What are we talking about ?
• A disease that affects ALL
children before the age of 5
years
• Responsible for 5 % deaths
o...
Rotavirus – in 4 parts
Dr Gaurav Gupta
Charak Clinics
www.charakclinics.com
DCH, DNB, MAAP, MIAP
Rotavirus – the 4 parts
1. Virology – boring yet interesting !
2. Scary Statistics about Rotavirus – the
Indian connection...
Rotavirus Virology – Part 1
• Rota – means wheel-like in greek
• Double-stranded RNA virus
Rotavirus – this is how it looks!Rotavirus – this is how it looks!
Rotavirus Virology
• VERY resistant to destruction (Why is this
important?)
• VP4 antigen: P serotype;
11 human rotaviruse...
Global distribution of human group A
rotavirus P-G types (1989-2004)
http://www.cdc.gov/ncidod/EID/vol4no4/parasharG.htm#f...
Are these multiple serotypes important ?
NOT REALLY !
Because Natural RV infection attenuates
severity of subsequent infec...
Cumulative probability of rotavirus infection in 200
Mexican infants during the 1st 2 years of life
1.01.0
0.90.9
0.80.8
0...
Scary Statistics– Part 2
• Diarrhoea is third largest
cause of death in under 5
• Rotavirus are the single
most important ...
Modified after Emerg Infect Dis 2006; 12: 304
5 million clinic visits
25 million domiciliary
episodes
1 : 250
1 : 65
Event...
Part 3 - Can we clinically diagnose
Rotavirus gastroenteritis (RVGE)?
• High fever and vomiting in a 6 month
to 2 year chi...
When is a Viral GE unlikely?
• Blood / WBCs in the stool
• Persistent high fever
• Persistent severe bilious vomit without...
Part 4 – Preventing rotavirus
• Democratic Virus – affects the
entire world equally, without
differentiating the rich & po...
Vaccine development
• Goals of a rotavirus vaccine
– Aim to duplicate the degree of
protection following natural infection...
What vaccines are available?
• Rotashield (Wyeth) – Available in 1998, Animal
Rhesus Monkey strain, withdrawn after 1 year...
Vaccines based upon human rotaviruses
• A live-attenuated monovalent human rotavirus vaccine (RotarixR
) P[8]G1
– > 63,000...
RotarixR
RotaTeqTM
Origin Human monovalent
P[8]G1
Bovine-human pentavalent
P[8] G1-G4
Oral doses 2 3
Efficacy (95% CI)
any...
Other vaccine candidates
• Human-bovine reassortants
– Bovine rotavirus tetravalent (BRV-TV) vaccine: G1-G4
• Adding G8 + ...
Cost Effectiveness of Rota Vaccine
• A CMC Vellore study shows that average diarrhea
hospitalization costs Rs. 4,000/- to ...
Remember …..
• Largest number of death in the WORLD due to
Rotavirus occur in India. (More than 300
children/ day)
• ORS i...
Common Questions
1. What is the maximum age for first
dose?
2. What if the child vomits?
3. Can it be given with OPV/ Brea...
Let us ERADICATE
the thought of viral
diarrhea
Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs
Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs
Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs
Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs
Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs
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Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs with specific reference to India.

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Rotavirus - Simplified Virology, Statistics, Symptoms, Vaccination & Common FAQs

  1. 1. What are we talking about ? • A disease that affects ALL children before the age of 5 years • Responsible for 5 % deaths of all children less than 5 years.
  2. 2. Rotavirus – in 4 parts Dr Gaurav Gupta Charak Clinics www.charakclinics.com DCH, DNB, MAAP, MIAP
  3. 3. Rotavirus – the 4 parts 1. Virology – boring yet interesting ! 2. Scary Statistics about Rotavirus – the Indian connection 3. Can we clinically identify Rotavirus Diarrhea 4. Preventing Rotavirus Diarrhea – what GSK wants me to talk about 
  4. 4. Rotavirus Virology – Part 1 • Rota – means wheel-like in greek • Double-stranded RNA virus
  5. 5. Rotavirus – this is how it looks!Rotavirus – this is how it looks!
  6. 6. Rotavirus Virology • VERY resistant to destruction (Why is this important?) • VP4 antigen: P serotype; 11 human rotaviruses • VP7 antigen: G serotype; 10 human rotaviruses • Commonly found strains: P[8]G1; P[8]G3; P[8]G4; and P[4]G2
  7. 7. Global distribution of human group A rotavirus P-G types (1989-2004) http://www.cdc.gov/ncidod/EID/vol4no4/parasharG.htm#fig%204) Other P[6]G8 Africa P[8]G5 Brazil P[11]G10 India P[6]G12 India
  8. 8. Are these multiple serotypes important ? NOT REALLY ! Because Natural RV infection attenuates severity of subsequent infections, regardless of serotype
  9. 9. Cumulative probability of rotavirus infection in 200 Mexican infants during the 1st 2 years of life 1.01.0 0.90.9 0.80.8 0.70.7 0.60.6 0.50.5 0.40.4 0.30.3 0.20.2 0.10.1 11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717 1818 1919 2020 2121 2222 2323 2424 ProbabilityofrotavirusinfectionProbabilityofrotavirusinfection Age (months)Age (months) 1st infection1st infection 2nd infection2nd infection 3rd infection3rd infection 4th infection4th infection 5th infection5th infection * *Complete protection against moderate-to-severe diarrhoea NEJM 1996; 335: 1022
  10. 10. Scary Statistics– Part 2 • Diarrhoea is third largest cause of death in under 5 • Rotavirus are the single most important cause of diarrhoea worldwide. • Annually rotaviruses cause – 5% of all deaths in children – 527,000 deaths • 80% of deaths are in infancy • > 100,000 in India – 39% of childhood hospitalisations for diarrhea Lancet Infect Dis 2007; 7: 56 Wkly Epidemiol Rec 2007; 82: 285 JID 2005; 192(Suppl 1) S1 EID 2006;12: 304
  11. 11. Modified after Emerg Infect Dis 2006; 12: 304 5 million clinic visits 25 million domiciliary episodes 1 : 250 1 : 65 EventRisk of Particular Event 100,000 deaths 0.4 million hospitalisations 1 : 5 1 : 1 Estimated prevalence of rotavirus disease in India
  12. 12. Part 3 - Can we clinically diagnose Rotavirus gastroenteritis (RVGE)? • High fever and vomiting in a 6 month to 2 year child • Severe vomiting resistant to anti- emetics • Followed by explosive diarrhea, severe with significant peri-anal excoriation • The diarrhea can be mild to severe and generally lasts 3-9 days. Illness usually begins 3 days after exposure.
  13. 13. When is a Viral GE unlikely? • Blood / WBCs in the stool • Persistent high fever • Persistent severe bilious vomit without diarrhea
  14. 14. Part 4 – Preventing rotavirus • Democratic Virus – affects the entire world equally, without differentiating the rich & poor – almost 40 % of hospital admissions worldwide due to diarrhea are due to RVGE. • Hand-washing and sanitation does not work due to the resistant nature of the virus. • Vaccine works well
  15. 15. Vaccine development • Goals of a rotavirus vaccine – Aim to duplicate the degree of protection following natural infection – Prevent moderate to severe disease • Decrease numbers of children: – Dying from rotavirus disease – Admitted to hospital – Presenting to health care facilities » Hospital » Community
  16. 16. What vaccines are available? • Rotashield (Wyeth) – Available in 1998, Animal Rhesus Monkey strain, withdrawn after 1 year due to clustering of cases of Intussusception. • Rotateq (Merck) – Pentavalent Bovine Live Attenuated vaccine. • > 70,000 subjects • Predominantly in the United States and Finland • No evidence for increased risk of intussusception
  17. 17. Vaccines based upon human rotaviruses • A live-attenuated monovalent human rotavirus vaccine (RotarixR ) P[8]G1 – > 63,000 infants – Predominantly in 11 countries from Latin America – No evidence for increased risk of intussusception – Efficacy for rotavirus disease • 85% against severe rotavirus disease (81% after 1 dose) • 100% against the most severe dehydrating episodes • Protective efficacy against severe disease – Homotypic G1 serotype 92% – Homotypic P[8] non-G1 serotype 88% NEJM 2006; 354: 11
  18. 18. RotarixR RotaTeqTM Origin Human monovalent P[8]G1 Bovine-human pentavalent P[8] G1-G4 Oral doses 2 3 Efficacy (95% CI) any disease severe hospitalisation Severe disease (95% CI) G1 G2 G3 G4 G9 All cause gastro admissions N = 20,169 ND 85 (72,92) 85 (70,94) 92 (74,98) 41 (-72,94) 88 (8,100) - 91 (62,99) 42 (29,53) N = 68,038 74 (67,79) 95 (91,97) 96 (90,98) 95 (92,97) 88 (<0,99) 93 (49,99) 89 (52,98) 100 (67,100) 59 (52,65) Post 1st dose shedding 50-80% 9% NEJM 2006; 354: 11 + 23
  19. 19. Other vaccine candidates • Human-bovine reassortants – Bovine rotavirus tetravalent (BRV-TV) vaccine: G1-G4 • Adding G8 + G9 • Brazil, China and India – Naturally occurring human-bovine reassortants • Delhi (116E) neonatal strain P[10]G9 single bovine VP4 gene • Vellore (I321) neonatal strain P[11]G10 – Bovine strain with 2 human-derived NSPs » Recently shown to be non-protective • Human neonatal rotavirus strains – Some strains appear naturally attenuated and protective – Melbourne neonatal RV3 strain P[6]G3 • Low immunogenecity, but protective against disease in a small study JID 2006; 194: 370 Vaccine 2006; 24: 5817 Vaccine 2002; 20: 2950
  20. 20. Cost Effectiveness of Rota Vaccine • A CMC Vellore study shows that average diarrhea hospitalization costs Rs. 4,000/- to 5,000/- • Rotavirus is a dehydrating diarrhea, with significant chances of doctor visit and hospitalization. • Vaccine is almost 90-100 % effective against severe RV diarrhea & hospitalization.
  21. 21. Remember ….. • Largest number of death in the WORLD due to Rotavirus occur in India. (More than 300 children/ day) • ORS is less likely to be effective in Rotavirus, due to increased tendency for vomiting, and destruction of intestinal villi by RV causing malabsorption of glucose, sodium and potassium.
  22. 22. Common Questions 1. What is the maximum age for first dose? 2. What if the child vomits? 3. Can it be given with OPV/ Breast feed/ other vaccines? 4. How to best administer the vaccine? 5. Can Rotarix cause Intussusception? 6. Can we give one dose in children between 5-6 month? After 6 months? 7. How to counsel parents regarding this vaccine? 8. What are the contraindications for Rotavirus vaccine?
  23. 23. Let us ERADICATE the thought of viral diarrhea

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