Viral diarrhea in children: Time to start rapid diagnosis and vaccination

Mohamed Usman Abdullah; Poongodi Lakshmi Santhana Kumaraswamy; Syed Ibrahim Ahamed Nagoor

doi:10.4103/jss.JSS_29_17

ORIGINAL ARTICLE

Year : 2017 | Volume : 44 | Issue : 3 | Page : 134-136

Viral diarrhea in children: Time to start rapid diagnosis and vaccination

Mohamed Usman Abdullah¹, Poongodi Lakshmi Santhana Kumaraswamy², Syed Ibrahim Ahamed Nagoor¹
¹ Senior Pediatric Consultant, Royal Hospital, Tirunelveli, Tamil Nadu, India
² Department of Microbiology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, India

Date of Web Publication

14-Feb-2018

Correspondence Address:
Poongodi Lakshmi Santhana Kumaraswamy
Department of Microbiology, Tirunelveli Medical College, Tirunelveli - 627 011, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jss.JSS_29_17

Abstract

Background: Acute diarrheal diseases are the most common cause of morbidity and mortality in children under 5 years of age throughout the world. This study was done to find out the incidence of rotavirus and adenovirus infection in children below 5 years of age. Materials and Methods: A total of 105 stool samples were collected from hospitalized children below 5 years of age with diarrhea from a private children hospital and tested for rotavirus and adenovirus antigen detection by rapid immunochromatography (RICT). Results: Of the 105 patients tested, 44 (42%) were positive for rotavirus, and two (2%) were positive for adenovirus by RICT. None of the children were positive for both rotavirus and adenovirus. Out of 105 children, only two had received rotavirus vaccine. They were negative for both rotavirus and adenovirus. Conclusion: The rotavirus vaccine can be included in the Universal Immunization Programme. Although the sensitivity and specificity of RICT were reported as 75% and 95% only, it is useful to detect viral diarrhea at the point of care for effective management and containment of diarrheal outbreaks at field level.

Keywords: Acute diarrheal diseases, adenovirus, antigen, rapid immunochromatography, rotavirus

How to cite this article:
Abdullah MU, Santhana Kumaraswamy PL, Ahamed Nagoor SI. Viral diarrhea in children: Time to start rapid diagnosis and vaccination. J Sci Soc 2017;44:134-6

How to cite this URL:
Abdullah MU, Santhana Kumaraswamy PL, Ahamed Nagoor SI. Viral diarrhea in children: Time to start rapid diagnosis and vaccination. J Sci Soc [serial online] 2017 [cited 2021 Apr 20];44:134-6. Available from: https://www.jscisociety.com/text.asp?2017/44/3/134/225502

Introduction

Diarrheal diseases have been recognized in humans since antiquity. In India, despite effective antidiarrheal disease prevention program started in 1978, diarrhea still remains a major public health concern.^[1] Acute diarrheal diseases are the most common cause of morbidity and mortality in children under 5 years of age throughout the world.^{[2],[3],[4],[5]} In poorer countries, it is a major cause of malnutrition.^[6] Many diarrheal deaths are caused by dehydration. Until the early 1970s, bacterial, viral, or parasitic etiology of diarrheal disease in children could be detected in fewer than 30% of cases. Viruses such as rotavirus, human calicivirus, astrovirus, and adenovirus are recognized as important causes of this disease, particularly in children.^[7],[8],[9] However, in developing countries, data on the prevalence of enteropathogenic viruses are sparse, since laborious and expensive virological testing is usually not performed. Early diagnosis is essential for effective management, identification of individuals who are the potential sources of infection to others and containment of outbreak.^[10] In this background, this study was done to find out the incidence of rotavirus and adenovirus infection in the stool of children below 5 years of age.

Materials and Methods

A total of 105 stool samples were collected from hospitalized children below 5 years of age with diarrhea from July 2016 to February 2017 at a private children hospital. All the samples were tested for rotavirus and adenovirus antigen detection by rapid immunochromatography – RICT (SD BIOLINE Rota/Adeno Rapid) Ethical clearance, filled in pro forma and informed consent from reliable informants was also obtained. Statistical analysis was done using Chi-square test. Statistical software IBM SPSS statistics 20 (International Business Machine, New York, USA) was used.

Results

Of the 105 patients tested, 63 were males and the remaining 42 were females. Of the 63 males, 42 (67%) were <12 months, 15 (24%) were between 13 and 24 months, and the remaining 6 (10%) were between 25 and 60 months of age. Of the 42 females, 21 (50%) were <12 months, 17 (40%) were between 13 and 24 months, and the remaining four (10%) were 25 and 60 months of age. The mean age of males was 15.1 months, and the mean age of females was 15.5 months. Rotavirus positivity among male and female children was not statistically significant (P < 0.05) [Table 1].

Table 1: Distribution of rotavirus and adenovirus positivity in children

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Of the 105 patients tested, 44 (42%) were positive for rotavirus, and two (2%) were positive for adenovirus by RICT. Out of 105 children, only two had received rotavirus vaccine. They were negative for both rotavirus and adenovirus. None of the children were positive for both rotavirus and adenovirus [Table 1].

Discussion

Since rotavirus is difficult to cultivate in tissue culture, other methods such as rotavirus antigen detection by immunoassays have been developed.^[11] Originally, electron microscopy was used which is labor intensive.^[10] It is not available widely, costly and needs expertise to handle. Further, detection of rotavirus by electron microscopy requires more than 10⁶ particles per ml of feces.^[8]

Rotavirus is highly communicable, infected persons shed large quantities of virus in their stool.^[12],[13] Although immune deficient persons may shed rotavirus for more than 30 days after infection, a true carrier state is not described. Rotavirus causes outbreaks in nurseries, hospitals, and schools because it is very stable and remains in the environment for weeks or months if not disinfected.^[14] Vaccinated strains are shed in the feces of vaccinated infants, transmission of vaccine strain increases herd immunity in population with low vaccine coverage area. However, symptomatic infection by vaccine strain has also been documented.^[15]

The incidence of rotavirus diarrhea was 42% by RICT in children below 5 years in the present study [Table 1]. Older children and adults are also infected but they generally suffer from subclinical infections.^[13],[14]

The sensitivity and specificity of RICT were reported as 75% and 95%, respectively.^[16] Hence, RICT has to be compared with the gold standard methods or molecular methods.

The incidence is similar among children in industrialized and developing countries. This signifies that improvement in hygiene and access to safe water alone may not significantly reduce the prevalence of rotavirus. Thus, vaccination offers one of the promising methods to reduce the prevalence. However, as the immunity is type specific and there is a lot of heterogeneity in rotaviruses, knowledge of the geographical distribution and temporal distribution of circulating genotypes are essential in the formulation of vaccine.^[17],[18]

In the present study, children who received rotavirus vaccine were negative for rotavirus. This highlights that the rotavirus vaccine can be included in the Universal Immunization Programme (UIP) which provides trustworthy safety against diarrheal disease. The efficacy of the vaccine was not assessed due to a small number of vaccines in this study.

In the current study, adenovirus was detected in two cases [Table 1]. Adenovirus also causes respiratory illness. Children tend to ingest sputum resulting in shedding of virus in stool. Hence, it is difficult to interpret adenovirus infection in children.^[9]

Children with viral diarrhea do not require an antibiotic, early diagnosis will avert the misappropriate use of antibiotics. This not only reduces the cost of treatment and risk of adverse reactions, but also decreases the emergence of resistant bacteria.^[19]

Conclusion

The rotavirus vaccine can be included in the UIP. Although the sensitivity and specificity of RICT were reported as 75% and 95% only, it is useful to detect viral diarrhea at the point of care for effective management and containment of diarrheal outbreaks at field level.

Acknowledgment

We would like to thank Dr. Sunitha who assisted with the statistical analysis of the results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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