title: Sentinel hospital-based surveillance for assessment of burden of rotavirus gastroenteritis in children in Pakistan.
abstract: OBJECTIVE
  To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine.
  
  
  METHODS
  A cross-sectional study was carried out over a period of two years from 2006 - 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping.
  
  
  RESULTS
  6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593).
  
  
  CONCLUSIONS
  Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Abdul Momin
authors.initials: AM
authors.lastname: Kazi
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Gohar Javed
authors.initials: GJ
authors.lastname: Warraich
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Shahida
authors.initials: S
authors.lastname: Qureshi
authors.affiliation: Pakistan Medical Research Council, Islamabad, Pakistan.
authors.forename: Huma
authors.initials: H
authors.lastname: Qureshi
authors.affiliation: Pakistan Medical Research Council, Islamabad, Pakistan.
authors.forename: Muhammad Mubashir Ahmad
authors.initials: MM
authors.lastname: Khan
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Anita Kaniz Mehdi
authors.initials: AK
authors.lastname: Zaidi
mesh_terms: D003430:Cross-Sectional Studies; D005759:Gastroenteritis / Q000453:epidemiology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D010154:Pakistan / Q000453:epidemiology; D012401:Rotavirus / Q000472:pathogenicity*; D012400:Rotavirus Infections / Q000453:epidemiology