Protective Effect of Natural Rotavirus Infection in an Indian Birth Cohort

Abstract

BACKGROUND More than 500,000 deaths are attributed to rotavirus gastroenteritis annually worldwide, with the highest mortality in India. Two successive, naturally occurring rotavirus infections have been shown to confer complete protection against moderate or severe gastroenteritis during subsequent infections in a birth cohort in Mexico. We studied the protective effect of rotavirus infection on subsequent infection and disease in a birth cohort in India (where the efficacy of oral vaccines in general has been lower than expected). METHODS We recruited children at birth in urban slums in Vellore; they were followed for 3 years after birth, with home visits twice weekly. Stool samples were collected every 2 weeks, as well as on alternate days during diarrheal episodes, and were tested by means of enzyme-linked immunosorbent assay and polymerase-chain-reaction assay. Serum samples were obtained every 6 months and evaluated for seroconversion, defined as an increase in the IgG antibody level by a factor of 4 or in the IgA antibody level by a factor of 3. RESULTS Of 452 recruited children, 373 completed 3 years of follow-up. Rotavirus infection generally occurred early in life, with 56% of children infected by 6 months of age. Levels of reinfection were high, with only approximately 30% of all infections identified being primary. Protection against moderate or severe disease increased with the order of infection but was only 79% after three infections. With G1P[8], the most common viral strain, there was no evidence of homotypic protection. CONCLUSIONS Early infection and frequent reinfection in a locale with high viral diversity resulted in lower protection than has been reported elsewhere, providing a possible explanation why rotavirus vaccines have had lower-than-expected efficacy in Asia and Africa. (Funded by the Wellcome Trust.)

Epidemiological and clinical characteristics of acute gastroenteritis according to their etiology (rotavirus or other) in children younger than 5 years old treated in a private institution in the City of Buenos Aires

“…Severity as per the Vesikari scale was worse in R+ patients, as seen in other publications. 13,14 T h e r a t e o f p a t i e n t s t h a t r e q u i r e d hospitalization was higher than the number indicated by the Hospital de Niños "Dr. Ricardo Gutiérrez" and the findings of the SPRIK study, 15 but it was similar to the number reported by the REVEAL study. 11 The proportion of R+ children out of the total number of hospitalized patients was similar to the proportion found in the Argentine multicenter study (42%) 5 and the German study (45%).…”

“…11 The proportion of R+ children out of the total number of hospitalized patients was similar to the proportion found in the Argentine multicenter study (42%) 5 and the German study (45%). 12 However, it was lower than in the publications from Chile (49%), 10 the SPRIK study (56%) 14 and the REVEAL study (60%), 11 but higher than the rate found in Brazil (15.6%). 16,17 Results from other studies from Europe and Israel were diverse.…”

Prevalence of rotavirus diarrhea among hospitalized under-five children

“…The results of G and P typing shows that the G1P [8] strain is the most common contributing half the number of cases. This finding is also [19]. The proportion of untypable strains may suggest the potential for emergence of new rotavirus strains in Kerala.…”

Human Milk Contains Novel Glycans That Are Potential Decoy Receptors for Neonatal Rotaviruses

“…DISCUSSION We analyzed VP8* domains from three strains of RV with different clinical characteristics (supplemental Table S6) for binding on HM-SGM-v2. Human N155 belongs to the G10P [11] genotype and has been associated with a high incidence of gastrointestinal symptoms and asymptomatic infections in neonates in India (77)(78)(79)(80). RV3 belongs to the G3P [6] genotype, associated with asymptomatic infections in neonates and found to be protective against subsequent severe gastroenteritis in these infants (81).…”