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. 2014 Oct 8;9(10):e108221.
doi: 10.1371/journal.pone.0108221. eCollection 2014.

Sentinel hospital-based surveillance for assessment of burden of rotavirus gastroenteritis in children in Pakistan

Abdul Momin Kazi  1 , Gohar Javed Warraich  1 , Shahida Qureshi  1 , Huma Qureshi  2 , Muhammad Mubashir Ahmad Khan  2 , Anita Kaniz Mehdi Zaidi  1 ; members of the Pakistan Rotavirus Study Group
Affiliations

Sentinel hospital-based surveillance for assessment of burden of rotavirus gastroenteritis in children in Pakistan

Abdul Momin Kazi et al. PLoS One. .

Abstract

Objectives: To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine.

Methods: A cross-sectional study was carried out over a period of two years from 2006 - 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping.

Results: 6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593).

Conclusions: Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Geographic distribution of the five sentinel sites participating in rotavirus surveillance in Pakistan from 2006–2008.
Figure 2
Figure 2. Cumulative age distribution of children less than 5 years of age admitted with severe diarrhea at five sentinel hospitals in Pakistan, 2006–2008.
Bars represent number of children with rotavirus- positive diarrhea. Points represent cumulative rate (%) of rotavirus- positive gastroenteritis.
Figure 3
Figure 3. Distribution of rotavirus positive gastroenteritis by age in months at five sentinel hospitals in Pakistan from 2006–2008.
See this image and copyright information in PMC

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