NEW DELHI : Centre has announced the countrywide coverage of Rotavirus vaccine that protects young children from severe diarrhea caused by rotavirus infections, but high burden of the disease and changing strains of the virus pose major challenge for government aiming to end diarrheal deaths by 2022.

As research funded by country’s apex research body Indian Council of Medical Research (ICMR) has revealed that there is an ongoing high burden of Rotavirus in the country and the circulating strains of the virus are changing fast.

India introduced the oral rotavirus vaccine (ROTAVAC) in 2016, in four states of India as part of the Universal Immunization Programme (UIP), and expanded to five more states in 2017. Rotavirus vaccine is currently available in 28 States and union territories and is expected to be available in all 36 States/UTs by September 2019, according to a recent union health ministry announcement.

A team of researchers studied four years data on rotavirus gastroenteritis in hospitalized children under 5 years of age prior to vaccine introduction. The study published in the BioMed Central Journal (BMC) in its latest issue, was done on over 6576 children from seven sites in southern and northern India hospitalized for diarrhoea between July 2012 and June 2016. Stool samples were screened for rotavirus and genotyped. The study was conducted in tertiary hospitals in seven cities of India, with five sites in southern India and two in the north (Delhi and Ludhiana). All the testing was performed at Christian Medical College (CMC), Vellore.

The study found that the overall rotavirus positivity was 41.7% in the north compared to 33.1% in the south India. The study also found an emergence of G3P [8] strain across southern and northern sites from 2015 onwards emphasizing the rapid temporal changes in circulating rotavirus strains.

“The circulation of uncommon genotypes, such as G1P[4], G1P[6], G2P[6], G2P[8], G3P[4], G3P[6], G4P[6], G9P[6], G12P[4], and G12P[11] and the high proportion of mixed infections (8%) indicate that the children probably acquire infections from a variety of sources, and could serve as sources of new global strains," said Gagandeep Kang, corresponding author of the study.

The study highlights the high prevalence of rotavirus gastroenteritis in India and the diversity of rotavirus genotypes across different geographical regions. “Pre- vaccine surveillance data is necessary to evaluate the potential change in admission rates for gastroenteritis and circulating rotavirus genotypes after vaccine introduction, thus assessing impact," said Kang.

Rotavirus-associated diarrhoea was seen throughout the year at all the sites. However, there was distinct seasonality for rotavirus associated diarrhoea, with highest prevalence seen during December–February, the study said.

“The government has decided to expand Rotavirus vaccine across all 36 states by September, 2019 which is currently available only in 28 States and union territories in India The government aims to end morbidity and mortality in children due to diarrhoea by 2022. No children should die due to preventable diseases," said Harsh Vardhan, Union Minister of Health and Family Welfare.

Out of all the causes of diarrhoea, rotavirus is a leading cause of diarrhoea in children less than 5 years of age. It is estimated that rotavirus cause 8,72,000 hospitalizations; 32,70,000 outpatient visits and estimated 78,000 deaths annually in India. Rotavirus diarrhoea presents in similar manner like any other diarrhoea but can mainly be prevented through rotavirus vaccination.

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