Rota virus diarrhea in children under five admitted to Basrah General Hospital Haifa ’ a

Background: This study is a retrospective record-based study involving all children aged less than five years admitted to Basrah General Hospital with acute gastroenteritis during study period 2008-2013. Objectives: To measure the prevalence of rotavirus infection and to relate the infection to selected epidemiological variables. Methods: All children less than five years old admitted to pediatric ward in Basrah General Hospital with acute gastroenteritis over the period 20082013 were included. They were 942 in number. The data were collected through special form (diarrhea case report form). It included two parts, the first part about patient’s information and clinical information while the second one was about the laboratory information. Results: The overall prevalence of rotavirus infection among the study children was 43.7%. The highest prevalence rate was in 2009 (53.0%) and the lowest rate was in 2010 (33.6%). The infection increased in the colder months of the year. The infection was more among age group 6-12 months (58.7%) affecting males and females in similar degree and no statistical significance could be found. All the positive rotavirus cases complained from diarrhea (100%), vomiting (74.5%) and fever (70.1%). Conclusions: Rotavirus a common cause of acute gastroenteritis in children under five years old. The prevalence was higher in infant between 6-11 months.

Infection spreads through contaminated food or drinking-water, or from person to person as a result of poor hygiene. [1]iarrheal diseases represent a major health problem in developing countries. [1]Rotaviruses (RV) are the leading cause of severe diarrheal disease and dehydration in infants and children under the age of 5 years worldwide [2] and accounts for up to 50% of hospitalizations for severe diarrhea in infants and children. [3]otavirus infection can also occur in adults, [4] especially in institutionalized or hospitalized elderly patients. [5]Its importance is still not widely known within the public health community, particularly in developing countries. [6]Rotavirus constitutes approximately 39% of all severe diarrhea cases across the world, and is responsible for the deaths of more than 600,000 people annually.A sudden onset of symptoms typically manifests in children 1 to 2 days after infection with RV.The clinical picture of Rotavirus Gastroenteritis (RVGE) is characterized by 4 to 7 days of acute febrile illness, vomiting, and watery, non-bloody diarrhea.This combination can lead to rapid dehydration without appropriate intervention.Secondary infections with RV are clinically milder or asymptomatic. [4,7]The most widely available method for confirmation of rotavirus infection is detection of rotavirus antigen in stool by enzyme immunoassay (EIASA).Several commercial test kits are available that detect an antigen common to human rotaviruses.These kits are simple to use, inexpensive, and very sensitive. [8]Other techniques are also in use such as electron microscopy, reverse transcription polymerase chain reaction, nucleic acid hybridization, sequence analysis, and culture. [9]Rotavirus antigen has also been identified in the serum of patients 3-7 days after disease onset [10,11] but at present, routine diagnostic testing is based primarily on testing of fecal specimens.There are no methods for the prevention or control of infection or illness with rotaviruses.Although improved hygiene is of course generally desirable, it does not appear that such measures would markedly affect transmission of rotavirus infection.Therefore, the development of rotavirus vaccine is of primary importance.In February 2006, the United States Food and Drug Administration (FDA) approved RotaTeq.RotaTeq administration has been recommended for children as 3 separate oral doses at ages 2, 4, and 6 months.In April 2008, the FDA approved Rotarix, another oral vaccine, for prevention of rotavirus gastroenteritis.Rotarix administration is currently recommended as 2 separate doses to patients at ages 2 and 4 months. [10,11]Rotarix was efficacious in a large study showing that it protected patients against severe rotavirus gastroenteritis as well as decreasing the rate of severe diarrhea or gastroenteritis of any cause. [12]Two rotavirus vaccines against Rotavirus infection are safe and effective in children. [13]Rotarix by GlaxoSmithKline. [14]and RotaTeq by Merck. [13]Both are taken orally and contain attenuated live virus . [12]TIENTS AND METHODS This is a retrospective record-based study covered the years 2008-2013 inclusive.Children aged less than 60 months admitted with acute D gastroenteritis to pediatric ward in Basrah General Hospital who were notified to the surveillance unit at the department of public health in Basrah were included.Data were collected through special form (diarrhea case report form) designed for data related to rotavirus surveillance system.It included two parts.The first part included questions that covered patient information including name, age (by months) and sex and questions related to clinical information such as symptoms (fever, diarrhea and number of episodes of diarrhea, vomiting and number of episodes of vomiting during twenty four hours, degree of dehydration status, duration of hospitalization and outcome.The second part of the form was about the laboratory information that covered the following aspects:

Prevalence of rotavirus over year:
The overall rotavirus prevalence rate among the 942 patients less than five year old admitted to the Basrah General Hospital with acute diarrhea was 43

Seasonal pattern:
The rotavirus was detected throughout the year and exhibited some magnitude of seasonal variation.Low rates are seen during the months of April-July as compared to all other months.The variation in seasonal pattern was statistically significant (P=0.001),(Table -2).

DISCUSSION
Acute gastroenteritis is one of the most common causes of visiting health centers, and viral diarrhea is a major cause of morbidity and mortality in developing countries. [15,16]This study showed that rotaviruses are important etiological agents of acute gastroenteritis in children less than 5 years of age in Basrah.Rotavirus gastroenteritis represented 43.7% in children with acute gastroenteritis, a result that was in agreement with the results found by other studies done in Basrah [17] and in Baghdad. [18]A similar prevalence (45.4%) was obtained in study performed in selected hospitals in Jordan during 2007-2008. [19]This prevalence rate of rotavirus gastroenteritis in the present study was also within the world range (29%-45%). [20]The prevalence rate in the present study was less than the prevalence rate reported in study carried out in Nicaragua in the central America (67%). [21]While this rate was higher than the 29.5% in Ahvaz, Iran in 2005. [22]nd 19.7% in United State of America during 2001-2003. [23]The previous results indicated that variation was exist in the prevalence rate of rotavirus gastroenteritis among various populations. [24]These variations may be related to the variation of personal and community hygiene, anti-infective properties of breast-milk, sanitation measures and vaccination coverage.All these are highly effective in preventing rotavirus infection.Geographical location seems to be important for determining the seasonal variability of rotavirus-related gastroenteritis.Seasonal variation was not observed in countries with tropical climates. [25]Iraq is one of the subtropical climate countries where the virus may present year around. [26]This concept is similar to other studies about rotavirus prevalence from Turkey, [27] Malawi [28] Uganda [29] and Bangaladesh. [30]Studies in America, [31] Italy, [32] Taiwan, [33] and China [34] have shown that the peak is in winter.Other studies showed that peaks of infection were in dry months in Brazil [35] and summer and winter in Japan. [36]Rotavirus was found in all age groups studied, but the highest prevalence was found in children aged 6-11 month (58.7%).This age pattern goes with the results of other studies done in selected hospitals during the period May 2007-April 2008 in Jordan. [19]and in Abuzar Hospital in Ahvaz in Iran. [37]The present study showed no sex variation in prevalence rate of infection with.This result was inconsistent with other study carried out in Karbala which found that the percentage of infection among males was higher than females. [38]3] In this study the rotavirus positive gastroenteritis was significantly different from rotavirus negative gastroenteritis in respect to vomiting, while no such difference observed in respect to fever.These results agree with other study carried out in Dastgheib Hospital, Shiraz, Iran, from September 2008 to February 2010. [44]here was a statistical significant difference regarding dehydration status between positive rotavirus cases and negative cases, and these results disagree with other study carried out in Jordan which found that here was no statistical significant difference. [19]n conclusion, Rotavirus was a common cause of acute gastroenteritis in children under five years old.The prevalence was higher in infant between 6-11 months.We recommend that Latex test is simple, inexpensive and sensitive to detect rotavirus antigen in stool, so it should be available in primary health centers and hospitals in order to be used as a screening test and to decrease the abuse of antibiotics for diarrheal cases and Enzyme-Linked immunosorbant assay (ELISA) test should be available in all pediatric hospitals and also used as a confirmatory test for positive cases.

1 - 2 - 3 - 4 - 6 -
Stool specimens collected, either yes or no.Date of stool collected.Date of sending the specimen to laboratory.Date of receiving laboratory results.5-Rotavirus EIASA results.Genotyping result: G………P……….The stool samples were collected from each suspected case during the acute illness within 24 hours of hospital admission and sent to the Central public health laboratory in Baghdad for investigation is part of the surveillance system in Iraq.Analysis of the data obtained was made by using SPSS (Statistical Package for Social Sciences) version 19 and the data were analyzed by Chi squared test and P value of less than 0.05 was considered significant.Calculation of mean values were made for age and duration of stay in hospital.

Table 1 . Prevalence rates of rotavirus infection among patients over the years 2008-2013.
.7% as detected by Enzyme-linked immunosorbent assay technique (ELISA).

Seasonal pattern of rotavirus infection among children with diarrhea Age and sex: The
prevalence rate by age (Table-3) and sex (Table-4) indicate that rotavirus was found in all age groups.The prevalence rate was the highest among children aged 6-11months (49.9%).Low rates are noticed in older children 18 months and older.The pattern of prevalence and age was statistically significant.Regarding sex, the prevalence rate was very close in male and female children, (Table-4).