1. Guided by –
Dr. Y.D. Badgaiyan
Prof. and Head
Deptt of Community Medicine
CIMS, Bilaspur (C.G.)

2.  Diarrhea, is the third leading killer of children
in India.
 It is responsible for 13% of all deaths in
children <5 years of age.
 It kills an estimated 3,00,000 children in
India each year.

3.  Rotaviruses are the major agents causing
endemic and epidemic of diarrhea in young
children in both developed and developing
countries.
 In India, approximately 30% of hospitalized
diarrhea cases are caused by rotaviruses.

4.  In India, 1 of every 250 children die of
rotavirus diarrhea each year.
 Which is about 17 percent of the world’s
estimated rotavirus deaths.

5.  No specific treatment available but,
vaccines are available for prevention
of Rotavirus diarrhea.
 WHO’s Strategic Advisory Group of
Experts (SAGE) on immunization has
recommended inclusion of rotavirus
vaccine in the National Schedules in
countries, where < 5 mortality due to
diarrheal diseases is ≥ 10%.

6.  Before inclusion of rotavirus vaccine in
National Immunization Programme in
India, we have to consider a few laid down
criteria for an informed decision making.
 Disease burden, safety and
efficacy, affordability, programme capacity
and cost- effectiveness of the vaccination
programme are important issues.

8.  Rotaviruses have a distinct wheel like
appearance in electron microscopy,
 thus have been named rota which in latin
means wheel.
 Virus is member of the family Reoviridae, and
it has a genome of 11 segments of double-
stranded RNA.

9.  The rotaviruses are divided in seven groups
A,B,C (human and animal viruses) and D,E,F,G
(animal viruses).
 Group A rotaviruses are the most frequently
identified pathogens.

12.  Rotavirus diarrhea is most common in
children of 6-24 months age group.
 Rotavirus infections display seasonal pattern
with peak incidence in winter (Oct-Feb).
 Risk factors are overcrowding and
malnutrition.

13.  Rota viruses are transmitted by the feco-oral
route through contaminated environment.
 Respiratory route of transmission through
aerosol is also suggested.

14.  Low grade fever,
 vomiting,
 watery diarrhea,
 dehydration, and irritability.
 Tachycardia and shock, resulting in ischemic
injury to the kidneys and CNS are rare
complications.

15.  The incubation period of rotavirus diarrhoea
varies from 1-7 days.
 In newborns, the infection is usually
asymptomatic, but 8-24 per cent of neonates
may have minimal diarrhoea, and vomiting
associated with fever.

16.  In infants and young children, there is an
abrupt onset of severe vomiting and diarrhea.
 Vomiting usually precedes the onset of
diarrhoea.
 Stools are usually loose and watery, mucus
may be present in 25 per cent of cases but
blood is very rare.

17.  Mild to moderate dehydration is seen in 80
per cent of cases and severe loss of fluids
and electrolytes may be fatal if untreated.
 Mild fever is seen in a large majority of cases.

18.  The illness usually lasts 3-8 days, but virus
shedding continues for about 10 days to 1
month.
 In immunodeficient children, rotavirus can
persist for months.

19.  Older children and adults are infected but
they generally suffer from subclinical
infections and virus is infrequently detected
in their stool samples.

20.  Rotavirus is excreted in large numbers in the
faeces (>106 particles/g faeces).
 Direct EM examination of stool sample for
rotavirus is specific test and has a sensitivity
of 80-90 per cent.

21.  Other common tests are -
- LA (Latex Agglutination)
- ELISA and
- PAGE (Poly- Acrylamide Gel Electrophoresis).
 Most widely used method is ELISA.

22.  Reverse Transcriptase – polymerase chain
reaction (RT-PCR) is confirmatory methods
for detecting rotavirus in stool samples.

24.  Rotavirus is currently by far the most
common cause of severe diarrhea in infants
and young children worldwide and of
diarrheal deaths in developing countries.
 Rotavirus shows proportionately increasing
trend with time.

25.  It is estimated that rotavirus accounted for
21% hospitalized cases with diarrhea from
1986 to 1999,
 which increased to 39% of hospitalized cases
with diarrhea in the period 2000–2004.

26.  Rotavirus diarrhea causes about 6,11,000
childhood deaths (454,000–705,000).
 More than 80% of these deaths occur in low-
income countries.

27.  Based on WHO estimates, in India there is 3.2
episodes of diarrhea per child per year
(2008).
 and
 110 million episodes of diarrhea in children
under 5 year of age.

28.  Studies between 2001 and 2009 in India also
showed an increasing trend of rotavirus
isolation from 23.5% to 39.2% among
hospitalized children with diarrhea.

29.  It is postulated that improvements in
sanitation and use of antimicrobials have had
a greater impact on prevention of bacterial
and parasitic gastroenteritis (GE) , but not for
the rotavirus diarrhea.

30.  The prevalence of rotavirus in neonates is
high in India, ranging from 22% to 73% .
 Neonatal infections are commonly
asymptomatic, with 69-95% not showing
overt signs of GE.

31.  Most rotavirus disease in India occurs in the
first two years of life.
 In hospital-based studies, 87% (ISV: 58- 95%)
of all rotavirus cases in children under 5 yr
occurred by 18 months of age.

32.  Additionally, rotavirus Gastro-enteritis is
uncommon in the youngest children.
 Only 13% (ISV: 10-25%) of rotavirus cases in
hospital studies were in children younger
than 6 months old.

33.  In young children, infection with rotavirus
may be attenuated by the persistence of
maternal antibodies and thus, severe disease
is less common.

34.  Most studies in India have found association
between rotavirus infection and time of year.
 Most have observed an increase in rotavirus-
associated diarrhea during the winter
months, October to February, throughout the
country.

35.  The observed proportion of rotavirus cases
occurring in the cooler season has ranged
from 59% to 72%.
 The northern, more temperate regions may
exhibit stronger seasonality.

36.  Rotavirus isolates from India are genetically
heterogeneous.
 Such genetic diversity is characteristic of Asia
as a whole.
 It is suggested that rotavirus strains
circulating in India are part of a larger Asian
transmission pool.

37.  No specific treatment exists for rotavirus
gastroenteritis, and repeated infections are
common in children.
 Sanitation and hygiene improvements have
had a tremendous impact on diarrheal
diseases due to bacteria and parasites but
less impact on rotavirus disease.

38.  Reduced osmolality oral rehydration solution
(ORS) effectively prevents and treats
dehydration, and also reduces diarrheal
output.
 But the 2005 National Family Health Survey
found that only 26% of children with diarrhea
receive ORS.

39.  Unlike many other diarrheal pathogens, the
proportion of diarrhea caused by rotavirus
does not vary widely between developed and
developing countries.
 To date, the only specific prevention strategy
is immunization with rotavirus vaccines.

41.  Currently, two rotavirus vaccines are available
on the international market.
 1. Rotarix
 2. Rota Teq

42.  Rotarix (GlaxoSmithKline, Rixensart, Belgium)
is a mono-valent rotavirus vaccine.
 (RV1) created by attenuating a highly
antigenic strain of human G1P rotavirus.

43.  Rota Teq (Merck and Co., Whitehouse
Station, USA) is a penta-valent vaccine.
 (RV5) created by re-assorting G and P
antigens from human
rotavirus, G1, G2, G3, G4 and P with a bovine
rotavirus strain.

44.  These vaccines appear to be cross protective
against non-vaccine strains, with similar
efficacy against vaccine and non-vaccine
strains.
 In high and middle income countries, recent
introductions of RV1 and RV5 have had
remarkable impact on rotavirus disease
despite limited uptake in the under 5
population.

45.  Based on the experiences of other developing
countries, a rotavirus vaccine introduced in
India would be expected to exhibit lower
efficacy against rotavirus GE than seen in
high income countries,
 but still prevent a significant proportion of
all-cause GE mortality and hospitalizations.

46.  Live oral vaccines have had an inconsistent
performance in India and other developing
countries.
 For example, oral polio vaccine (OPV) is less
immunogenic and requires more doses to
protect children in India compared with
children in the developed world.

47.  In developing countries, higher levels of
maternal rotavirus antibodies are passively
transferred to babies during gestation and
persist in infancy.
 Other reasons for poor vaccine performance
could be a higher prevalence of distinct
medical conditions such as
tuberculosis, intestinal infections and
malnutrition.

48.  It is estimated that at current immunization
levels, a national rotavirus vaccination
program in India would prevent 27,000 to
44,000 deaths in children <5 years of age
annually.
 Rotavirus vaccine would prevent 1 case of
severe gastroenteritis disease for every 11
children immunized, and prevent one death
for every 470 children immunized.

49.  The potential impact of rotavirus vaccines in
India is partially hindered by a relatively low
proportion of children who receive routine
immunizations.
 If full immunization with rotavirus vaccine
were reached, an additional 14,000 rotavirus
deaths each year could be prevented.

50.  Improving the overall performance of the
immunization system is critical to the success
of any vaccine introduction.

52.  Rotavirus diarrhea causes substantial
mortality and morbidity in young children in
India with the greatest burden among
children <2 years of age.
 Despite the tremendous diversity of rotavirus
strains in India, rotavirus vaccines provide
cross-protection and have been shown to be
effective against both vaccine and non-
vaccine strains.

53.  At current coverage levels of routine
childhood immunizations, the introduction of
rotavirus vaccine in India could prevent up to
only one third of rotavirus-related deaths.
 Introduction of rotavirus vaccine into the
national immunization program of India at an
affordable price would be a cost effective way
to reduce the tremendous morbidity and
mortality due to rotavirus disease in Indian
children.

54. THANK YOU