Nosocomial rotavirus gastroenteritis in pediatric patients: A cross sectional study using molecular analysis

Mojdeh Habibi, Shahrzad Modaress Gilani, Aliakbar Rahbarimanesh, Shahab Modarres Gilani
4.046 866


Objective: Rotavirus is one of the most important etiological agents of nosocomial infections in childhood. This cross sectional study was designed to determine the incidence and the main risk factors of rotavirus nosocomial infection in children admitted to the Bahrami Children Hospital, Tehran, Iran. Analyzing the genetic diversity and phylogenetic pattern of rotavirus was also performed. Identifying the most common genotypes of rotavirus contributes in establishing a suitable vaccination program.
Study design: A total of 105 stool samples were obtained on the first day of admission of children admitted to different wards of Bahrami Children Hospital, Tehran, Iran during December 2009 to December 2010. An additional sample was collected from rotavirus-negative children within 48 hour of their admission. Children who were initially rotavirus-negative and became positive 2 days or more after admission were considered as certain nosocomial cases. Rotavirus infection was detected in the feces samples using RNA PAGE method and RT PCR in order to specify the rotavirus genotypes. Both VP4 and VP7 primers were utilized in order to identify the rotavirus genotypes.
Results: During the study period, 105 children were enrolled. The incidence of rotavirus nosocomial infection was 20% with high rates in children aged 12-24months. Nausea, vomiting and high grade fever were the prominent symptoms in the infected patients. Existence of an underlying disease including congenital heart disease and intractable seizures predisposed the children to infection. The most commonly found genotype in nosocomial infection was G1P [8] and G1P [4].
Conclusion: Nosocomial rotavirus infection cause significant morbidity in hospitalized children especially young infants. According to the most common genotypes found in patients with nosocomial infection in this study, appropriate vaccination programs should be considered in developing countries.


diarrhea, stool sample, infancy, nosocomial infection

Full Text:



1- Estes MK. Rotaviruses and their replication. In: Knipe DM, Howley PM (eds.) Fields Virology. Lippincott-Raven Publishers, Philadelphia, 2001; 1747-1785. 2- Parashar UD, Hummelman EG, Bresee JS, Miller

MA, Glass RI. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis 2003; 9: 5653- Kapikian AZ, Hoshino Y, Chanock RM. Rotaviruses.

In: Knipe DM, Howley PM. (eds.) Fields' Virology, 4t h ed. Lippincott Williams and Wilkins, Philadelphia, 2001; 1787-1833. 4- Mattion NM, Cuhen J, Estes MK. The rotavirus proteins. In: Kapikian AZ (ed.), Viral Infections of the Gastrointestinal Tract. Marcel Dekker, New York, 1994: 169-2 5- Crawley JM., Bishop RF, Barnes GL. Rotavirus gastroenteritis in infants aged 0-6 months in Melbourne, Australia: implications for vaccination. J Paediatr Child Health 1993; 29:219-21. 6- Grimwood K, Lund JC, Coulson BS, Hudson IL, Bishop RF, Barnes GL. Comparison of serum and mucosal antibody responses following severe acute rotavirus gastroenteritis in young children. J Clin Microbiol 1988; 26:732-8. 7- Iturriza-Gomara M, Green J, Brown DW, Ramsay M, Desselberger U, Gray JJ. Molecular epidemiology of human group A rotavirus infections in the United

Kingdom between 1995 and 1998. J Clin Microbiol 200; 38:4394-401. 8- Diggle L. Rotavirus diarrhoea and future prospects for prevention. Br J Nurs 2007; 16: 970-4. 9- Jarvis WR, Middleton PJ, Gelfand EW. Significance of viral infections in severe combined immunodeficiency disease. Pediatr Infect Dis 1983; 2:187-92. 10- Fiegin RD, Cherry JD. Textbook of pediatric infectious disease. Philadelphia: Saunders; 19 Rotavirus; pp. 1901–13. 11- Gouvea V, Glass RI, Woods P, Taniguchi K, Clark HF, Forrester B, Fang ZY: Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J Clin Microbiol 1990, 28:276-282. 12- Iturriza-Gomara M, Kang G, Gray J: Rotavirus genotyping: keeping up with an evolving population of human rotaviruses. J Clin Virol 2004, 31:259-265. 13- Samajdar S, Varghese V, Barman P, et al. Changing pattern of human group A rotaviruses: emergence of G12 as an important pathogen among children in eastern India. J Clin Virol 2006, 36:183-188. 14- Gentsch JR, Glass RI, Woods P, et al. Identification of group A rotavirus gene 4 types by polymerase chain reaction. J Clin Microbiol 1992, 30:1365-1373. 15- Iturriza-Gomara M, Green J, Brown DW, Desselberger U, Gray JJ. Diversity within the VP4 gene of rotavirus P strains: implications for reverse transcription-PCR genotyping. J Clin Microbiol 2000, 38: 898-90 16- Iturriza Gomara M, Wong C, Blome S, Desselberger U, Gray J. Molecular characterization of VP6 genes of human rotavirus isolates: correlation of genogroups with subgroups and evidence of independent segregation. J Virol 2002, 76: 6596-6601. 17- Shaoxiong J, Paul EK, Robert CH, Matthew JC, Eugene JG, Roger IG. Trends in hospitalizations for diarrhea in United States children from 1979 through 1992: estimates of the morbidity associated with rotavirus. Pediatric Infect Dis. 1996; 15:397–404. 18- Kordidarian R, Kelishadi R, Arjmandfar Y. Nosocomial infection due to rotavirus in Infants in Alzahra Hospital, Isfahan, Iran. J Health Popul Nutr. 2007; 25: 231–235. 19- Ogilvie I, Khoury H, El Khoury AC, Goetghebeur MM. Burden of rotavirus gastroenteritis in the pediatric population in central and eastern Europe. Human Vaccines 2011; 5: 523-533. 20- Rotavirus vaccine for prevention of rotavirus gastroenteritis among children. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Morb Mortal Wkly.Rep 1999; 48:1-20. 21- Black RE, Herson MH, Rahman AS et al. A two-year study of bacterial, viral, and parasitic agents associated with diarrhea in rural Bangladesh. J Infect Dis 1980; 142: 66022- Kapikian AZ, Kim HW, Wyatt RG et al. Human rotavirus-like agent as the major pathogen associated with

"winter" gastroenteritis in hospitalized infants and young children. N Engl J Med 1976; 294: 965-72. 23- Gusmao R, Mascaenhas J, Gabbay Y, et al. Rotavirus as a cause of nosocomial infantile diarrhea in northen

Brazil: Pilot study. Mem Inst Oswaldo Cruz 1995; 90: 74324- Nelson EAS, Bresee JS, Parashar UD, Widdowson

MA, Glass RI. Rotavirus epidemiology: The Asian Rotavirus Surveillance Network. Vaccine 2008; 26: 3192– 3196