ONE-STEP DETECTION OF CONCOMITANT INFECTIONS, AND EPIDEMIOLOGIC PROFILE OF ROTAVIRUS, ADENOVIRUS, ASTROVIRUS AND NOROVIRUS DIARRHEA IN NIGERIAN INFANTS: IMPLICATIONS FOR DIARRHEA BURDEN Page No: 4381-4394

By: Michael Oluyemi Babalola

Keywords: Ado Ekiti, co-infection, diarrhea, rota+adeno+astronoro, infants

Abstract: The etiology of infective diarrhea is polymicrobial, but erroneously attributable to teething in infants and young children in the community. In a resource limited setting, where diarrhea illness significantly contributes to hospitalization and mortality of children, we investigated the rapid simultaneous detection and epidemiologic profile of the four major enteric viruses of diarrhea, for prompt diagnosis, appropriate care / treatment, and prelude to instituting timely interventions to mitigate the burden of viral diarrhea disease in developing countries. In an hospital-based cross sectional descriptive study, convenience sampling was adopted to obtain 175 stool specimens after parental consent, from under -5 years children who sought treatment for acute diarrhea disease from August 2012 to July 2014 at a Tertiary teaching Hospital in Ado Ekiti, Nigeria. The specimens were tested for concurrent detection of concomitant infection by the target viruses, using the CerTest® 4th generation quadruple Immuno chromatographic assay, and the data generated were analyzed quantitatively. At least one viral agent was detected in 103/175 (59%) respondents. Single infection occurred in 87/103 (84.5%) and co-infections in 16/103 (15.5%), comprising 14/16 (87.5%) respondents with dual, and 2/16 (12.5%) with triple infections. The most prevalent virus was Rotavirus with a rate of 16% (28/175), Adenovirus was 12.6% (22/175), Astrovirus was 8.6% (15/175), while Norovirus was 12.6% (22/175). The prevalent age at infection by Rotavirus and Adenovirus were in children aged 0-6 months with 50% and 18.8% respectively, followed by Norovirus (27.3%) in children aged 19-24 months, while Astrovirus and Norovirus were 21.4% respectively in children aged 25-30 months. Coinfection by rotavirus + adenovirus was 6.3% in children 0-6 months; rotavirus + norovirus was 9.1% in children aged 19 - 24 months; adenovirus + norovirus was 3.6% in 13 - 18 months; astrovirus + norovirus was 7.1% in 25 - 30 months; and rotavirus + astrovirus + norovirus was 9.1% in children aged 13 - 18 months. The four viruses showed seasonal cluster in the dry months of Nov 2012 and 2013, followed by each of Rotavirus, Adenovirus and Norovirus in the months of December 2012 - February 2013, and December 2013 - February 2014. Rotavirus and Adenovirus slightly occurred year round with monthly peaks in Jan, Feb, and April. Astrovirus was detected consistently in the months of August - November 2012, and 2013, respectively. About 60% of acute gastroenteritis in hospitalized under-5 children were caused by at least one of the four major etiologies of viral diarrhea. Co-infection of children by the enteric viruses was high. A paradigm shift in preponderance from rotavirus to adenovirus or astrovirus is anticipated in the future. The concomitant infection by these viruses have significant implications for the burden of diarrhea disease, treatment outcomes, development of cocktail of viral diarrhea vaccines, implementation of immunization, and monitoring the success of vaccination in the children



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