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Rotavirus infection in paediatric community-acquired acute gastroenteritis: a retrospective cross-sectional study in a private hospital in Malaysia

Adele, Tan Guat Kean

Malaysian Journal of Paediatrics and Child Health, 2007;15(1):7-15.
MyJurnal

Objectives: 1) To establish the incidence of rotavirus infection in paediatric patients admitted to a private hospital in Malaysia with a diagnosis of community-acquired acute gastroenteritis. 2) To determine whether patients with rotaviral acute gastroenteritis have greater disease severity. Design Retrospective cross-sectional study. Setting An urban private hospital in Malaysia. Participants All paediatric patients with a discharge diagnosis of acute gastroenteritis (AGE) admitted to the hospital between September 2005 and March 2006. A total of 261 patients were included in the study. Results Rotavirus infection contributed to 54% of paediatric hospital admissions with discharge diagnoses of acute gastroenteritis. 74% of children with rotavirus infection were aged 5 years and below. This study demonstrated that patients with rotaviral gastroenteritis had greater disease severity, as measured by two indicators. Firstly, the average length of hospital stay was longer in patients who were rotavirus positive (5.14 days) compared to those who were rotavirus negative (4.81 days). These results were statistically significant (p

Matched MeSH terms: Rotavirus Infections; Rotavirus
Genotypes of rotavirus diarrhoea in a children hospital of Bangladesh

Ahmed S, Hussain M, Akhter S, Islam T, Ahmed SU, Kabir ML

Mymensingh Med J, 2012 Jul;21(3):497-502.
PMID: 22828550

Globally, rotaviruses are the single most important etiologic agents of severe childhood dehydrating diarrhea that accounts for more than 125 million of cases, 25-55% of all hospital admissions for diarrhea and ≈600,000 deaths every year. In Bangladesh, while overall diarrhea related deaths are declining, the proportion of diarrhea deaths due to rotavirus is increasing. This study was aimed at estimating the burden of rotavirus diarrhea and isolating the genotypes of rotavirus in a children hospital of Bangladesh; thereby endorsing a logical search for an appropriate rotavirus vaccine. This cross sectional study was carried out in the Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh during 2006-2007. Children aged between one month and five years suffering form diarrhea were enrolled in the study. Stool samples were analyzed by ELISA for rotavirus antigen. The rotavirus-positive samples were further analyzed for genotype determination. Among 656 stool samples, 39.5% samples were positive for rotavirus antigen. The mean age of the children studied was 12±9.9 months; the peak being in the second half of infancy. G2 was identified as the most dominant genotype (45.5%) followed by G1 (24.8%), G12 (9.6%), G9 (8.5%) and G4 (2.1%) genotypes. Since G2 were found to be the predominant circulating rotavirus strain in this study and some other studies in Bangladesh, the recommended vaccine for prevention of rotavirus infection in Bangladesh should cover this strain to have maximum effectiveness.

Matched MeSH terms: Rotavirus/classification*; Rotavirus/genetics
Fulltext Anticipating rotavirus vaccines--a pre-vaccine assessment of incidence and economic burden of rotavirus hospitalizations among children < 5 year of age in Libya, 2012-13

Alkoshi S, Leshem E, Parashar UD, Dahlui M

BMC Public Health, 2015;15:26.
PMID: 25616973 DOI: 10.1186/s12889-015-1400-7

Libya introduced rotavirus vaccine in October 2013. We examined pre-vaccine incidence of rotavirus hospitalizations and associated economic burden among children < 5 years in Libya to provide baseline data for future vaccine impact evaluations.

Matched MeSH terms: Rotavirus Infections/economics*; Rotavirus Infections/epidemiology*; Rotavirus Vaccines*
Rota Viral Infection: A Significant Disease Burden to Libya

Alkoshi S, Ernst K, Maimaiti N, Dahlui M

Iran J Public Health, 2014 Oct;43(10):1356-63.
PMID: 26060697

Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children.

Matched MeSH terms: Rotavirus Infections; Rotavirus
Fulltext Emergence of equine-like G3 strains as the dominant rotavirus among children under five with diarrhea in Sabah, Malaysia during 2018-2019

Amit LN, Mori D, John JL, Chin AZ, Mosiun AK, Jeffree MS, et al.

PLoS One, 2021;16(7):e0254784.
PMID: 34320003 DOI: 10.1371/journal.pone.0254784

Rotavirus infection is a dilemma for developing countries, including Malaysia. Although commercial rotavirus vaccines are available, these are not included in Malaysia's national immunization program. A scarcity of data about rotavirus genotype distribution could be partially to blame for this policy decision, because there are no data for rotavirus genotype distribution in Malaysia over the past 20 years. From January 2018 to March 2019, we conducted a study to elucidate the rotavirus burden and genotype distribution in the Kota Kinabalu and Kunak districts of the state of Sabah. Stool specimens were collected from children under 5 years of age, and rotavirus antigen in these samples was detected using commercially available kit. Electropherotypes were determined by polyacrylamide gel electrophoresis of genomic RNA. G and P genotypes were determined by RT-PCR using type specific primers. The nucleotide sequence of the amplicons was determined by Sanger sequencing and phylogenetic analysis was performed by neighbor-joining method. Rotavirus was identified in 43 (15.1%) children with watery diarrhea. The male:female ratio (1.9:1) of the rotavirus-infected children clearly showed that it affected predominantly boys, and children 12-23 months of age. The genotypes identified were G3P[8] (74% n = 31), followed by G1P[8] (14% n = 6), G12P[6](7% n = 3), G8P[8](3% n = 1), and GxP[8] (3% n = 1). The predominant rotavirus circulating among the children was the equine-like G3P[8] (59.5% n = 25) with a short electropherotype. Eleven electropherotypes were identified among 34 strains, indicating substantial diversity among the circulating strains. The circulating genotypes were also phylogenetically diverse and related to strains from several different countries. The antigenic epitopes present on VP7 and VP4 of Sabahan G3 and equine-like G3 differed considerably from that of the RotaTeq vaccine strain. Our results also indicate that considerable genetic exchange is occurring in Sabahan strains. Sabah is home to a number of different ethnic groups, some of which culturally are in close contact with animals, which might contribute to the evolution of diverse rotavirus strains. Sabah is also a popular tourist destination, and a large number of tourists from different countries possibly contributes to the diversity of circulating rotavirus genotypes. Considering all these factors which are contributing rotavirus genotype diversity, continuous surveillance of rotavirus strains is of utmost importance to monitor the pre- and post-vaccination efficacy of rotavirus vaccines in Sabah.

Matched MeSH terms: Rotavirus Infections/epidemiology; Rotavirus Infections/pathology*; Rotavirus/classification; Rotavirus/genetics*; Rotavirus/isolation & purification
Increase in rotavirus prevalence with the emergence of genotype G9P[8] in replacement of genotype G12P[6] in Sabah, Malaysia

Amit LN, John JL, Mori D, Chin AZ, Mosiun AK, Ahmed K

Arch Virol, 2023 Jun 03;168(6):173.
PMID: 37269384 DOI: 10.1007/s00705-023-05803-9

Rotaviruses are major causative agents of acute diarrhea in children under 5 years of age in Malaysia. However, a rotavirus vaccine has not been included in the national vaccination program. To date, only two studies have been carried out in the state of Sabah, Malaysia, although children in this state are at risk of diarrheal diseases. Previous studies showed that 16%-17% of cases of diarrhea were caused by rotaviruses and that equine-like G3 rotavirus strains are predominant. Because the prevalence of rotaviruses and their genotype distribution vary over time, this study was conducted at four government healthcare facilities from September 2019 through February 2020. Our study revealed that the proportion of rotavirus diarrhea increased significantly to 37.2% (51/137) after the emergence of the G9P[8] genotype in replacement of the G12P[8] genotype. Although equine-like G3P[8] strains remain the predominant rotaviruses circulating among children, the Sabahan G9P[8] strain belonged to lineage VI and was phylogenetically related to strains from other countries. A comparison of the Sabahan G9 strains with the G9 vaccine strains used in the RotaSiil and Rotavac vaccines revealed several mismatches in neutralizing epitopes, indicating that these vaccines might not be effective in Sabahan children. However, a vaccine trial may be necessary to understand the precise effects of vaccination.

Matched MeSH terms: Rotavirus Infections*; Rotavirus Vaccines*
Group A rotavirus infection in animals from an animal house and in wild-caught monkeys

Awang A, Yap K

J Diarrhoeal Dis Res, 1990 Sep;8(3):82-6.
PMID: 2122998

Randomly selected samples from different animal colonies from two laboratory animal houses and from the wild-caught monkeys were tested for the presence of anti-rotavirus antibodies to estimate the rates of infection with group A rotavirus. Antibodies to the common group A rotaviral antigen were detected by a competitive enzyme-linked immunosorbent assay (ELISA) using reagents of WHO ELISA rotavirus detection kit. The results of the study showed that white mice, albino rats, and guinea pigs from long-established breeding colonies and resident house rats and house shrews from the animal house had no serological evidence of rotaviral infection. In contrast, one mousedeer from a colony of 19 animals and most of the rabbits from two separate breeding colonies at the same animal house were serologically positive for the infection. Also a significant number of the same species of monkey kept in captivity were found to acquire the infection. Leaf monkeys had no serological evidence of rotaviral infection. The infection rate in wild cynomolgus monkeys did not seem to be influenced by the different ecological environments of their respective habitats. The rate of infection in adults and juveniles was similar.

Matched MeSH terms: Rotavirus Infections/epidemiology; Rotavirus Infections/veterinary*
Paediatric gastroenteritis in the eastern Malaysian state of Sarawak: an epidemiological and clinical study

Barker RA, Maxwell PH, Hong CP, Cordery MC, Chrystie IL

Trans R Soc Trop Med Hyg, 1988;82(6):898-901.
PMID: 2855768

Over a period of 2 months, 35 of 69 (51%) cases of juvenile diarrhoea studied in eastern Malaysia were associated with rotavirus excretion; rotavirus associated diarrhoea occurred most commonly in the 6-24 month age group. Polyacrylamide gel electrophoresis (PAGE) of genome ribonucleic acid showed that only 4 rotavirus electropherotypes could be detected. Of those, 2 predominated and 2 were detected only once each; one of these may have been a reassortment of the two predominant electropherotypes. Analysis of the clinical features of patients excreting rotavirus subgroup 1 or 2, determined by PAGE, demonstrated that rotavirus subgroup 1 was associated with more hypotonic dehydration and need for intravenous therapy: lethargy was significantly more common among those excreting rotavirus subgroup 2.

Matched MeSH terms: Rotavirus Infections/complications; Rotavirus/isolation & purification
Re-emergence of genotype G9 during a five-and-a-half-year period in Turkish children with rotavirus diarrhea

Bozdayi G, Altay A, Yahiro T, Ahmed S, Meral M, Dogan B, et al.

Arch Virol, 2016 Oct;161(10):2879-84.
PMID: 27444180 DOI: 10.1007/s00705-016-2986-5

This study was done to understand the dynamics of rotavirus genotype distribution in Turkish children. Samples were collected from January 2006 through August 2011 from children at a hospital in Ankara. Rotavirus was detected in 28 % (241/889) of the samples. Genotype G9P[8] was predominant (28 %), followed by G1P[8] (16.3 %) and G2P[8] (15.9 %). G9 was absent in the samples from 2006 and 2007 and then re-emerged in 2008 and increased gradually. Phylogenetic analysis showed that Turkish G9 rotaviruses of the present study formed a sublineage with strains from Italy and Ethiopia, possibly indicating spread of a clone in these countries.

Matched MeSH terms: Rotavirus Infections/epidemiology*; Rotavirus Infections/virology; Rotavirus/classification*; Rotavirus/genetics*; Rotavirus/isolation & purification
Fulltext Rare rotavirus strains in children with severe diarrhea, Malaysia

Ch'ng LS, Lee WS, Kirkwood CD

Emerg Infect Dis, 2011 May;17(5):948-50.
PMID: 21529427 DOI: 10.3201/eid1705.101652
Matched MeSH terms: Rotavirus Infections/virology*; Rotavirus/classification; Rotavirus/genetics; Rotavirus/physiology*
Out-of-pocket costs associated with rotavirus gastroenteritis requiring hospitalization in Malaysia

Chai PF, Lee WS

Vaccine, 2009 Nov 20;27 Suppl 5:F112-5.
PMID: 19931708 DOI: 10.1016/j.vaccine.2009.08.069

From August 2006 to July 2007 a prospective study of out-of-pocket costs incurred by care-givers of children hospitalized for rotavirus gastroenteritis was conducted in a hospital in Malaysia. Data on caretaker out-of-pocket costs were collected from 260 children hospitalized with diarrhoea. A stool sample was collected from 198 of these children of which 46 (23%) were positive for rotavirus by latex agglutination assay. The mean (median; interquartile range) out-of-pocket cost incurred by the care-givers was US$194 (US$169; US$47-738), constituting 26% of average monthly income of the households surveyed. Major components of the cost were hospital expenses (45%) and productivity loss (37%). These findings will allow further assessment of the cost-effectiveness of any future rotavirus immunization program in Malaysia.

Matched MeSH terms: Rotavirus Infections/economics*
Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea

Dupont C, Foo JL, Garnier P, Moore N, Mathiex-Fortunet H, Salazar-Lindo E, et al.

Clin Gastroenterol Hepatol, 2009 Apr;7(4):456-62.
PMID: 19268266 DOI: 10.1016/j.cgh.2008.12.007

Diosmectite is a clay used to treat children with acute watery diarrhea. However, its effects on stool output reduction, the key outcome for pediatric antidiarrheal drugs, have not been shown.

Matched MeSH terms: Rotavirus/isolation & purification
Fulltext The epidemiology and burden of childhood rotavirus infection in a tertiary hospital in Sabah, Malaysia

Goh CT, Cheah PK, Soo TL, Lee WS

Med J Malaysia, 2009 Jun;64(2):146-9.
PMID: 20058575 MyJurnal

We aimed to determine the epidemiology and burden of rotavirus (RV) gastroenteritis (GE) in children requiring hospital care in an urban setting in Sabah, Malaysia. A prospective study of all patients younger than 12 years of age admitted with acute GE to Queen Elizabeth Hospital, Sabah, over a six-month period (October 2005 to March 2006) was conducted. During the study period, a total of 167 children with acute GE who had stool samples examined for RV were studied. RV accounted for 16% of all diarrhoeal cases, and 1.7% of all admissions to the children's wards during the study period. There was no difference in severity of GE between RV and non-RV groups. RV infection is a common cause of childhood GE requiring hospital care in Sabah.

Matched MeSH terms: Rotavirus Infections/economics; Rotavirus Infections/epidemiology*
Reinfection of adult cattle with rotavirus B during repeated outbreaks of epidemic diarrhea

Hayashi M, Murakami T, Kuroda Y, Takai H, Ide H, Awang A, et al.

Can. J. Vet. Res., 2016 Jul;80(3):189-96.
PMID: 27408331

Rotavirus B (RVB) infection in cattle is poorly understood. The objective of this study was to describe the epidemiological features of repeated outbreaks of epidemic diarrhea due to RVB infection in adult cattle on a large dairy farm complex in Japan. In October 2002, approximately 550 adult cows and approximately 450 in February 2005 had acute watery diarrhea at several farms on the complex. Four months before the first outbreak, RVB antibody-positive rates at subsequently affected farms were significantly lower than at non-affected farms (30% to 32% versus 61% to 67%). During the acute phase of both outbreaks, RVB antibody-positive rates in diarrheal cows tested were as low as 15% to 26%. Most of the farms affected in the second outbreak were also involved in the first outbreak. Some adult cows with RVB diarrhea in the first outbreak showed not only RVB seroresponse, but also RVB shedding in the second outbreak, although none of these cows developed diarrhea. Nucleotide sequences of the VP7 and VP4 genes revealed a close relationship between RVB strains in both outbreaks. Taken together, these results indicate that outbreaks of epidemic RVB diarrhea in adult cows might be influenced by herd immunity and could occur repeatedly at the same farms over several years. To our knowledge, this is the first report on repeated RVB infections in the same cattle.

Matched MeSH terms: Rotavirus Infections/epidemiology; Rotavirus Infections/veterinary*; Rotavirus Infections/virology; Rotavirus/classification*; Rotavirus/genetics
Fulltext Estimates of the burden of rotavirus disease in Malaysia

Hsu VP, Abdul Rahman HB, Wong SL, Ibrahim LH, Yusoff AF, Chan LG, et al.

J Infect Dis, 2005 Sep 1;192 Suppl 1:S80-6.
PMID: 16088810

BACKGROUND: Accurate national estimates of the disease burden associated with rotavirus diarrhea are essential when considering implementation of a rotavirus vaccination program. We sought to estimate rotavirus disease-associated morbidity and mortality in Malaysia, using available sources of information.
METHODS: We analyzed national data from the Ministry of Health (Kuala Lumpur, Malaysia) to derive rates of hospitalization, clinic visits, and deaths related to acute gastroenteritis (AG) among children <5 years of age. The number of events attributable to rotavirus infection was estimated by multiplying age-stratified rates of detection of rotavirus from 2 hospital surveillance sites by national data.
RESULTS: In 1999 and 2000, an average of 13,936 children (1 in 187 children) were hospitalized annually for AG. Surveillance of visits to outpatient clinics for AG identified an average of 60,342 such visits/year between 1998 and 2000. The AG-associated mortality rate was 2.5 deaths/100,000 children. On the basis of the finding that 50% of children were hospitalized for rotavirus diarrhea, we estimated that 1 in 61 children will be hospitalized for rotavirus disease and that 1 in 37 children will seek treatment as an outpatient.
CONCLUSIONS: Among Malaysian children, there is a significant burden associated with AG- and rotavirus disease-related hospitalizations and outpatient visits, and this burden potentially could be prevented by the use of rotavirus vaccines.
Data source: (1) hospital discharges, (2) clinic visits for AG, and (3) registration of deaths, together with (4) new data from hospital-based rotavirus surveillance studies

Matched MeSH terms: Rotavirus Infections/mortality; Rotavirus Infections/epidemiology*
Epidemiology and strain characterization of rotavirus diarrhea in Malaysia

Hung LC, Wong SL, Chan LG, Rosli R, Ng AN, Bresee JS

Int J Infect Dis, 2006 Nov;10(6):470-4.
PMID: 17046306

The objectives of the study were to describe the epidemiology and strain characterization of rotavirus (RV), to determine the proportion of hospitalizations for diarrhea attributable to RV among children under 5 years of age, and to estimate the disease burden of RV diarrhea in Malaysia.

Matched MeSH terms: Rotavirus Infections/epidemiology*; Rotavirus/classification*
Fulltext Analysis of factors in response to rotavirus vaccination counselling in a private paediatric clinic

Kannan Kutty P, Pathmanathan G, Salleh NM

Med J Malaysia, 2010 Jun;65(2):127-32.
PMID: 23756797 MyJurnal

Rotavirus vaccine is available as an optional vaccine in Malaysia. The counselling of optional vaccines is considered an integral part of the health services offered in a private paediatric clinic. While ensuring that all babies are up-todate with their compulsory immunization, counselling of optional vaccines like the rotavirus vaccine could give parents the choice to make an informed decision on the acceptance of this vaccine. Over a period of two years, we counselled the parents regarding diarrhoea caused by rotavirus disease and the rotavirus vaccine. In this study, the factors that were significantly associated with the acceptance of the rotavirus vaccine were the gender of the baby, the mother's age, the mother's occupation, the mode of payment for the vaccine, the number of previous visits to the clinic by the parents, the number of counselling sessions given to the parents and the pre-counselling awareness or knowledge of rotavirus disease and rotavirus vaccine. It is hoped that these findings may assist busy clinicians in their continuous efforts to provide health education and vaccination counselling to the parents of their patients.

Matched MeSH terms: Rotavirus Infections; Rotavirus*; Rotavirus Vaccines*
Detection of false positives by incorporation of a confirmatory blocking test into a commercial enzyme-linked immunosorbent assay specific for adenovirus antigen

Kirnpal-Kaur BS, Yap KL, Tan SC

Malays J Pathol, 1997 Dec;19(2):133-6.
PMID: 10879254

A blocking test was incorporated into the commercial IDEIA Adenovirus test (DAKO Diagnostics Ltd., Cambridgeshire, UK) to detect false positive results when faecal specimens were tested for adenovirus antigen. Immune rabbit serum raised against pooled adenovirus particles from human faecal specimens, together with the pre-immune serum, was used. Assessment of positive showed that false positives were produced under two different conditions: when results were based on visual determination instead of a cut-off value determined from photometric reading, and when absorbance values were not immediately read at the end of the test. Under the optimum condition for reading and assessment of test results (immediate reading and photometric determination), 11% of 65 adenovirus-positive samples were checked by the blocking ELISA as false positives. The rest of the specimens showed blocking of positive absorbance values by 70 to 98%. ELISA was found to be more sensitive than immune electron microscopy on samples with lower antigen concentration.

Matched MeSH terms: Rotavirus Infections/diagnosis; Rotavirus Infections/immunology; Rotavirus Infections/virology; Rotavirus/immunology; Rotavirus/isolation & purification
Infectious agents causing diarrhoea in Malaysian children

Koe, S.L., Puthucheary, S.D., Lam, S.K.

Malaysian Journal of Child Health, 1991;3(1):29-33.
MyJurnal

The stools of 97 children with acute gastroenteritis, attending a private paediatric clinic, were studied for infectious agents. Putative pathogenic microorganisms were identified in 47 cases (48.5%). Food poisoning Salmonella was the most common bacteria detected, 25 cases (25.8%). Rotavirus was present in 9 cases (9.2%). Interview of the parents and care-persons revealed a general lack of knowledge in the proper cleaning and sterilisation of milk bottles, rubber teats and pacifiers. In 44 households there were at least one animal kept and there were positive bacterial isolates from 47% of such households. However, positive isolates were found in only 26% of households with no kept animals. The implications of these findings are discussed. (Copied from article).

Matched MeSH terms: Rotavirus
Global economic evaluations of rotavirus vaccines: A systematic review

Kotirum S, Vutipongsatorn N, Kongpakwattana K, Hutubessy R, Chaiyakunapruk N

Vaccine, 2017 06 08;35(26):3364-3386.
PMID: 28504193 DOI: 10.1016/j.vaccine.2017.04.051

INTRODUCTION: World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted.
METHODS: We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs.
RESULTS: 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings.
CONCLUSION: Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.

Matched MeSH terms: Rotavirus Infections/prevention & control*; Rotavirus Vaccines/economics; Rotavirus Vaccines/therapeutic use*

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