Genetic Characteristics of Rotavirus Acute Gastroenteritis Among Hospitalized Children of Odisha in Eastern India.

OBJECTIVE: To generate epidemiological data of rotavirus diarrhea among hospitalized children less than 5 y of age and to characterize the circulating rotavirus genotypes post introduction of rotavirus vaccine in Universal Immunization Program (UIP). METHODS: This prospective study was conducted from April 2016 to July 2019 at Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics & SCB Medical College, Cuttack, Odisha among hospitalized children with acute gastroenteritis (AGE) under five years of age. Stool samples collected were tested for rotavirus by a commercial enzyme immunoassay and strains were characterized by reverse-transcription polymerase chain reaction (PCR). The data was analysed using a chi-square test with 95% confidence interval and risk ratio. RESULTS: Rotavirus diarrhea was seen in 715 (36.4%) of the 1963 samples tested. The peak incidence of rotavirus diarrhea was during the winter season, i.e., from the month of December to February. Most of the infections were in children between 6 mo to 2 y of age, affecting boys and girls equally. The commonest genotypes were G3P[8] (50.34%) followed by G1P[8] (17.46%). CONCLUSION: This study highlights the high prevalence of rotavirus diarrhea among children which emphasize the need for continued rotavirus vaccination. The changing patterns of genotype distribution stress the need for continued surveillance post introduction of vaccines to understand the effect of vaccines on strain evolution over a longer period and detect emergence of new genotypes.

Clinical Profile, Risk-Factors, and Outcome of Rotaviral Diarrhea and Non-rotaviral Diarrhea Among Under-Five Children at Cuttack, Odisha, India.

OBJECTIVE: To understand the prevalence of rotavirus diarrhea and its associated clinical and socio-demographic characteristics. METHODS: The prospective hospital-based study was conducted at SVP Post Graduate Institute of Pediatrics and SCB Medical College, Odisha, India among children under-five years of age from April 2016 to July 2019. From all eligible children admitted at hospital, a case-report form containing information on clinical and socio-demographic characteristics was collected and an attempt was made to collect stool sample. A simple logistic regression method was used to assess factors associated with rotavirus diarrhea. RESULTS: Of the 1963 children, median (IQR) age was 12 (8-19) mo with a female/male ratio was 1:2.05. The prevalence of rotavirus diarrhea was 36.4% (95% CI, 34.2%-38.6%). Children in the age group of 6-11 (OR 1.64, 95% CI, 1.24-2.18), 12-23 (OR 1.73, 95% CI, 1.31-2.29) mo had higher odds of getting rotavirus diarrhea, compared to those in that of 24-59 mo. The prevalence of wasting, stunting, underweight among children with rotavirus diarrhea was 25.2% (95% CI, 22%-28.4%), 2.1% (95% CI, 1.1%-3.1%), 9.0% (95% CI, 6.8%-11.2%), respectively. CONCLUSION: The results of this study confirmed that diarrhea remains an important cause of hospitalization in children. Further studies are required in the community for Rotavirus and its genotyping.

The screening and morbidity pattern of sickle cell anemia in chhattisgarh.

Our objective was to find out prevalence of sickle cell anemia among the population of three districts (Kanker, Dantewada and Raigarh) of Chhattisgarh with clinical and hematological profile of sickle cell disease patients. A cross sectional study was done. A total of 15,701 persons collectively from three districts voluntarily attended the mobile camp and were screened for sickle cell anemia. First solubility test were done and were confirmed by Hb electrophoresis. The prevalence of sickle cell trait (HbAS) was 1,672 (10.6 %), sickle cell disease (HbSS) and inconclusive band was 97 (0.66 %). The HbSS and inconclusive band were subjected to HPLC. Among them 12 (0.076 %) cases were double heterozygous for Hb-S and beta thalassemia minor (SB+), 2 (0.012 %) cases were double heterozygous for Hb-S and Hb-E (S/HBE), 1 (0.006 %) case was double heterozygous for Hb-S and Hb-D Punjab (S/HBD) and 22 (0.14 %) cases had Hb-S with Hb-F level more than 20 % (SSF). Maximum number of HbSS cases were 13 (2.29 %) out of 567 children in the age group 0-5 years and HbAS cases were 124 (15.6 %) out of 794 persons in the age group 21-25 years. On comparison between vaso-occlusive and steady state, homozygous patients showed decrease in Hb, HCT, MCH, RBC in vaso-occlusive crises (p < 0.001) than steady state. Also there was one moderate negative correlation in number of blood transfusion (r = 0.46) with fetal hemoglobin (HbF) level. Patients with high HbF can have severe disease. This happens due to uneven distribution of fetal hemoglobin in F-cells with mean HbF remaining constant but in our study, those who had HbF level above 15-20 % were having fewer crises.

Neonatal screening of sickle cell anemia: a preliminary report.

OBJECTIVE: To evaluate feasibility of systematic neonatal screening for sickle cell disease in Chhattisgarh. METHODS: A pilot study was done from February 2008 through January 2009 in Department of Pediatrics & Neonatology, Pt. J.N.M. Medical College & Dr.B.R.A.M. Hospital, Raipur (Chhattisgarh) on a total of 1,158 neonates. Blood samples from the neonates were taken after 48 h of birth on filter paper for detection of sickle cell anemia using Biorad hemoglobin variant Neonatal sickle cell short programme by high performance liquid chromatography (HPLC). On follow up, cases were analyzed by HPLC using Beta thalassemia short program to rule out false negative case and other hemoglobin variants. RESULTS: Of the 1,158 neonates screened, 628 were boys (54.2%) and 530 were girls (45.8%). Sickle cell disease was found in 3 cases (0.2%) (95%C.I 0.12-0.28), sickle cell trait was found in 68 cases (5.8%) (95%C.I 4.5-7.5). After 6-9 mo of age three cases of sickle cell diseases were reinvestigated, out of which one case turned out to be double heterozygous for sickle cell and beta thalassemia trait. Fourteen preterm neonates reported as normal in initial screening were called for follow up after 6 mo of age, 10 infants reported in OPD and 4 lost in follow up. These 10 infants were reinvestigated; 2 had sickle cell disease, 1 had sickle cell trait and 7 infants were normal. Sixty eight cases of sickle cell trait found with initial screening were also called for follow up after 6 mo of age; 61 cases reported in OPD between 6 mo to 1 y of age and 7 cases lost in follow up. Sixty one infants were reinvestigated; 60 had sickle cell trait and 1 had sickle cell disease which was reported earlier as Sickle cell trait (FAS). Thus on total follow up of cases, there were 5(0.4%) sickle cell disease, 61(5.26%) sickle cell trait, 1(0.08%) double heterozygous for sickle cell and beta thalassemia trait which needs mutation studies for thalassemia characterization (s/ß(0) or s/ß(+)). CONCLUSIONS: Early detection of sickle cell disease (SS) done by neonatal screening will help in early prevention and management of complications in postnatal period.