Rotavirus gastroenteritis in Indian children < 5 years hospitalized for diarrhoea, 2012 to 2016.

BACKGROUND: In 2016, the Government of India introduced the oral rotavirus vaccine (ROTAVAC, Bharat Biotech, India) in 4 states of India as part of the Universal Immunization Programme, and expanded to 5 more states in 2017. We report four years of data on rotavirus gastroenteritis in hospitalized children < 5 years of age prior to vaccine introduction. METHODS: Children from 7 sites in southern and northern India hospitalized for diarrhoea were recruited between July 2012 and June 2016. Stool samples were screened for rotavirus using enzyme immunoassay (EIA). The EIA positive samples were genotyped by reverse-transcription polymerase chain reaction. RESULTS: Of the 5834 samples from the 7 sites, 2069 (35.5%) were positive for rotavirus by EIA. Genotyping was performed for 2010 (97.1%) samples. G1P[8](56.3%), G2P[4](9.1%), G9P[4](7.6%), G9P[8](4.2%), and G12P[6](3.7%) were the common genotypes in southern India and G1P[8](36%), G9P[4](11.4%), G2P[4](11.2%), G12P[6](8.4%), and G3P[8](5.9%) in northern India. CONCLUSIONS: The study highlights the high prevalence of rotavirus gastroenteritis in India and the diversity of rotavirus genotypes across different geographical regions. Pre- vaccine surveillance data is necessary to evaluate the potential change in admission rates for gastroenteritis and circulating rotavirus genotypes after vaccine introduction, thus assessing impact.

Leveraging the National Rotavirus Surveillance Network for Monitoring Intussusception.

OBJECTIVE: To assess feasibility of monitoring intussusception by hospitals participating in the National Rotavirus Surveillance Network. METHODS: Questionnaire-based survey in 28 hospitals. One hospital with electronic records selected for detailed data analysis. RESULTS: There was 75% response to the questionnaire. Few network hospitals were suitable for monitoring intussusception in addition to ongoing activities, but there was at least one potential sentinel hospital in each region. The hospital selected for detailed data analysis of cases of intussusception reported an incidence rate of 112 per 100,000 child years in infants. Over 90% of intussusceptions were managed without surgery. CONCLUSIONS: Selection of sentinel hospitals for intussusception surveillance is feasible and necessary, but will require training, increased awareness and referral.

Prevalence of rotavirus diarrhea among hospitalized under-five children.

OBJECTIVE: To estimate the prevalence of rotavirus diarrhea among hospitalized children less than 5 years of age in Kerala State and to determine the circulating strains of rotavirus in Kerala. DESIGN: Multicenter, cross-sectional study. SETTING: Eight representative hospitals in Kunnathunadu Thaluk, Ernakulam district, Kerala. PARTICIPANTS: Children in the age group under 5 years. METHODS: Hospitalized children admitted with acute diarrhea were examined and standardized case report form was used to collect demographic, clinical and health outcome. Stool specimens were collected and ELISA testing was done. ELISA rotavirus positive samples were tested by reverse transcription PCR for G and P typing (CMC Vellore). RESULTS: Among the 1827 children, 648 (35.9%) were positive for rotavirus by the Rotaclone ELISA test. The prevalence of rotavirus diarrhea in infants less than 6 months of age was 24.7%; 6- 11 months 31.9%; 12- 23 months 41.9%; 24- 35 months 46.9%; and 33.3% in 36- 59 months. Rotavirus infections were most common during the dry months from January through May. G1P[8] (49.7%) was the most common strain identified followed by G9P[8] (26.4%), G2P[4] (5.5%), G9P[4] (2.6%) and G12P[6] (1.3%). CONCLUSIONS: The prevalence of rotavirus diarrhea among hospitalized children less than 5 years is high in Ernakulam district, Kerala State.

Pre-operative lymphoscintigraphy before sentinel lymph node biopsy for breast cancer.

Pre-operative lymphoscintigram for axillary sentinel lymph node biopsy (SLNB) may not be required for successful SLNB. The 117 consecutive patients who underwent SLNB had pre-operative lymphoscintigraphy. The operating surgeon was blinded to the results of the lymphoscintigram before SLNB. After SLNB was complete, the surgeon was unblinded to the results of the lymphoscintigram; re-exploration carried out if more nodes were predicted on the lymphoscintigram. 116 patients (99%) had successful SLNB before unblinding. In 85 patients (73%), operative findings corresponded with scintigraphic findings. In 26 patients (22%), the lymphoscintigram predicted more sentinel nodes than had been found; further nodes were identified and excised in only 4 patients (3%). None were positive for cancer. SLNB was successful in 99% of cases without pre-operative lymphoscintigraphy. Only 3% of patients had further nodes identified as a result of the lymphoscintigram. Pre-operative lymphoscintigraphy does not improve the ability to perform axillary SLNB during breast cancer surgery.

The range of neural tube defects in southern India.

During a prospective study of 3500 consecutive births from November 1985 to January 1987 at three hospitals, 40 babies were found to have neural tube defects, an extremely high incidence (11.4/1000 births). The defects comprised anencephaly (n = 18), meningomyelocele (n = 11), Arnold-Chiari deformity (n = 3), encephalocele (n = 3), iniencephaly (n = 2), and one each of occipital meningocele, spina bifida occulta, and anencephaly with rachischisis. There were significant differences in incidence between those with consanguineous and nonconsanguineous parents and those whose mothers had previously given birth to malformed infants or who had had miscarriages, and those who had not. Significantly more defects were found among stillborn and low birthweight babies, among girls, and among those whose mothers were aged between 20 and 30 years. Just over a third (14) were breech presentations, and hydramnios was present in 16 (40%).