Natural rotavirus infection in Indian children

January 01, 0001

Natural rotavirus infection in Indian children

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. These investigators from multiple countries 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). They recruited children at birth in urban slums in Vellore; they were followed for 3 years after birth. 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.

They found: "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 authors concluded: "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."

Neither vaccine nor natural rotavirus infection is providing good immunity for small children in India.

For the full abstract, click here.

N Engl J Med N Engl J Med 2011; 365:337-346, 28 July 2011 © 2011 to the Massachusetts Medical Society
Protective Effect of Natural Rotavirus Infection in an Indian Birth Cohort. Beryl P. Gladstone, Sasirekha Ramani, Indrani Mukhopadhya, et al. Correspondence to Dr. Kang: [email protected]

Category: D. Digestive, B. Blood/Immune mechanisms. Keywords: rotavirus, diarrhea, children, India, seroconversion, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 16 August 2011

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