title: Rotavirus gastroenteritis among children less than 5 years of age in private outpatient setting in urban India.
abstract: Burden of rotavirus gastroenteritis (RVGE) in outpatient setting in India is not fully understood. A prospective study was undertaken to describe RVGE among Indian children less than 5 years of age presenting in outpatient departments with acute gastroenteritis (AGE). This study was conducted at 11 outpatient departments (OPDs) of private pediatric clinics in urban areas of India. A total of 605 eligible children were enrolled at OPDs. Stool samples of the subjects were collected and tested for presence of rotavirus antigen by enzyme immune assay (EIA) and were typed by reverse-transcriptase polymerase chain reaction (RT-PCR). Physician examined the children and documented the disease particulars. In addition, parents/guardians were interviewed for AGE related symptoms, health care utilization and cost incurred due to AGE, and parental stress associated with AGE. After OPD, parents/guardians completed diary cards and questionnaires to capture the information for 14 days following the enrollment. Complete data for analysis including stool sample results was available from 552 subjects. 23% (127/552; [CI 19.5, 26.5]) of stool samples were rotavirus (RV) positive. RT-PCR was done for 85.8% (109/127) of RV positive samples. G1, G2, G9, and G12 types were identified in 34.9% (38/109), 37.6% (41/109), 8.3% (9/109), and 6.4% (7/109) stool samples, respectively. P[4] and P[8] were identified in 36.7% (40/109) stool samples each, followed by P[6] identified in 15.6% (17/109) stool samples. At the time of enrollment, all three symptoms (vomiting, diarrhea, and fever) were observed concurrently in higher proportion of RV positive subjects compared to RV negative subjects (60.6% [77/127] vs. 42.8% [182/425], p=0.0004). Healthcare resource utilization, costs incurred due to disease, and parental stress were higher for RV positive subjects compared to RV negative subjects. In conclusion, RVGE was found to be a definite burden in AGE cases attending pediatric outpatient clinics in urban areas and it was associated with substantial economic and psychological burden. Introduction of rotavirus vaccine in India may help in reducing this disease burden.
authors.affiliation: MSD Pharmaceuticals Pvt Ltd, Mumbai, India. Electronic address: gajanan.namjoshi@merck.com.
authors.forename: Gajanan S
authors.initials: GS
authors.lastname: Namjoshi
authors.affiliation: Institute of Child Health, Kolkata, India.
authors.forename: Monjori
authors.initials: M
authors.lastname: Mitra
authors.affiliation: Department of Pediatrics, Bharati Vidyapeeth Medical College and Hospital, Pune, India.
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Lalwani
authors.affiliation: Sir Gangaram Hospital, New Delhi, India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Sachdeva
authors.affiliation: Dr. Bala Clinic, Chennai, India.
authors.forename: Sundaram
authors.initials: S
authors.lastname: Balasubramanian
authors.affiliation: Christian Medical College, Vellore, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Babji
authors.affiliation: Dr. Ghosh Clinic, Kolkata, India.
authors.forename: Apurba
authors.initials: A
authors.lastname: Ghosh
authors.affiliation: MSD Pharmaceuticals Pvt Ltd, Mumbai, India.
authors.forename: Sudhanshu
authors.initials: S
authors.lastname: Pandey
authors.affiliation: Chiranjeevi Hospital, Thane, India.
authors.forename: Suhas
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: Panchsheel Hospitals Pvt Ltd, New Delhi, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Goyal
mesh_terms: D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000821:virology; D017048:Health Care Costs; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D010045:Outpatients; D011446:Prospective Studies; D012401:Rotavirus / Q000235:genetics / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology*; D014505:Urban Population
keywords: Disease burden; EIA; Gastroenteritis; RT-PCR; Rotavirus