title: Group A rotavirus-associated diarrhea in children seeking treatment in Indonesia.
abstract: BACKGROUND
  Globally, group A rotavirus causes significant morbidity and mortality among children. Limited data exist on the epidemiology of rotavirus disease among Indonesian children.
  
  
  OBJECTIVE
  We describe the epidemiology of rotavirus-associated diarrhea among Indonesian children <6 years of age, including clinical symptoms and genotypes.
  
  
  METHODS
  We conducted a hospital-based, case series study at four referral hospitals between February 2004 and February 2005 among children with diarrhea. Rotavirus positivity was defined by a positive result from either EIA or RT-PCR. A semi-nested RT-PCR was used to determine specific rotavirus genotypes.
  
  
  RESULTS
  1660 stools were tested for pathogens. The overall rotavirus prevalence was 45.5%. Children with rotavirus-associated diarrhea were significantly younger (p<0.0001) and more likely to be hospitalized (81.3% versus 72.2%; p<0.0001). Symptoms associated with rotavirus included, vomiting, fever, nausea, fatigue and dehydration, while bloody stool was significantly less common with rotavirus-associated diarrhea.
  
  
  CONCLUSIONS
  Rotavirus was an important contributor of morbidity to our study sample. Rotavirus genotyping demonstrated a temporal shift from G1-G4 to G9, but this was highly associated with the P[8] gene, suggesting that a multivalent rotavirus vaccine, incorporating G9 P[8] antigen, may reduce the burden of diarrheal illnesses among Indonesian children.
authors.affiliation: U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia. putnam@namrutwo.org
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Putnam
authors.forename: Endang R
authors.initials: ER
authors.lastname: Sedyaningsih
authors.forename: Erlin
authors.initials: E
authors.lastname: Listiyaningsih
authors.forename: Sri Pandam
authors.initials: SP
authors.lastname: Pulungsih
authors.lastname: Komalarini
authors.forename: Yati
authors.initials: Y
authors.lastname: Soenarto
authors.forename: Octavianus Ch
authors.initials: OCh
authors.lastname: Salim
authors.forename: Decy
authors.initials: D
authors.lastname: Subekti
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Burgess
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blair
mesh_terms: D002675:Child, Preschool; D004403:Dysentery / Q000453:epidemiology / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D005838:Genotype; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D012401:Rotavirus / Q000235:genetics / Q000302:isolation & purification*; D012400:Rotavirus Infections / Q000453:epidemiology / Q000821:virology*