title: Viral etiologies of acute dehydrating gastroenteritis in pakistani children: confounding role of parechoviruses.
abstract: Despite substantial interventions in the understanding and case management of acute gastroenteritis, diarrheal diseases are still responsible for a notable amount of childhood deaths. Although the rotavirus is known to cause a considerable burden of pediatric diarrheal cases, the roles of other viruses remain undefined for the Pakistani population. This study was based on tertiary care hospital surveillance, from January 2009 to December 2010, including the detection of rotavirus, norovirus, astrovirus, and human parechovirus in children under the age of five using serological or molecular assays. Rotavirus, human parechovirus, norovirus, and astrovirus were detected in 66%, 21%, 19.5%, and 8.5% subjects, respectively. Human parechovirus genotypes, determined through analysis of VP1 gene sequences, showed a great diversity among co-circulating strains. Eighty percent of hospitalized children had dual or multiple viral infections, while 98% parechovirus positive cases were co-infected with rotavirus. The remarkable diversity of viruses associated with the childhood diarrhea in Pakistan calls for large-scale epidemiological surveys, coupled with case control studies, to ascertain their role in clinical manifestations. In addition, these findings also highlight the need for the implementation of up-to-date health interventions, such as the inclusion of a rotavirus vaccine in routine immunization programs for the improvement of quality in child health care.
authors.affiliation: Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan. meharangez@yahoo.com.
authors.forename: Muhammad Masroor
authors.initials: MM
authors.lastname: Alam
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. kadnan12@gmail.com.
authors.forename: Adnan
authors.initials: A
authors.lastname: Khurshid
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. vibgyors@yahoo.com.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shaukat
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. ranavirologist@gmail.com.
authors.forename: Muhammad Suleman
authors.initials: MS
authors.lastname: Rana
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. vibgyors@yahoo.com.
authors.forename: Salmaan
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. meharangez@yahoo.com.
authors.forename: Mehar
authors.initials: M
authors.lastname: Angez
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. nisar.nadia@googlemail.com.
authors.forename: Nadia
authors.initials: N
authors.lastname: Nisar
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. uzmaaamir73@yahoo.com.
authors.forename: Uzma Bashir
authors.initials: UB
authors.lastname: Aamir
authors.affiliation: Department of Biotechnology, Quaid-i-Azam University, Islamabad 45320, Pakistan. mnaeemqau@gmail.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Naeem
authors.affiliation: Department of Virology, National Institute of Health, Chak Shahzad, Park Road, Islamabad 44000, Pakistan. zaidis@pak.emro.who.int.
authors.forename: Syed Sohail Zahoor
authors.initials: SS
authors.lastname: Zaidi
mesh_terms: D002675:Child, Preschool; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000453:epidemiology / Q000209:etiology*; D062665:Epidemiological Monitoring; D005260:Female; D005759:Gastroenteritis / Q000150:complications* / Q000453:epidemiology / Q000821:virology*; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D001257:Mamastrovirus; D010154:Pakistan / Q000453:epidemiology; D012327:RNA Virus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology*; D012328:RNA Viruses / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D062606:Tertiary Care Centers