title: Rotavirus genetic diversity, disease association, and temporal change in hospitalized rural Kenyan children.
abstract: BACKGROUND
  The effectiveness of rotavirus vaccines will be dependent on the immunity conferred against prevalent and emergent variants causing severe diarrheal disease. Longitudinal surveillance of disease-causing strains is a prerequisite to intervention.
  
  
  METHODS
  Molecular characterization was conducted on rotavirus-positive stool samples from children admitted with diarrhea to a rural district hospital during 2002-2004. Extracted viral RNA was separated by polyacrylamide gel electrophoresis, and rotavirus VP4 (P types) and VP7 (G types) specificities were determined.
  
  
  RESULTS
  Among 558 investigated cases, the predominant genotype was P[8]G1 (42%), followed by P[8]G9 (15%), P[4]G8 (7%), P[6]G8 (6%), and P[8]G8 (4%), with 10% mixed strains. Overall, there were 6 different P types and 7 G types. No association was identified between genotype and child age, sex, or severity of diarrhea. The P and G genotypes and polyacrylamide gel electropherotypes showed significant temporal variation in frequency: P[8]G1 decreased from 51% (95% confidence interval [CI], 43%-58%) in 2002 to 30% (95% CI, 24%-37%) in 2004, and P[4]G8 increased from 2% (95% CI, 0%-5%) in 2002 to 13% (95% CI, 9%-19%). Quarterly data revealed seasonally endemic and emergence and/or decay patterns.
  
  
  CONCLUSIONS
  Our study of rotavirus strains causing severe diarrhea in rural Kenyan children showed a predominance of P[8]G1 and confirms the importance of G8 and G9 strains in sub-Saharan Africa. Considerable genetic diversity of rotavirus strains was observed, including substantial mixed and unusual types, coupled with significant temporal strain variation and emergence. These results warn of variable vaccine efficacy and the need for long-term surveillance of circulating rotavirus genotypes.
authors.affiliation: Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
authors.forename: D James
authors.initials: DJ
authors.lastname: Nokes
authors.forename: Ina
authors.initials: I
authors.lastname: Peenze
authors.forename: Lufuno
authors.initials: L
authors.lastname: Netshifhefhe
authors.forename: John
authors.initials: J
authors.lastname: Abwao
authors.forename: Mariet C
authors.initials: MC
authors.lastname: De Beer
authors.forename: Mapaseka
authors.initials: M
authors.lastname: Seheri
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Williams
authors.forename: Nicola
authors.initials: N
authors.lastname: Page
authors.forename: Duncan
authors.initials: D
authors.lastname: Steele
mesh_terms: D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000821:virology; D005243:Feces / Q000821:virology; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007630:Kenya / Q000453:epidemiology; D012401:Rotavirus / Q000235:genetics*; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000821:virology*; D012424:Rural Population; D012621:Seasons; D013997:Time Factors