The LB and LD profiles circulated throughout most of the study period. However, in june, when the highest detection rate occurred, the vast majority (92.5 percent) of the positive samples displayed the LB profile, thus suggesting an outbreak caused by this rotavirus profile. Rotavirus induced gastroenteritis in common in one tropical region of Brazil, it is an important cause of diarrhea in hospitalized children ages 6 to 24 months, it is most common during dry, cold months of the year, and it may occur in electrophoretype restricted epidemics. Such analyses throughout Brazil will assist in developing sound guidelines regarding its prevention.

Rotavirus infection among hospitalized children with acute watery diarrhea in Basrah - Iraq

To estimate the frequency and describe the clinical profile of rotavirus infection in children under five years admitted with acute watery diarrhea. A prospective study done on 268 patients. All were investigated for the detection of rotavirus antigen in their stool by ELISA test. The report focuses on 116 [43.3%] patients in whom rotavirus was detected. The percentage of rotavirus infection among children with acute watery diarrhea was 43.3%. The percentage was higher in the first year of life and males were more affected than females. Malnourished children were at higher risk of having prolonged diarrhea and prolonged shedding of the virus from the intestine. Rotavirus infection should be suspected in any patient with acute watery diarrhea, as there is no specific clinical pattern. Malnourished children are at a higher risk of developing prolonged diarrhea after rotavirus infection that may aggravate their nutritional status

Electroferotipos e incidencia de rotavirus en la ciudad de Paysandú, Uruguay / Electropherotypes and rotavirus incidence in Paysandu city, Uruguay

Se estudiaron 100 muestras de materia fecal, pertenecientes a niños entre 0-3 años de edad, con diagnóstico de gastroenteritis y que concurrieron a este laboratorio en el período febrero 1996-enero 1997. Las muestras fueron exclusivamente analizadas mediante la detección del electroferotipo típico del ARN viral de rotavirus por electroforesis en geles de poliacrilamida y posterior tinción argéntica. Se observaron 14 muestras positivas, todas correspondientes a rotavirus grupo A

Red de laboratorios de Rotavirus: resultados del primer año de vigilancia / Rotavirus laboratory network: results after one year experience

Rotavirus es el principal agente productor de diarrea infantil y se ha estimado que provoca en Argentina 21.000 hospitalizaciones, 85.000 atenciones ambulatorias, y un costo mayor a los 27 millones de dolares anuales. Ante la inminente aprobación de una vacuna contra este patógeno se organizó un Sistema de Vigilancia Epidemiológica en base a una Red de laboratorios. Se presentan los resultados obtenidos luego del primer año de funcionamiento de esta Red. Se encontró que el 9 por ciento de la internación pediátrica es debido a diarrea aguda, y rotavirus se halló en el 42,1 por ciento de los casos estudiados. Se estimó que rotavirus provoca el 3,8 por ciento de las internaciones pediátricas. La internación por diarrea y la internación asociada a diarrea por rotavirus fue mayor en el primer año de vida (62 por ciento y 71,3 por ciento respectivamente). En el semestre de diciembre a mayo el número de internaciones por diarrea fue significativamente mayor que en el semestre restante. Se detectó un pico de diarreas por rotavirus entre abril y junio en las distintas Unidades centinelas. Estos resultados señalan a los rotavirus como el principal agente etiológico de la gastroenteritis infantil aguda en nuestro país y avalan la necesidad de incorporar su diagnóstico en todos los hospitales pediátricos. Los costos adicionales serán ampliamente superados por los beneficios relacionados con elmejor manejo de las camas hospitalarias, los recursos del laboratorio, y el paciente internado por diarrea, el uso correcto de antibióticos, y el control de la diseminación intrahospitalaria de rotavirus

Diarrea por rotavirus: impacto en un hospital de niños de Buenos Aires / Rotavirus diarrhea: impact in a pediatric hospital of Buenos Aires

Ante la disponibilidad de una vacuna contra rotavirus, se desarrolló el presente estudio destinado a conocer el impacto de este virus en un hospital pediátrico del país. Se estudiaron entre septiembre 1997 y agosto 1998, 648 niños < 3 años con diarrea acuosa aguda asistidos en el Consultorio Externo de Clínica - Sector Diarreas y hospitalizados en las Salas de Internación Clínica Nº 4,5 y 6 del Hospital Ricardo Gutiérrez de la Ciudad de Buenos Aires. Se encontró rotavirus asociado al 36 por ciento de las diarreas ambulatorias y al 45 por ciento de las hospitalizadas. En el año de estudio, estimamos que el Hospital asistió a 1674 diarreas por rotavirus en forma ambulatoria, 14 de las cuales requirieron hospitalización. El estudio describe un pico de diarreas por rotavirus entre marzo y junio, mientras que las diarreas no causadas por rotavirus presentaron un pico entre enero y marzo (muy probablemente de origen bacteriano). Rotavirus presentó una mayor frecuencia entre 6 a 23 meses de edad; de las 233 diarreas por rotavirus identificadas, sólo el 10 por ciento ocurrieron en mayores de 2 años y el 13 por ciento durante los primeros 6 meses de vida. Esta situación es de relevancia dado que la vacuna de rotavirus se aplica en 3 dosis orales a los 2, 4 y 6 meses de edad, y podría haber prevenido la mayoría de los casos observados.