TITLE

Prevalence of Rotavirus and Adenovirus among children less than 5 years presenting with Acute Watery Diarrhoea to a

tertiary care hospital in Pondicherry- A cross-sectional study

• Name of the PG: Dr. N. Zaheen Zehra, Dept. of Paed.

• Guide Dr. D. Gunasekaran, Professor, Dept. of Paed.

• Co-Guide Dr. M. Lalitha, Asst. Prof. Dept. of Paed.

• Co-Guide Dr. R. Kalaivani, Asst. Prof. Dept. of Micro.

INTRODUCTION ACUTE WATERY DIARRHOEA(AWD):• One of the most common causes of admission to

health centres in under 5 age group

• Second leading cause of death in this age group

• 1.7 billion cases of diarrhoeal diseases reported every year globally

• Viruses remain the most common etiologic agents for AWD worldwide

INTRODUCTION

ROTAVIRUS AND ADENOVIRUS:

• Important viral causes of AWD in children worldwide

• 29% of all diarrhoeal deaths in children <5 years of age is due to Rotavirus

• 23% of Rotavirus deaths are in the Indian subcontinent

WHY THIS STUDY?• Etiology of AWD varies in different settings- Studies

pertaining to viral etiology of AWD not been done in areas around Pondicherry

• If viral etiology is proven to be high- more emphasis on rational use of antibiotics- help foster antimicrobial stewardship

• Point of care testing- short duration to get results- will throw some light on the routine use of this test in the office practice

RESEARCH QUESTION Using the immuno-chromatographic detection

method, What is the prevalence of Rotavirus and Adenovirus in children less than 5 years of age presenting with acute watery diarrhea in our setting?

AIM & PRIMARY OBJECTIVE

To determine the prevalence of rotavirus and adenovirus, using the immuno-chromatographic stool test in children less than 5 years of age presenting with acute watery diarrhea to a tertiary care hospital setting.

OBJECTIVESSecondary: • To study the clinical profile of children with AWD

• To study the profile of severity of dehydration at presentation in the studied group

• To study the nature of rehydration therapy and need for hospitalization

• To try and find the clinical predictors for rotaviral diarrhea

MATERIALS AND METHODS OF STUDY

• Design: Cross sectional study• Setting: Department of Pediatrics, MGMCRI

over a period of one and half years

STUDY DEFINITION for AWD

• Passage of three or more loose or liquid stools per day in a child who has been passing normal consistency stools previously

• If baseline frequency itself is 3 or more times of normal consistency stools- Any recent increase in the number of stools from the usual frequency and/ or any recent change in consistency of stools of the child as reported by the mother shall also be taken as diarrhea

SAMPLE SIZE• OpenEpi Software version 3.01 used

• Considering the prevalence of Rotavirus Diarrhoea as 35.8% and confidence level of 95%- Total sample size= 354

Inclusion criteria

• All children in the age group 1 month to 5 years of age who present to the Pediatric outpatient department/ casualty with acute watery diarrhea satisfying the study definition would be included into the study

Exclusion criteria• Neonates (less than 28 days of age)- transitional stools confounder

• Children with obvious dysentery at admission

• Children with diarrhea for more than or equal to 14 days- persistent diarrhea

• Children who have received rotavirus vaccination at any point of time

• Children who develop diarrhea after admission to the hospital for other illness/ children who develop diarrhea after treatment with antibiotics for non- gastrointestinal illness- may be antibiotic associated diarrhea

MATERIALS TO BE USED • VIKIA® Rota-Adeno kits manufactured by Biomerieux

• It is a rapid, qualitative, chromatographic immunoassay for the simultaneous detection of rotaviruses and adenoviruses.

• Sensitivity for Rotavirus - 100% Sensitivity for Adenovirus - 97.6%

• Specificity for both- 100%.

PROCEDURE• 50 mg or 50 µl of the freshly obtained stool sample • Will be mixed diluents provided and homogenized• 2 drops are then added to the sample well on the cassette

• Then based on the line that appears, the test is read (only control line: -ve for rota & adeno virus, control line plus blue line = + ve for rotavirus, control line plus red line = adenovirus, no control line= invalid test and needs to be repeated)

• The total time required is just 10 minutes.

STATISTICAL METHODSParameter Test to be used

Prevalence of Rotaviral infection among the study population

Proportion

Prevalence of Adenoviral infection among the study population

Proportion

Comparison of mean age of rotaviral subgroup vs adenoviral subgroup

t – Test

Clinical predictors of rotaviral disease Logistic regression

Comparison of severity of dehydration and complications in rotaviral subgroup with others

Chi Square Test

Child age < 5 years with AWD, satisfying the study definition- Inclusion & Exclusion Criteria.

Informed consent

Collection of clinical and demographic data

Stool sample tested- Rota + / Adeno + / -ve for both

Record data onto a database

Statistical Analysis

ETHICAL ISSUES• This is an observational study. Stool sample is required for

the test. Obtaining stool sample will be in a non-invasive manner. The Test will be done free of cost.

• Management of the child will be done by the treating doctors using standard protocols.

• Consent will be obtained from parents to allow us to utilize the clinical details, lab reports and the management details of their children for analysis. Care will be taken to anonymise the obtained data and to keep them confidential. Only if they give written consent, their children will be included in the study

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