Tuesday, July 15, 2008

Surveillance of rotavirus diarrhea: A new frontier for the mature EPI in Sri Lanka
( Abstract of the presentation made at the Rotavirus symposium in Istanbul, Turkey, on 3-4 June 2008 )
Wijesinghe PR1 , Batuwanthudawe R1, Galagoda G 2, Abeysinghe MRN1, De Silva S3, Nyambat B4, Kirkwood CD5, Kilgore PE4
Correspondence – Gunathilake@khalsa.com
1Epidemiology Unit, Ministry of Health, 2Medical Research Institute, 3Lady Ridgeway Hospital for Children, Colombo, Sri Lanka; 4International Vaccine Institute, Seoul, Korea; 5Murdoch Childrens Research Institute, Melbourne, Australia.

Background
Over the past several years there has been a dramatic decline in diarrhea-specific mortality rates and diarrhoea-related case fatality among infants and children in Sri Lanka. Despite this reduction in deaths, diarrhoea-specific morbidity continues to impose a heavy burden on the health care system with diarrhoea ranking as the 6th leading cause of all in-ward admissions. Though diarrhoeal diseases continue to be a public health problem, aetiologic diagnosis is infrequent. As a result, the proportional morbidity and the local epidemiology of rotavirus diarrhea is not well-known. , surveillance was initiated with a view to estimating the proportion of diarrhea due to rotavirus and describing local epidemiology of rotavirus diarrhea among diarrhoeal admissions of under five children in the premier paediatric hospital in Sri Lanka.

Methods
Fecal specimens were collected from all diarrhoeal admissions from children less than 5 years of age in the diarrhoeal treatment unit (DTU) and inpatient hospital wards during a 24-month period. Specimens were frozen at –20 °C and rotavirus testing was performed (IDEIA rotavirus enzyme immunoassay, Oxoid, United Kingdom). Rotavirus positive specimens were analysed by RT-PCR genotyping assays to determine the distribution of rotavirus G and P types. Relevant data were collected from parents using an interviewer-administered questionnaire and surveillance data were entered into a standardized database management system.

Results
Overall, the proportion of rotavirus among [ 1179 total diarrheal patients tested] all-cause diarrhea admissions was 23.9%. Rotavirus diarrhea was most common among children in the age groups of 6-11 (37%), 12-23 (23%) months. Rotavirus diarrhea patients were hospitalized throughout the year, however, the rotavirus peak from January to March was consistent with the pattern of increase in all cause diarrhea admissions. Although 65% of rotavirus diarrhea patients had vomiting, the duration of vomiting was <3 color="#ff0000">Conclusions
A significant proportion of diarrhoeal admissions proved to be due to rotavirus and occurred mostly in children below 2 years of age. These data, despite their limited generalisability, will help policy decisions to introduce rotavirus vaccines to the mature Sri Lankan EPI in the future.

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