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Paediatrica IndonesianaVOLUME 51 NUMBER 3May
Original Article
138Paediatr Indones, Vol. 51, No. 3, May 2011
Epidemiology of Rotavirus diarrhea in children under
five: A hospital-based surveillance in Jakarta
Muzal Kadim1, Yati Soenarto2, Badriul Hegar1, Agus Firmansyah1
AbstractBackground Rotavirus is still a major cause of acute diarrheain children around the world, both in developed and developing
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children under five years of age treated for acute diarrhea, on average
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showed that the incidence of rotavirus diarrhea in children ranged
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studies identifying the genotypes of rotavirus strains in Indonesia.
This information is indispensable for manufacturing vaccines.
Objective To examine the epidemiology of rotavirus diarrhea,including genotypes and clinical characteristics, in children under
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Methods This study was a prospective surveillance conductedat Cipto Mangunkusumo Hospital, Jakarta from January to
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years of age who suffered from acute diarrhea.
Results Ninety-nine patients joined the study. The incidence ofURWDYLUXVLQIHFWLRQLQWKLVVWXG\ZDV7KH\RXQJHVWZDV
months of age and the oldest 54 months of age, with an average age
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Nutritional status, degree of dehydration, bloating, fever, blood
in stool, and mucus in the feces were not significantly different
between rotavirus and non-rotavirus diarrhea. Vomiting tended to
be more frequently experienced by children with rotavirus diarrhea
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seasonal pattern for rotavirus diarrhea. Most G genotypes in thisVWXG\ZHUH***DQGWKHPDMRULW\RI
3JHQRW\SHVZHUH33DQG3
Conclusions7KHLQFLGHQFHRIURWDYLUXVGLDUUKHDLQKRVSLWDOL]HGFKLOGUHQXQGHUILYH\HDUVRIDJHLQ-DNDUWDZDVZLWKD
SUHGRPLQDQFHRI**DQG*JHQRW\SHV[Paediatr Indones.
2011;51:138-43].
Keywords: epidemiology, incidence, acute
diarrhea, rotavirus, children, Jakarta
Rotavirus is the leading cause of acute
diarrhea in children across the world with
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diarrhea in children less than five years old.
Children in Asian and African countries account for
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cases worldwide in children less than five years
old were caused by rotavirus. The highest number
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of rotavirus diarrhea in Asia (Malaysia, Vietnam,Thailand, Hong Kong, Taiwan, Korea, India, Middle
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showed that rotavirus diarrhea remains a health
problem with negatively impacting health costs, time
wasted and quality of life, due to the high morbidity
and mortality rates.4-17
Improved hygiene and sanitation can drastically
lower the incidence of diarrhea caused by non-
rotavirus agents, whereas rotavirus diarrhea is
only slightly influenced by hygiene and sanitation
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RI&KLOG+HDOWK*DGMDK0DGD8QLYHUVLW\0HGLFDO6FKRRO6DUGMLWR
+RVSLWDO
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Muzal Kadim et al: Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance
Paediatr Indones, Vol. 51, No. 3, May 2011 139
improvements. Rotavirus is often referred as a
democratic virus, because it can affect children in
developing and developed countries with similar
incidence. Through vaccination it is hoped that
morbidity and mortality rates of diarrhea caused by
rotavirus infection can be reduced in children. In
countries that have carried out a rotavirus vaccinationprogram, decreases in the incidence of severe rotavirus
infection have been observed, although mild infection
remains ongoing.
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incidence of rotavirus infection as a cause of acute
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Muzal Kadim et al: Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance
140Paediatr Indones, Vol. 51, No. 3, May 2011
Table 1 shows the clinical characteristics
associated with rotavirus infection including sex, age,
nutritional status, degree of dehydration, vomiting,
bloating, fever, and stool characteristics.
Figur e 2 shows the seasonal pattern of
rotavirus infection. The distribution suggested that
rotavirus infection was present at all times in a year.
Nevertheless, the highest number of cases mainly
occurred between January and June and decreased
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Forty stools specimens testing positive forrotavirus were randomly taken for genotype
examination. We found the G genotype distribution
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respectively.
Table 1. Clinical characteristics associated with rotavirus infection
in children < 5 years old with acute diarrhea
Clinical
Characteristic
Rotavirus
Positive
N = 66 (%)
Rotavirus
Negative
N = 33 (%)
P*
Male sex
Age group
0 5 months
6 35 months
36 59 months
Nutritional status
weight/height (z-score)
Under(< -2)
Normal (-2 to 2)
Over (> 2)
Degree of dehydrationNo dehydration
Mild-moderate
Severe
Vomiting
Yes
No
Bloating
Yes
No
Fever
Yes
No
Blood in stool
Yes
No
Mucus in stoolYes
No
33 (50)
11 (17)
53 (80)
2 (3)
15 (22.5)
50 (76)
1 (1.5)
1 (1.5)
64 (97)
1 (1.5)
58 (88)
8 (12)
41
25
8 (12)
58 (88)
2 (3)
64 (97)
22 (33)
44 (67)
19 (57)
8 (24)
22 (67)
3 (9)
8 (24)
24 (73)
1 (3)
0 (0)
33 (100)
0
22 (67)
11 (33)
26
7
5 (15)
28 (85)
4 (12)
29 (88)
11 (33)
22 (67)
0.477
0.247
0.861
0.600
0.012
0.095
0.674
0.074
1.00
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Figure 3. Rotavirus genotype distribution in children
< 5 years old in Jakarta.
Figure 2. Seasonal pattern of Rotavirus diarrhea in children < 5 years old in Jakarta.
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Muzal Kadim et al: Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance
Paediatr Indones, Vol. 51, No. 3, May 2011 141
Discussion
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study was higher than that of other studies around
WKHZRUOGDQDYHUDJHLQFLGHQFHRI4-17 Rotavirus
remains a major cause of acute diarrhea in children
and previous studies in Indonesia showed that theincidence of rotavirus infection as a cause of acute
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Muzal Kadim et al: Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance
142Paediatr Indones, Vol. 51, No. 3, May 2011
Nutritional status, degree of dehydration, abdominal
bloating and fever were not significantly different
between rotavirus and non-rotavirus diarrhea cases.
Vomiting tended to be more frequently experienced by
children with rotavirus diarrhea, hence these patients
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QRQURWDYLUXVGLDUUKHD6WRROFKDUDFWHULVWLFVZHUHQRWa good determinant for distinguishing rotavirus and
non-rotavirus diarrhea.
Acknowledgements
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Wahab for data analysis, Abu Thalib Aman for determining
genotypes of rotavirus strains, and the nurses and administrative
staff for their assistance in this study.
References
3DUDVKDU8'+XPPHOPDQ(*%UHVVH-60LOOHU0$*ODVV
RI. Global illness and deaths caused by rotavirus disease in
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VHYHUHFKLOGKRRGGLDUUKHD(PHUJ,QIHFW'LV
&HQWHUVIRU'LVHDVH &RQWURODQG3UHYHQWLRQ &'&
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0RUE0RUWDO:NO\5HS
%UHVHH-6+XPPHOPDQ(1HOVRQ$6*ODVV5,5RWDYLUXVLQAsia: the value of surveillance for informing decisions about the
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1HOVRQ($67DP-6%UHVHH-63RRQ.H, Ng CH, Ip K6,
et al. Estimates of rotavirus disease burden in Hong Kong:
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Muzal Kadim et al: Epidemiology of Rotavirus diarrhea in children under five: A hospital-based surveillance
Paediatr Indones, Vol. 51, No. 3, May 2011 143
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