title: The molecular epidemiology of circulating rotaviruses: three-year surveillance in the region of Monastir, Tunisia.
abstract: BACKGROUND
  Rotavirus infection is the most common cause of severe, dehydrating, gastroenteritis among children worldwide. In developing countries, approximately 1440 children die from rotavirus infections each day, with an estimated 527,000 annually. In infants, rotavirus is estimated to cause more than 2 million hospitalizations every year depending on the income level of the country. The purpose of this study was to estimate the proportion of rotavirus gastroenteritis and identify the distribution of circulating G and P genotype rotavirus strains among children consulting several dispensaries in the region of Monastir (outpatients departments) or admitted to Monastir University Hospital (inpatients department) with acute gastroenteritis.
  
  
  METHODS
  This study was undertaken during a 3-year period from April 2007 to April 2010 in Tunisian children under 13 suffering from acute gastroenteritis. Group A rotaviruses were detected in stools by ELISA and genotyped using multiplex reverse transcription PCRs with type-specific primers on the basis of their outer capsid proteins. Statistical analyses were performed with SPSS software, version 19.
  
  
  RESULTS
  Of the 435 stool samples from children with acute gastroenteritis, 27.6% were positive for rotavirus A. The predominant G type was G1 (37.5%), followed by G3 (25%), G2 (17.5%), G4 (12.5%), G9 (2.5%) and three mixed-G infections G3G4 (2.5%) were identified. Only P[8] (80.8%), P[4] (16.7%) and P[9] (0.8%) genotypes were found. The predominant single G/P combination was G1P[8] (37.5%), followed by G3P[8] (25%), G2P[4] (16.7%), G4P[8] (12.5%), G9P[8] (1.7%) and one case of the unusual combination G9P[9] (0.8%). The G-mixed types G3G4 combined with P[8] (2.5%). Infants less than 3 months of age were most frequently affected. The prevalence of rotavirus infection peaked in the winter season, when temperatures were low, and decreased in summer.
  
  
  CONCLUSIONS
  Rotavirus gastroenteritis is a common disease associated with significant morbidity, mortality, and economic burden. Epidemiological knowledge of rotavirus is critical for the development of effective preventive measures, including vaccines. These data will help to make informed decisions as to whether rotavirus vaccine should be considered for inclusion in Tunisia's National Immunisation Programme.
authors.affiliation: Laboratory of Infectious Diseases and Biological Agents, Faculty of Pharmacy, University of Monastir, TU-5000 Monastir, Tunisia. mouna20781@yahoo.fr
authors.forename: Mouna
authors.initials: M
authors.lastname: Hassine-Zaafrane
authors.forename: Khira
authors.initials: K
authors.lastname: Sdiri-Loulizi
authors.forename: Imen
authors.initials: I
authors.lastname: Ben Salem
authors.forename: Jérôme
authors.initials: J
authors.lastname: Kaplon
authors.forename: Siwar
authors.initials: S
authors.lastname: Ayouni
authors.forename: Katia
authors.initials: K
authors.lastname: Ambert-Balay
authors.forename: Nabil
authors.initials: N
authors.lastname: Sakly
authors.forename: Pierre
authors.initials: P
authors.lastname: Pothier
authors.forename: Mahjoub
authors.initials: M
authors.lastname: Aouni
mesh_terms: D000956:Antigens, Viral / Q000032:analysis; D036022:Capsid Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D017931:DNA Primers / Q000235:genetics; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000821:virology; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017720:Molecular Epidemiology; D060885:Multiplex Polymerase Chain Reaction; D012367:RNA, Viral / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012401:Rotavirus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000821:virology*; D014416:Tunisia / Q000453:epidemiology
chemical_list: D000956:Antigens, Viral; D036022:Capsid Proteins; D017931:DNA Primers; D012367:RNA, Viral