Infectious etiology of intussusception in Indian children less than 2 years old: a matched case-control analysis.

BACKGROUND: Enteric infections are hypothesized to be associated with intussusception in children. A small increase in intussusception following rotavirus vaccination has been seen in some settings. We conducted post-marketing surveillance for intussusception following rotavirus vaccine, Rotavac introduction in India and evaluated association of intussusception with enteric pathogens. METHODS: In a case-control study nested within a large sentinel hospital-based surveillance program in India, stool samples from 272 children aged less than 2 years admitted for intussusception and 272 age-, gender- and location-matched controls were evaluated with Taqman array card based molecular assays to detect enteric viruses, bacterial enteropathogens and parasites. Matched case-control analysis with conditional logistic regression evaluated association of enteropathogens with intussusception. Population attributable fractions (PAF) were calculated for enteropathogens significantly associated with intussusception. RESULTS: The most prevalent enteropathogens in cases and controls were enteroaggregative Escherichia coli, adenovirus 40/41, adenovirus C serotypes and enteroviruses. Children with intussusception were more likely to harbor adenovirus C serotypes (adjusted odds-ratio (aOR) = 1.74; 95% confidence interval (CI) 1.06-2.87) and enteroviruses (aOR = 1.77; 95% CI 1.05-2.97) than controls. Rotavirus was not associated with increased intussusception risk. Adenovirus C (PAF = 16.9%; 95% CI 4.7% - 27.6%) and enteroviruses (PAF = 14.7%; 95% CI 4.2% - 24.1%) had the highest population attributable fraction for intussusception. CONCLUSION: Adenovirus C serotypes and enteroviruses were significantly associated with intussusception in Indian children. Rotavirus was not associated with risk of intussusception.

Epidemiology of Acute Gastroenteritis Caused by Rotavirus among Children Less than Five Years Old Admitted in Hospital, in North India.

OBJECTIVES: To report the data of burden of rotaviral acute gastroenteritis in under-five children from two states post-introduction of the vaccine. METHODS: Children under 5 y of age hospitalized with diarrhea from the states of Haryana and Himachal Pradesh in north India were recruited in the study. Commercially available ELISA kits were used for testing rotavirus in the collected stool samples. Genotyping of the positive samples was done by reverse-transcription polymerase chain reaction. RESULTS: Out of 345 samples collected, 69 (20%) were found to be positive for rotavirus by ELISA. Genotyping was done and G3P[8] (31.3%), G1P[8] (13.4%), G2P[4] (13.4%) were found to be prevalent strains. Mixed strains were also found in 19.4% stool samples. CONCLUSIONS: The study highlighted the high burden of rotavirus associated diarrhea in north Indian states. The data is helpful for evaluating the impact of vaccine on the severity of acute gastroenteritis and the changing strains after the introduction of rotavirus vaccine in the Universal Immunization Program.

Clinicoepidemiological Profile and Genetic Characterization of Circulating Rotavirus Strain among Children < 5 Years Hospitalized for Acute Gastroenteritis in Western Rajasthan, India.

OBJECTIVE: To determine the clinical and epidemiological profile and circulating strains of rotavirus among children less than 5 y of age hospitalized for diarrhea in a tertiary care center of western Rajasthan. METHOD: Children < 5 y of age admitted for acute gastroenteritis were recruited in this hospital-based surveillance study. Detailed clinical history and sociodemographic information was collected for all enrolled children. Severity of the gastroenteritis was assessed using the 20-point Vesikari Clinical Severity Scoring System. Rotavirus positivity was tested in the stool samples collected from children by commercially available techniques and further molecular characterization done as per defined protocol. RESULTS: Out of 1055 enrolled children, overall positivity rate of typable rotavirus was 18.95% (169/892). Among children who were less than 24 mo of age, positivity due to rotavirus diarrhea was maximum (24.4%). Distinct seasonality was observed as maximum cases of rotavirus diarrhea were detected in the months of December to February. Commonest G type was G3 (54%) followed by G1 (19%) while predominant P type was P[8] (77%) followed by P[4] (11%). G3P[8] (51.83%) was the commonest genotype observed in the study region. CONCLUSION: The current study found positivity of rotavirus to be 18.95% among children aged 0-59 mo admitted due to acute gastroenteritis is a tertiary care setting in northern part of India. Emergence of newer predominant strains emphasizes the need of continued surveillance to determine the changing trends.

Epidemiology and Genotype Distribution of Rotavirus Gastroenteritis in Under-Five Children of South Rajasthan, India.

OBJECTIVE: To determine the epidemiology of rotavirus diarrhea and its genotypes distribution among under five children from Udaipur, Rajasthan. METHODS: Hospital-based prospective study among children aged 0-59 mo of age hospitalized due to acute gastroenteritis and assess the clinical and epidemiological profile. Stool samples collected during 2017-2019 from 734 children, were tested by enzyme immune assay (EIA) to identify rotavirus and the samples that were positive were subjected to genotyping using published methods. RESULTS: Rotavirus was detected in 12.94% (95/734) of the stool samples. Maximum positivity (38.9%) was seen in children aged 12-23 mo followed by 34.7% in 6-11 mo of age. Detection rates were higher (46.31%, 44/95) during winter months of December-February; 65% children with rotavirus diarrhea had severe dehydration followed by moderate dehydration in 32% of cases. G3P[8] (40, 43.01%) was the commonest genotype followed by G9P[4] (10, 10.75%). CONCLUSION: Among under-five children hospitalized due to acute gastroenteritis in a tertiary care setting in Udaipur, Rajasthan, 12.9% of children were rotavirus positive with predominant (43.01%) circulation of G3P[8] strains.

Rotavirus Gastroenteritis Hospitalizations Among Under-5 Children in Northern India.

OBJECTIVE: To study epidemiological profile, prevalence, and molecular epidemiology of RVGE in hospitalized under-5 children at a tertiary care teaching rural hospital located in sub-Himalayan belt of Northern India. METHODS: This was a hospital-based surveillance study done over 4 y (2016-2019) including under-5 children hospitalized with acute gastroenteritis (AGE). Demographic and clinical parameters were recorded in a pre-designed performa. After consent, stool samples were collected and sent to Christian Medical College (CMC), Vellore for RV screening by enzyme immunoassay (EIA). Each EIA-positive sample was further subjected to G and P typing using published methods. RESULTS: Out of total 851 included children, rotavirus gastroenteritis (RVGE) was detected in 23.03% (196/851) cases by EIA. The highest incidence for RVGE-positive cases (40.43%) was observed in 2016 with gradual decline over next 3 y. Maximum cases of diarrhea were observed in 12-23 mo age group along with highest rotavirus detection. G3P[8] was most common genotype (46.94%) found, followed by G1P[8] (13.78%), G2P[4] (4.59%), G1P[6] (8.16%) and G9P[4] (3.57%). Mixed genotype was seen in 13.78% of total cases. CONCLUSION: This study summarizes the changing trends in the epidemiology of RVGE in Northern India along with the major circulating genotypes postvaccine introduction.

Rotavirus Gastroenteritis Hospitalizations Among Under-Five Children in Bhubaneswar, Odisha, India.

OBJECTIVE: To report rotavirus-associated AGE (AGE) profile of admitted children among vaccine-introduced areas in Bhubaneswar, Odisha. METHODS: This study was conducted between 2016 and 2019 at the Capital Hospital, Jagannath hospital and Hi-Tech Medical College and Hospital. All AGE patients below five years old, hospitalized in the study facilities were enrolled. A stool sample was collected and transported to the central laboratory (Christian Medical College, Vellore) for rotavirus antigen detection and genotyping. Clinical and demographic information was collected using a predesigned case report format (CRF). RESULTS: Out of the 1213 stool samples, 447 (36.9%) were identified to have rotavirus with 350 (78.3%) of them belonging to 6 mo to 2 y age group. Rotavirus gastroenteritis exhibited a single peak from November to February. A total of 414 (92.6%) of rotavirus gastroenteritis children had severe or very severe dehydration with odds of rotavirus diarrhea leading to severe dehydration being 1.5 (95% CI, 1-2.4) compared to moderate dehydration. The common genotype combination was G3P[8] (46%) followed by G1P[8] (19%), G2P[4] (5%), and G9P[4] (3%). CONCLUSION: Rotavirus gastroenteritis peaked between December to February while the most common genotype combination among the rotavirus GE was G3P[8] and G1P[8]. The present study provides the clinical profile of admitted children in the hospitals with diarrhea and the circulating strains of rotavirus which will help in documenting the epidemiology and the performance of vaccine against the disease in the state.

Demographic Profile and Genotypic Distribution of Rotavirus Gastroenteritis from Rural Haryana, India.

OBJECTIVE: To know the prevalence of rotavirus among hospitalized <5 y children, their demographic profile and genotypic distribution of rotavirus strain from tertiary care center of rural Haryana. METHODS: An observational 3-year study done from June 2016 to June 2019 where children under 5 y of age hospitalized for acute gastroenteritis were enrolled. Various demographic, environmental, and clinical parameters were assessed. Stool samples were collected and sent to CMC, Vellore for rotavirus screening by enzyme immune assay (EIA) and RV-positive samples were genotyped using reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Out of 444 stool sample screened, 107 were positive (24.1%) for rotavirus. RV positive cases seen mostly in 6-24 mo age group with moderate to severe dehydration at presentation and peaks in winter months (Dec - Feb). G3P[8] (35.24%) is the most prevalent genotype identified followed by G1P[8] (20.95%), G1P[6] (11.43%), G2P[4] (6.67%) and G12P[8] (2.86%). CONCLUSION: Continuous surveillance is required to monitor the circulating genotypes in postvaccination phase and assess the effectiveness and impact of the vaccine.

Rotavirus Gastroenteritis in Eastern Uttar Pradesh, India.

OBJECTIVE: To identify cases of rotavirus diarrhea in Uttar Pradesh among children less than 5 y of age presenting with acute gastroenteritis, to study the clinical profile of the cases and to identify the rotavirus genotypes. METHODS: Any child who is 0-59 mo of age who is admitted to the study facility with diarrhea as the presenting complaint were enrolled into the surveillance after obtaining informed consent. Clinical history and sociodemographic information was recorded for all the patients. Patients with dehydration were treated as per standard protocol. Stool samples were collected for isolation of rotavirus and identification of its genotype. RESULTS: Of the 418 stool specimens collected, rotavirus was isolated in 47 (11.33%) samples. Rotavirus gastroenteritis was most common below the age of two years. A significant difference in the clinical characteristics between children who were positive for rotavirus and those who tested negative were not observed in this study. But patients with rotavirus diarrhea had longer duration of hospital stay (OR 3.31; CI 1.24-8.87). The outcome was similar in the two groups (OR 2.64; CI 0.27-25.89). G3P[8] was the most common type genotype isolated in 13 (28.89%) patients followed by G2P[4] in 7 (15.56%) patients. Thirteen patients (28.89%) had mixed genotype. CONCLUSION: Rotavirus diarrhea was most common below two years of age. G3P[8] was the most common genotype identified.

Gastroenteritis in Haryana, India Post Introduction of Rotavirus Vaccine.

OBJECTIVE: To evaluate the epidemiology of rotavirus gastroenteritis in Haryana post-introduction of rotavirus vaccine. Expanded National rotavirus surveillance network in India reported high burden of rotavirus diarrhea in India. The Government of India introduced the monovalent rotavirus vaccine made in India by Bharat Biotech in the national immunization programme from 2016 onward along with oral polio vaccine (OPV) and Pentavalent vaccines. METHODS: A multi-centric, hospital-based surveillance study in the initial vaccine introducing states was started in a phased manner over a period of 3 y. PGIMS, Rohtak is a tertiary care center and was a part of the surveillance from 2016 to 2019. Children aged 0-59 mo admitted with acute gastroenteritis were enrolled into the surveillance and their stool samples were collected. Samples were tested at Christian Medical College (CMC), Vellore to detect rotavirus and reverse transcription-polymerase chain reaction (RT-PCR) was used for G and P typing. RESULTS: A total of 904 children were enrolled in the present surveillance over a period of 3 y starting 1st July 2016 to 30th June 2019. Stool samples were collected and analyzed for 827 children and out of them 141 samples were positive for rotavirus (17.1%). Maximum rotavirus positivity was observed during the winter months. Rotavirus positivity percentage was observed maximum in 12-23 mo age group. A declining trend was observed in rotavirus positivity from 22.8% in 2016 to 14.5% in 2019. Most common strains of rotavirus isolated were G3P[8] followed by G1P[8]. CONCLUSION: This study highlights that epidemiology of acute gastroenteritis among children less than 5 y of age in Haryana postintroduction of rotavirus vaccination in the state and the decline in rotavirus positivity from 22.8% in 2016 to 14.5% in 2019.

Epidemiology of Intussusception Hospitalizations in Children Under 2 Years of Age Post Rotavirus Vaccine Introduction in Tamil Nadu and Puducherry, India.

OBJECTIVE: High burden of rotavirus associated diarrhea has been documented among Indian children. The phased introduction of an indigenous rotavirus vaccine 'ROTAVAC' in India's national immunization programme began in 2017. Phase-III trial showed the vaccine to have a low-intussusception-risk profile. However, evaluation of post-licensure trends of intussusception is necessary to assess potential vaccine-associated intussusception risk. This study's objective was to describe the epidemiology of intussusception hospitalizations in children under two years of age in Tamil Nadu and Puducherry following ROTAVAC introduction. METHODS: A cross-sectional surveillance was established in six hospitals in Tamil Nadu and Puducherry. Children under two years of age with intussusception fulfilling Brighton Collaboration's criteria for level 1 diagnostic certainty were enrolled. Patient and disease characteristics were captured using a standardized questionnaire. Descriptive and inferential statistical analyses were performed using Stata Version 13. RESULTS: Overall, 287 cases were enrolled and had a median age of seven months. Frequently presenting symptoms were vomiting (78%), abdominal pain (76%), and blood in stool (71%). Abdominal ultrasonography or radiography confirmed diagnosis in 65% of cases and managed by nonoperative measures. Remaining 35% of cases were diagnosed and managed with surgery. Over 98% of the cases had positive treatment outcomes. Age less than five months (OR = 4.36), and hospitalization at a state government health facility (OR = 5.01) were significant predictors for children to receive surgical management. CONCLUSIONS: The present study documents the epidemiology of intussusceptions immediately after the rollout of rotavirus vaccine in Tamil Nadu and Puducherry. No appreciable increase in intussusception hospitalizations was seen in the study hospitals after vaccine introduction.

Rotavirus Diarrhea in Hospitalized Under-5 Children in Madhya Pradesh, India and the Prevalent Serotypes After Vaccine Introduction.

OBJECTIVE: To report epidemiology of rotavirus gastroenteritis among under-five children hospitalized for acute diarrhea after the introduction of vaccine in Madhya Pradesh. METHODS: Children hospitalized for diarrhea between August 2017 and December 2019 were recruited. Stool sample was collected and shipped to Christian Medical College (CMC), Vellore maintaining proper cold chain. Samples were then screened for rotavirus using enzyme immunoassay (EIA). The samples that were positive for rotavirus were further genotyped by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: Of the 794 stool samples collected, 150 (18.8%) samples were positive for rotavirus. Highest positivity was seen in winter months and in children less than 2 y of age. G3P[8] was found to be the most prevalent serotype. CONCLUSIONS: The study highlights lowering prevalence of rotavirus gastroenteritis in the authors' region post vaccine introduction. It also highlights the change in prevalent serotypes.

Rotavirus Diarrhea and its Determinants Among Under-Five Children Admitted in a Tertiary Care Hospital of Southern Haryana, India.

OBJECTIVE: To estimate the prevalence of rotavirus diarrhea and its demographic, social, and clinical characteristics among children less than five years of age admitted in a rural tertiary care institute. METHODS: This prospective hospital-based observational study was carried out during February 2016 to June 2019. Diarrheal admissions of children aged 0-59 mo were screened and those who met the inclusion criteria were included in the study. Sociodemographic and clinical information was collected using a case report form. Stool samples were collected within 48 h of admission and transported in cold chain every month to the referral laboratory situated at Christian Medical College for testing. RESULTS: Among the children admitted with acute diarrhea, 148 (11.02%) were positive for rotavirus in the study. As per Vesikari scoring system, around three fourth (76.2%) of children were having severe or very severe diarrhea. Severity of diarrhea was more among rotavirus positive cases as assessed by the Vesikari scoring system. The rotavirus diarrhea showed a peak during November to February. CONCLUSION: Rotavirus diarrhea is an issue of public health importance, particularly due to its association with the severe diarrhea. As evidenced from similar settings in the world, rotavirus vaccine introduction and increased coverage is the most important strategy towards prevention and control of rotavirus diarrhea.

Acute Gastroenteritis in Children Below 5 Years of Age at Tirupati, Andhra Pradesh, India Post Introduction of Rotavirus Vaccine into National Immunization Programme.

OBJECTIVE: To identify the burden of rotavirus acute gastroenteritis (AGE) and the genotypes presenting in the authors' area in the period after introduction of rotavirus vaccine in Universal Immunization Programme (UIP). METHODS: Children aged less than 5 y and presenting to hospital for the treatment of AGE were enrolled into the study from January 2016 to June 2019. Clinical details including age, gender, extent of illness, number of stools, concomitant vomiting and fever, grade of dehydration, and associated illness were recorded. Stool samples were tested for rotavirus using a commercially available ELISA Kit. Genotyping was performed for the rotavirus antigen-positive samples. RESULTS: Rotavirus positive AGE was seen in 14.2% of the children. High burden of rotavirus gastroenteritis was seen in the age group of 6-23 mo and more cases were observed from December to February months. In our region the prevalent rotavirus genotypes in positive samples are G3 and G1 in G-typing, P[8] and P[4] in P-typing, respectively. G3P[8] and G1P[8] are the most prevalent genotypes identified in our area with a frequency of 35.1% and 25.9%, respectively. Almost all the cases (97.7%) got discharged and only one patient has died. CONCLUSION: The findings conclude a declining trend in the rotavirus positive AGE cases in the authors' area after introduction of Rotavac vaccine in the UIP.

Rotavirus Gastroenteritis in Western Uttar Pradesh, India.

OBJECTIVE: To establish hospital-based surveillance to identify cases of rotavirus (RV) among children < 5 y of age hospitalized for acute gastroenteritis (AGE) and to determine the burden and profile of circulating RV genotypes in the region. METHODS: This study was conducted at a tertiary level hospital in Bijnor district of western Uttar Pradesh, India from January 2018 to January 2020. The duly filled case reporting forms and specimens of all the enrolled children were transported in cold chain to the referral laboratory at Christian Medical College (CMC), Vellore on a monthly basis for testing and storage of stool samples as well as data entry and analysis. RESULTS: A total of 1055 under-5 children admitted with AGE, were enrolled. Proper stool specimens were collected from 932 children. Rotavirus was found positive in 368 (39.5%) stool specimens. Marked seasonality was observed in RV-positive cases with the highest incidence was noticed during winter months. The 0-11 mo age group had the highest incidence of RV-GE followed by 12-23 mo. G1 (42.08%) was the most frequent G-type whereas G1P[8] (26.23%) was the commonest circulating genotype. CONCLUSION: The study confirms a significant burden of RV among AGE cases in young children in western Uttar Pradesh. The findings of the study may serve as useful baseline information to the Government of India for assessing vaccine performance after its introduction in the national immunization programmes.

Nutritional Assessment and its Association with Rotavirus Positivity Among Under Five Children Admitted with Diarrhea in a Tertiary Care Hospital of Southern Haryana, India.

OBJECTIVE: To estimate the burden of undernutrition and its association with rotavirus positivity among under-five children admitted with diarrhea. METHODS: This prospective observational study was carried out in hospital-setting from February 2016 to January 2020. For all cases who met the eligibility criteria, an informed written consent was obtained from parents/caregivers. A case report form was used to collect sociodemographic, anthropometric and clinical data. The anthropometric measurements of children were performed according to World Health Organization (WHO) guidelines. RESULTS: Nutritional assessment revealed that 74.1% study subjects were underweight [Weight-for-Age (WAZ) < -2], 59% were stunted [Height-for-Age (HAZ), < -2] and 52.3% were wasted Body Mass Index (BMIZ) < -2]. Stunting was found to be significantly higher among boys as compared to girls and rotavirus positive diarrhea was significantly less prevalent among stunted children. CONCLUSION: There exists a very high prevalence of underweight, stunting, and wasting among hospitalized children with diarrhea. As the better nutrition has not been shown to guard against rotavirus diarrhea, coverage scale-up of rotavirus vaccination, improved hygiene and sanitation, and focussed nutrition programmes are the need of the hour in India.

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.

A Hospital-Based Multi-Centric Study to Determine the Clinico-Epidemiological Profile of Intussusception in Children < 2 Years in Rajasthan, India.

OBJECTIVE: To determine the clinical and epidemiological profile of Intussusception in children aged <2 y after introduction of rotavirus vaccine in Universal Immunization Programme of Rajasthan. METHOD: This was a hospital-based multi-centric surveillance study conducted at three tertiary care sentinel sites in Rajasthan over a period of 2 y. Children <2 y of age admitted with intussusception as per Brighton's criteria 1 were enrolled. Demographic details including age, sex, clinical presentation, diagnostic methods, duration of symptoms, mode of treatment, and complications were recorded and analyzed. RESULTS: During the study period of 2 y, the authors identified 164 cases of intussusception based on level-1 Brighton's criteria. Median age at presentation was 7 mo [Interquartile range (IQR) 5-10 mo] with a male to female ratio of 2:1. Pain abdomen and blood stained stool were the commonest presenting complaints (88.4% and 81.7%, respectively). Commonest site of intussusception was Ileocolic (82.32%). Pathological lead point was identified in 18.9% cases. Distinct seasonality was observed as maximum cases of intussusception were detected in the months of Jan-March (34.1%). Surgical intervention was required in the 89.63% cases. The median time duration between onset of symptoms and admission at sentinel site was 2 d (IQR 1-3 d). Proportion of cases that required surgery increased as the time interval between onset of symptoms and admission increases. CONCLUSION: Intussusception is a common surgical condition among children under-two years of age with majority of cases occurring during infancy. Case management is dependent primarily on time duration elapsed between symptoms onset and admission to tertiary care centre. Early case detection and timely referral may provide an opportunity to avoid surgical interventions.

Post Vaccination Epidemiology and Genotyping of Rotavirus Gastroenteritis at a Tertiary Care Centre of North-East Rajasthan.

OBJECTIVES: To estimate the proportion of rotavirus diarrhea among hospitalized children aged under-five years, to determine the circulating rotavirus genotypes and to know impact rotavirus vaccine on prevalence and severity of rotavirus diarrhea. METHODS: This study was a hospital based cross-sectional observational study conducted over a period of 29 mo (September 2017 through January 2020). Stool samples were collected from children who fall within the age range of 0-59 mo with acute diarrhea attending emergency or needing admission. Stool samples were tested for rotavirus by the enzyme linked immune-sorbent assay (ELISA) and genotyped using published methods. RESULTS: Out of 1480 samples, 360 (24.32%) cases were positive for rotavirus by ELISA, majority of them were male (62.97%). Maximum rotavirus positivity was found in the age group of <11 mo (55.27%). Statistically significance difference was seen in episodes of diarrhea and experience of vomiting in rotavirus diarrhea cases. Highest prevalence has been seen during winter season. The most prevalent G and P type combinations were G3P [8] strains [122 (34.08%)], G2P [4] [83 (23.18%)], G1P [8] [27 (7.54%)] and G9P [4] [20 (5.59%)]. Mixed strains contribute a significant proportion of stool sample. CONCLUSIONS: Rotavirus is an important cause of diarrhea in hospitalized children. There is continued circulation of G9 and G12 strains and the emergence of G3P [8] as most common strain.

Intussusception after Rotavirus Vaccine Introduction in India.

BACKGROUND: A three-dose, oral rotavirus vaccine (Rotavac) was introduced in the universal immunization program in India in 2016. A prelicensure trial involving 6799 infants was not large enough to detect a small increased risk of intussusception. Postmarketing surveillance data would be useful in assessing whether the risk of intussusception would be similar to the risk seen with different rotavirus vaccines used in other countries. METHODS: We conducted a multicenter, hospital-based, active surveillance study at 27 hospitals in India. Infants meeting the Brighton level 1 criteria of radiologic or surgical confirmation of intussusception were enrolled, and rotavirus vaccination was ascertained by means of vaccination records. The relative incidence (incidence during the risk window vs. all other times) of intussusception among infants 28 to 365 days of age within risk windows of 1 to 7 days, 8 to 21 days, and 1 to 21 days after vaccination was evaluated by means of a self-controlled case-series analysis. For a subgroup of patients, a matched case-control analysis was performed, with matching for age, sex, and location. RESULTS: From April 2016 through June 2019, a total of 970 infants with intussusception were enrolled, and 589 infants who were 28 to 365 days of age were included in the self-controlled case-series analysis. The relative incidence of intussusception after the first dose was 0.83 (95% confidence interval [CI], 0.00 to 3.00) in the 1-to-7-day risk window and 0.35 (95% CI, 0.00 to 1.09) in the 8-to-21-day risk window. Similar results were observed after the second dose (relative incidence, 0.86 [95% CI, 0.20 to 2.15] and 1.23 [95% CI, 0.60 to 2.10] in the respective risk windows) and after the third dose (relative incidence, 1.65 [95% CI, 0.82 to 2.64] and 1.08 [95% CI, 0.69 to 1.73], respectively). No increase in intussusception risk was found in the case-control analysis. CONCLUSIONS: The rotavirus vaccine produced in India that we evaluated was not associated with intussusception in Indian infants. (Funded by the Bill and Melinda Gates Foundation and others.).