A Prospective Hospital-based Surveillance to Estimate Rotavirus Disease Burden in Bhutanese Children under 5 Years of Age

Wangchuk, Sonam; Tsheten,; Tshering, Karchung; Zangmo, Sangay; Tshering, Kunzang Pem; Dorji, Tandin; Nishizono, Akira; Ahmed, Kamruddin

doi:10.2149/tmh.2014-22

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…The present study has also confirmed our previous observation that the diarrheal peak in the colder months is caused by NoV GII. This is similar to the rotavirus season in Bhutan [ 35 ]. Therefore, the peak of diarrhea during the colder months is caused by both rotavirus and NoV GII.…”

Section: Discussionsupporting

confidence: 68%

Surveillance of norovirus among children with diarrhea in four major hospitals in Bhutan: Replacement of GII.21 by GII.3 as a dominant genotype

et al. 2017

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BackgroundDiarrhea is a major cause of morbidity and mortality among Bhutanese children. The etiology of diarrhea is not well known due to the challenges of conducting routine surveillance with Bhutan’s modest research facilities. Establishing an etiology is crucial toward generating evidence that will contribute to policy discussions on a diarrheal disease control program. Our previous study, during 2010–2012, revealed that norovirus (NoV) is an important cause of diarrhea among Bhutanese children, and that GII.21 was the major genotype circulating at that time. In other countries, GII.4 is the major genotype responsible for NoV infections. In this update report, we provide new prevalence data to describe the progression of the transformation and distribution of the NoV genotype among Bhutanese children.MethodsFrom June 2013 through May 2014, diarrheal stool samples were collected at one national referral hospital in Thimphu, two regional referral hospitals in the eastern and central regions, and one general hospital in the western region of Bhutan. NoV was detected by reverse transcription–polymerase chain reaction (RT–PCR), by amplifying the capsid gene. The RT–PCR results were confirmed by nucleotide sequencing of the amplicons.ResultsThe proportion of NoV-positive stool samples was 23.6% (147/623), of which 76.9% were NoV GII and the remainders were NoV GI. The median age of infected children was 15.5 months, with a fairly balanced female: male ratio. NoV GII was most prevalent in the colder months (late November–mid April) and NoV GI had the highest prevalence in the summer (mid April–late September). Nucleotide sequencing was successful in 99 samples of GII strains. The most common genotypes were GII.3 (42.6%), GII.4 Sydney 2012 (15.8%), and GII.4 unassigned (11.9%). No GII.21 was found in any child in the present study. Phylogenetic analysis showed that GII.3 strains in the present study belonged to an independent cluster in lineage B. These strains shared an ancestor with those from different countries and Bhutanese strains circulating during 2010.ConclusionNoV remains an important cause of diarrhea among Bhutanese children. Genotype GII.3 from a single ancestor strain has spread, replacing the previously circulating GII.21. Current NoV genotypes are similar to the strains circulating worldwide but are primarily related to those in neighboring countries. NoV GII is prevalent during the cold season, while GI is prevalent during the summer. To develop a NoV infection control policy, further studies are needed.

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Section: Discussionsupporting

confidence: 68%

Surveillance of norovirus among children with diarrhea in four major hospitals in Bhutan: Replacement of GII.21 by GII.3 as a dominant genotype

et al. 2017

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“…The findings from this study showed clear seasonal patterns in diarrhoeal incidence with two peaks every year, December–January and the largest peak occurring in June, at the same time that temperature and rainfall demonstrate seasonal peaks. A study in the capital city Thimphu showed that rotavirus infection was highest during the winter-spring (December–April) season, while diarrhoea was highest during the summer (May–July) [ 29 ]. Similar significant peaks of rotavirus were observed during the cold months in India [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Spatial and temporal patterns of diarrhoea in Bhutan 2003–2013

Wangdi

Clements

2017

BMC Infect Dis

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BackgroundTo describe spatiotemporal patterns of diarrhoea in Bhutan, and quantify the association between climatic factors and the distribution and dynamics of the disease.MethodsNationwide data on diarrhoea were obtained for 2003 to 2013 from the Health Information and Management System (HIMS), Ministry of Health, Bhutan. Climatic variables were obtained from the Department of Hydro Met Services, Ministry of Economic Affairs, Bhutan. Seasonal trend decomposition was used to examine secular trends and seasonal patterns of diarrhoea. A Bayesian conditional autoregressive (CAR) model was used to quantify the relationship between monthly diarrhoea, maximum temperature, rainfall, age and gender.ResultsThe monthly average diarrhoea incidence was highly seasonal. Diarrhoea incidence increased by 0.6% (95% CrI: 0.5–0.6%) for every degree increase in maximum temperature; and 5% (95 Cr I: 4.9–5.1%) for a 1 mm increase in rainfall. Children aged <5 years were found to be 74.2% (95% CrI: 74.1–74.4) more likely to experience diarrhoea than children and adults aged ≥5 years and females were 4.9% (95% CrI: 4.4–5.3%) less likely to suffer from diarrhoea as compared to males. Significant residual spatial clustering was found after accounting for climate and demographic variables.ConclusionsDiarrhoea incidence was highly seasonal, with positive associations with maximum temperature and rainfall and negative associations with age and being female. This calls for public health actions to reduce future risks of climate change with great consideration of local climatic conditions. In addition, protection of <5 years children should be prioritize through provision of rotavirus vaccination, safe and clean drinking water, and proper latrines.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2611-6) contains supplementary material, which is available to authorized users.

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“…The occurrence of RVGE peaks in children 4 to <24 months of age [19][20][21][22], which is also the population at the highest risk of severe disease requiring hospital admission. Temporal and spatial variations in RVGE incidence were observed with a peak in rotavirus incidence during the winter months, lasting until early spring [17,19,[22][23][24][25]. Year-round circulation of rotavirus was common in tropical areas, with peaks occurring during the cooler, dryer months of the year, periods of the year that vary between countries in the Northern or Southern Hemispheres [20,26].…”

Section: Epidemiology Of Rvge 31mentioning

confidence: 99%

A review of rotavirus vaccine use in Asia and the Pacific regions: challenges and future prospects

Buchy¹,

Chen²,

Zhang³

et al. 2021

Expert Review of Vaccines

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A Prospective Hospital-based Surveillance to Estimate Rotavirus Disease Burden in Bhutanese Children under 5 Years of Age

Cited by 8 publications

References 24 publications

Surveillance of norovirus among children with diarrhea in four major hospitals in Bhutan: Replacement of GII.21 by GII.3 as a dominant genotype

Surveillance of norovirus among children with diarrhea in four major hospitals in Bhutan: Replacement of GII.21 by GII.3 as a dominant genotype

Spatial and temporal patterns of diarrhoea in Bhutan 2003–2013

A review of rotavirus vaccine use in Asia and the Pacific regions: challenges and future prospects

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