Characterization by enzyme-linked immunosorbent assay using subgroup- and serotype-specific monoclonal antibodies of human rotavirus obtained from diarrheic patients in Bangladesh

Prevalence and genetic diversity of rotavirus in Bangladesh during pre-vaccination period, 1973-2023: a meta-analysis

Introduction

Rotavirus infection is a major cause of mortality among children under 5 years in Bangladesh. There is lack of integrated studies on rotavirus prevalence and genetic diversity during 1973 to 2023 in Bangladesh.

Methods

This meta-analysis was conducted to determine the prevalence, genotypic diversity and seasonal distribution of rotavirus during pre-vaccination period in Bangladesh. This study included published articles on rotavirus A, rotavirus B and rotavirus C. We used Medline, Scopus and Google Scholar for published articles. Selected literatures were published between 1973 to 2023.

Results

This study detected 12431 research articles published on rotavirus. Based on the inclusion criteria, 29 of 75 (30.2%) studies were selected. Molecular epidemiological data was taken from 29 articles, prevalence data from 29 articles, and clinical symptoms from 19 articles. The pooled prevalence of rotavirus was 30.1% (95% CI: 22%-45%, p = 0.005). Rotavirus G1 (27.1%, 2228 of 8219) was the most prevalent followed by G2 (21.09%, 1733 of 8219), G4 (11.58%, 952 of 8219), G9 (9.37%, 770 of 8219), G12 (8.48%, 697 of 8219), and G3 (2.79%, 229 of 8219), respectively. Genotype P[8] (40.6%, 2548 of 6274) was the most prevalent followed by P[4] (12.4%, 777 of 6274) and P[6] (6.4%, 400 of 6274), respectively. Rotavirus G1P[8] (19%) was the most frequent followed by G2P [4] (9.4%), G12P[8] (7.2%), and G9P[8], respectively. Rotavirus infection had higher odds of occurrence during December and February (aOR: 2.86, 95% CI: 2.43-3.6, p = 0.001).

Discussion

This is the first meta-analysis including all the studies on prevalence, molecular epidemiology, and genetic diversity of rotavirus from 1973 to 2023, pre-vaccination period in Bangladesh. This study will provide overall scenario of rotavirus genetic diversity and seasonality during pre-vaccination period and aids in policy making for rotavirus vaccination program in Bangladesh. This work will add valuable knowledge for vaccination against rotavirus and compare the data after starting vaccination in Bangladesh.

The relative frequencies of G serotypes of rotaviruses recovered from hospitalized children with diarrhea: A 10-year survey (1987-1996) in Japan with a review of globally collected data

Since rotavirus vaccines aim to protect children from severe diarrhea, knowledge of the prevailing G serotypes among rotaviruses from hospitalized children is essential. Thus, we determined the G serotypes of rotaviruses collected from children with acute diarrhea in a local referral hospital in Akita, Japan, over the 10-year period between January 1987 and December 1996. Based on the assumption that rotaviruses with an identical electropherotype possess the same G serotype, the G serotypes of 488 rotavirus-positive specimens that were classified into 63 electropherotypes were determined by enzyme-linked immunosorbent assay with a supplementary use of G typing by reverse transcription-PCR. The relative frequencies over the 10-year period were 77.0 (G1), 14.5 (G2), 2.7 (G3) and 5.3% (G4), leaving the possibility that only 0.4% had G serotypes uncommon to human rotaviruses. Of 24,050 rotaviruses extracted by reviewing 63 serotyping studies in literature, the relative frequencies of the four major G serotypes were 50.6 (G1), 9.3 (G2), 7.2 (G3) and 11.6% (G4). As to uncommon G serotypes, only 0.9% were described as serotypes other than G1-4, and our estimate for potential uncommon serotypes were at most 8.1%. Thus, both this long-term study focusing on the rotaviruses only from severe cases in a single hospital in Japan and the global review of G serotypes published to date indicate that the primary target of any rotavirus vaccines should be rotaviruses possessing serotypes G1-4.

Epidemiological study of the G serotype distribution of group A rotaviruses in Kenya from 1991 to 1994

An epidemiological study on the G serotype distribution of group A rotaviruses (GARV) isolated in Kenya was carried out in one urban hospital in Nairobi and in two rural hospitals in Nanyuki and Kitui to clarify the prevalent G serotypes before future introduction of the ready licensed rotavirus vaccine in Kenya. A total of 1,431 stool specimens were collected from children, who were mainly outpatients, aged from 0 to 6 years old with acute gastroenteritis from August 1991 to July 1994. Samples positive for GARV by conventional ELISA were then analyzed by subgrouping and serotyping ELISA and by PAGE. To ascertain the G serotypes of viruses in samples that were unable to be typed by serotyping ELISA, polymerase chain reaction was also attempted. The prevalence of GARV was 28.4% in the urban hospital, 22.5% in Nanyuki, and 13.7% in Kitui. Among rotavirus-positive samples, subgroup II rotaviruses were detected in 63.1%, and subgroup I rotaviruses were 25.9%. Serotype G4 was most prevalent, accounting for 41.6% followed by 23.3% of serotype G1, 17.0% of serotype G2, and serotype G3 was rarely isolated. Seven strains of serotype G8/P1B rotavirus was detected for the first time in Kenya by RT-PCR. Eleven specimens with an unusual composition of subgroup, serotype, and electropherotype were atypical GARV in which the P-serotype was P1A, P1B, or P2. Although uncommon GARV serotype G8/P1B and atypical GARV were detected, the four major GARV serotypes, G1 through G4, should be targeted at this moment for vaccination to control this diarrheal disease in Kenya. Continuous monitoring of the G- and P-serotype distribution of GARV should provide important information about the impact of rotavirus vaccination in Kenya.

Evidence of high-frequency genomic reassortment of group A rotavirus strains in Bangladesh: emergence of type G9 in 1995

We characterized 1,534 rotavirus (RV) strains collected in Bangladesh from 1992 to 1997 to assess temporal changes in G type and to study the most common G and P types using reverse transcription-PCR, oligonucleotide probe hybridization, and monoclonal antibody-based enzyme immunoassay. Results from this study combined with our previous findings from 1987 to 1991 (F. Bingnan et al., J. Clin. Microbiol. 29:862-868, 1991, and L. E. Unicomb et al., Arch. Virol. 132:201-208, 1993) (n = 2,515 fecal specimens) demonstrated that the distribution of the four major G types varied from year to year, types G1 to G4 constituted 51% of all strains tested (n = 1,364), and type G4 was the most prevalent type (22%), followed by type G2 (17%). Of 351 strains tested for both G and P types, three globally common types, type P[8], G1, type P[4], G2, and type P[8], G4, comprised 45% (n = 159) of the strains, although eight other strains were circulating during the study period. Mixed G and/or P types were found in 23% (n = 79) of the samples tested. Type G9 RVs that were genotype P[6] and P[8] with both long and short electrophoretic patterns emerged in 1995. The finding of five different genotypes among G9 strains, of which three were frequently detected, suggests that they may have an unusual propensity for reassortment that exceeds that found among the common G types. We also detected antigenic changes in serotypes G2 and G4 over time, as indicated by the loss of reactivity with standard typing monoclonal antibodies. Our data suggest that a vaccine must provide protection against type G9 RVs as well as against the four major G types because G9 strains constituted 16% (n = 56) of the typeable RV strains and have predominated since 1996.

Serotyping of group A rotaviruses in Egyptian neonates and infants less than 1 year old with acute diarrhea

Group A human rotavirus G serotypes were detected in stool specimens from neonates and infants with and without acute diarrhea in Cairo by using monoclonal antibodies in an enzyme-linked immunosorbent assay. Serotypes G1 and G4 predominated in all age groups. Mixed (G1 plus G4) and nontypeable specimens represented 16.1 and 38.7% of the total number serotyped, respectively.

Molecular epidemiology of human rotaviruses in Santiago, Chile

BACKGROUND

Protective immunity against rotavirus infection is directed against antigenic epitopes on the outer capsid proteins VP7 and VP4. Our aim was to characterize the epidemiology of rotavirus antigenic types over time in Santiago, Chile.

METHODS

We prospectively obtained 2097 stool samples for rotavirus testing, VP7 (G1 to G4) and VP4 (P4, P6, P8, P9) typing from children with diarrhea evaluated in emergency rooms of 5 base hospitals of Santiago. In addition 256 rotavirus-positive samples collected between 1985 and 1987 in the north health care area of Santiago were studied.

RESULTS

Of 995 rotavirus-positive samples obtained 825 (82%) were typable for 1 or more VP7 types. G1 represented 81% of the G-typed samples during 1993 through 1995 and 77% during 1985 through 1987, predominating in all health care areas. G2 was next most common in all 5 areas, representing 6 to 23% of typed samples, with 1 area, the Southeast concentrating a significantly higher number of G2 infections. G2 declined from 35% of rotavirus-positive samples in 1993 to 0% in 1995 (P < 0.001), and from 25% to 2% in the north health care area from 1985 to 1987 (P < 0.001). G4 was uncommon and significantly more prevalent in 1985 through 1987 than in 1993 through 1995 (7% vs. 3%, P = 0.015). G3 was not detected. G1P8 (53%) and G2P4 (16%) combinations were by far the most commonly detected G-P associations.

CONCLUSIONS

In Santiago, Chile, rotavirus antigenic type G1P8 has been highly prevalent and G2P4 has circulated in cycles. Differences in epidemiology of rotavirus antigenic types worldwide may prove to be relevant in efficacy of rotavirus vaccines.

Geographic distribution of human rotavirus VP4 genotypes and VP7 serotypes in five South African regions

The rotavirus outer capsid proteins elicit the production of neutralizing antibodies and are known to play a role in inducing resistance to disease. In this study, cDNA probes directed at the six most common human rotavirus VP7 serotypes (G1 to G4, G8, and G9) and five human rotavirus VP4 genotypes (P4, P6, P8, P9, and P10) were utilized. Hybridization analysis of 572 human rotavirus strains collected from five regions in South Africa was performed to determine the distribution of the VP7 serotypes and VP4 genotypes in nature. VP7 serotype G1 was identified most frequently, occurring in 51% of the rotavirus strains tested. VP7 serotypes G2 and G4 occurred in similar numbers, although their distribution varied regionally. Few serotype G3 strains and no G8 or G9 strains were identified. The P8 VP4 genotype occurred most frequently overall (66%), and the P4 genotype was detected next most frequently. The P6 genotype was identified in 28 symptomatically infected neonates and in 8 symptomatic infants. Few P9 strains were identified. The potential for reassortment events was demonstrated by dual infections with different viruses.

Human rotavirus subgroups and serotypes in children with acute gastroenteritis in Saudi Arabia from 1988 to 1992

Rotavirus infection was detected in 524 (42.2%) of the 1,242 stool specimens collected from infants and young children with acute gastroenteritis admitted to a major pediatric hospital in Jeddah, Saudi Arabia, between March 1988 and December 1992. Enzyme-linked immunosorbent assay (ELISA) and monoclonal antibodies specific for subgroup I and II were used to examine 80 rotavirus positive specimens. Subgroup I was detected in 21 (26.3%) and subgroup II in 49 (61.3%) specimens. Six specimens reacted with both subgroup I and II monoclonal antibodies and four specimens were untypeable. Serotyping of 355 rotavirus positive specimens using monoclonal antibodies specific for the human rotavirus serotypes 1 to 4 revealed a distribution profile of serotype 1, 53.5%; serotype 2, 6.8%; serotype 3, 5.9%; and serotype 4, 22.8%, along with mixed and untypeable specimens (11%). When the correlation between subgroup and serotype specificities was examined in 62 specimens, all subgroup I specimens were found to be serotype 2 or untypeable and all subgroup II specimens belonged predominantly to serotypes 1 (54.7%) and 4 (9.4%). Serotype 1, followed by, to a lesser extent, serotype 4, exhibited a temporal predominance in the 5-year investigation. A significant clustering of the various serotypes during the cooler months was evident almost throughout the study, particularly in 1989 and 1990.

Rotavirus vaccines and vaccination potential

The development of a successful rotavirus vaccine is a complex problem. Our review of rotavirus vaccine development shows that many challenges remain, and priorities for future studies need to be established. For example, the evaluation of administration of a vaccine with OPV or breast milk might receive less emphasis until a vaccine is made that shows clear efficacy against all virus serotypes. Samples remaining from previous trials should be analyzed to determine epitope-specific serum and coproantibody responses to clarify why only some trials were successful. Detailed evaluation of the antigenic properties of the viruses circulating and causing illness in vaccinated children also should be performed for comparisons with the vaccine strains. In future trials, sample collection should include monitoring for asymptomatic infections and cellular immune responses should be analyzed. The diversity of rotavirus serotype distribution must be monitored before, during, and after a trial in the study population and placebo recipients must be matched carefully to vaccine recipients. Epidemiologic and molecular studies should be expanded to document, or disprove, the possibility of animal to human rotavirus transmission, because, if this occurs, vaccine protection may be more difficult in those areas of the world where cohabitation with animals occurs. We also need to have an accurate assessment of the rate of protection that follows natural infections. Is it realistic to try to achieve 90% protective efficacy with a vaccine if natural infections with these enteric pathogens only provide 60% or 70% protection? Subunit vaccines should be considered to be part of vaccine strategies, especially if maternal antibody interferes with the take of live vaccines. The constraints on development of new vaccines are not likely to come from molecular biology. The challenge remains whether the biology and immunology of rotavirus infections can be understood and exploited to permit effective vaccination. Recent advances in developing small animal models for evaluation of vaccine efficacy should facilitate future vaccine development and understanding of the protective immune response(s) (Ward et al. 1990b; Conner et al. 1993).

Distinct yearly change of serotype distribution of human rotavirus in Thailand as determined by ELISA and PCR

A total of 241 group A rotavirus-positive stool samples collected from diarrhoeic patients in Thailand between July 1988 and June 1991 were characterized for their serotypes by enzyme-linked immunosorbent assay (ELISA) using serotype-specific monoclonal antibodies and by a polymerase chain reaction (PCR). In July 1988-June 1989, serotype 1 was the most prevalent (63.4%), followed by serotype 4 (11.0%) and serotype 2 (8.5%). In July 1989-June 1990, 59.8% were serotype 1, 24.3% were serotype 2, and 6.1% were serotype 3. In contrast, in July 1990-June 1991, serotype 3 was detected in the highest frequency (40.5%), 29.9% were serotype 1, and 27.3% were serotype 2. Thus, a distinct yearly change of serotype distribution of rotavirus in Thailand was observed in the three consecutive years. In particular, it was of note that the prevalence of serotype 3 greatly increased, in contrast to the previous studies in which almost no serotype 3 rotaviruses were detected in the years 1983-8 in Thailand.

Distribution of VP4 gene alleles in human rotaviruses by using probes to the hyperdivergent region of the VP4 gene

The rotavirus VP4 protein elicits the production of neutralizing antibodies and is known to play a role in inducing resistance to disease. At least five human rotavirus VP4 gene alleles have been described on the basis of antigenic polymorphism and/or nucleotide sequence differences. In the present study, we developed cDNA probes directed at the hyperdivergent region of the VP4 gene of the five described human rotavirus VP4 alleles (Wa, DS1, M37, AU228, and 69M) and used them in hybridization assays with human rotavirus strains from Latin America and Europe to determine the distribution of the VP4 gene alleles in nature. The Wa-like allele was detected most frequently, occurring in 57% of the 402 rotavirus strains tested, and the DS1-like allele was the next most common, occurring in 14% of the strains tested. The M37- and AU228-like alleles were detected in only 4 and 3% of the rotavirus strains tested, respectively, whereas the 69M-like VP4 gene allele was not detected. Several rotavirus strains from Europe did not react with any of the VP4 gene probes, although they did hybridize to a probe generated from a representative strain from the group. These data indicate the global distribution of various VP4 gene alleles and raise the possibility that other, unrecognized human VP4 alleles exist in nature because almost one-fourth of the strains could not be classified into any of the established VP4 groups.

Serotype analysis of rotaviruses from different locations in Malaysia

The distribution of rotavirus G (VP7) serotypes circulating in four locations in Malaysia, representing three geographical areas, was evaluated in 341 RNA-positive stool specimens obtained discontinuously between 1977 and 1988 from infants and young children under the age of five years who were hospitalized with acute gastroenteritis. A total of 306 specimens (256 stool suspensions and 50 that were adapted to growth in tissue culture) that were rotavirus positive by the confirmatory enzyme-linked immunosorbent assay (ELISA) were examined for serotype by ELISA utilizing monoclonal antibodies to rotavirus G serotype 1, 2, 3, 4, or 9. One hundred eighty (59%) of the 306 specimens could be serotyped; of these 180 specimens, 71% were serotype 4, 15% were serotype 1, 4% were serotype 2, and 4% were serotype 3. Serotype 9 rotavirus was not detected. Most (71%) of the specimens tested were obtained in 1988, when serotype 4 predominated in three locations in West Malaysia; no single serotype was predominant in a limited number of specimens from East Malaysia.

Identification of human and bovine rotavirus serotypes by polymerase chain reaction

The use of the polymerase chain reaction (PCR) for identifying serotypes of human and bovine rotaviruses was examined. In the identification of 115 human rotavirus samples in stools, results with PCR showed excellent agreement with results of serotyping by an enzyme-linked immunosorbent assay (ELISA) using serotype-specific monoclonal antibodies. Furthermore, the PCR showed a much higher sensitivity (93%) than the ELISA test (82.6%). The PCR method could also be applied for identifying the serotype of bovine rotaviruses.

Distribution of serotypes of human rotavirus in different populations

Serotyping is a useful tool to study the epidemiologic characteristics of rotaviruses in large populations and to assess the need for a vaccine to protect against all strains. By using an enzyme immunoassay with serotype-specific monoclonal antibodies to the four most common rotavirus serotypes, we analyzed 1,183 rotavirus-positive specimens from 16 stool collections in eight countries on four continents that were obtained from 1978 to 1989. Of the 926 strains (78%) that could be serotyped, 48% were serotype 1, 8% were serotype 2, 15% were serotype 3, and 7% were serotype 4. Twenty-two percent had insufficient numbers of double-shelled virus particles to react with the monoclonal antibody of the VP4 rotavirus protein and therefore could not be serotyped. Our results indicate that vaccines being developed must provide the greatest coverage against serotype 1 and that the serotype distribution cannot be predicted currently by the geographic area or prevalence in the preceding year.

Evidence for two serotype G3 subtypes among equine rotaviruses

Ten cultivable equine rotavirus isolates, two of North American, six of British, and two of Irish origin, were compared with standard rotavirus strains and with each other by cross neutralization, neutralization with a panel of monoclonal antibodies (MAbs), hybridization to a simian rotavirus (SA-11) VP7 gene probe, and reaction with rotavirus subgrouping and serotyping MAbs in enzyme-linked immunosorbent assays. Six isolates, two of which had previously been serotyped as G3 by other workers, were found to be serotype G3; one was confirmed to be G5, and three were not related to serotypes G1 to G10. The serotype G3 strains were divisible into two subtypes, G3A and G3B, on the basis of cross neutralization. This division was also apparent in reactions with neutralizing VP7-specific MAbs and in the liquid hybridization assay. Two of the isolates were not bound by either subgroup MAb, six were bound by both subgroup I and II MAbs, and two were bound by only the subgroup I MAb. The assays used in this characterization provide a range of epidemiological information for use in future field investigations.

Rotavirus serotype G3 predominates in horses

Foal fecal group A rotavirus strains were characterized by electropherotype, serotype, and subgroup and shown to be distinctly different from rotaviruses of other mammals. Of 86 strains that were electropherotyped, 98% had similar profiles, with gene segments 3 and 4 close together and segments 7, 8, and 9 widely spaced. Of 70 strains that had sufficient detectable VP7 antigen to be serotyped by enzyme-linked immunosorbent assays (ELISAs), 63% were serotype G3 (39% were subtype G3A and 24% were subtype G3B), 4% were serotype G13, and 33% were untypeable. Serotypes G1, G2, G4, G5, G6, G9, G10, and G14 were not detected, although G5 and G14 strains have been identified among cultivable equine strains. Of 50 strains that had sufficient detectable VP6 antigen to be subgrouped by ELISAs, only 12% were able to be assigned to either subgroup I or II, with the remaining 88% belonging to neither subgroup.

Cultivation and characterization of novel human group A rotaviruses with long RNA electropherotypes, subgroup II specificities, and serotype 2 VP7 genes

During an epidemiological study of human rotavirus infections in Bangladesh, three group A strains hybridized with a serotype 2 oligonucleotide probe, but they had long RNA electropherotypes. The three strains were collected from 8- to 20-month-old infants with acute diarrhea and moderate malnutrition. By a modified isolation procedure, two strains (T-B and T-C) were adapted in MA104 cell cultures. They were identified to be subgroup II specific by enzyme-linked immunosorbent assay with subgroup I- and II-specific monoclonal antibodies and were identified by a fluorescent focus reduction neutralization assay with hyperimmune antisera to be serotype 2 specific. Further characterization of these unusual rotavirus strains needs to be carried out.

Analysis of human rotavirus strains prevailing in Bangladesh in relation to nationwide floods brought by the 1988 monsoon

The virologic character of human rotavirus strains prevailing in Bangladesh was investigated in relation to the devastating nationwide floods brought by the 1988 monsoon. Human rotaviruses contained in stool specimens that were collected from inpatients with infantile and adult diarrhea in two hospitals in Mymensingh over a 13-month period (January 1988 to January 1989) and in one hospital in Dhaka over a 3-month period (February to April 1988) were examined for their subgroup, VP7 serotype, and RNA electropherotype. In concurrence with the spread of the flood (from the middle of August 1988), the number of infantile and adult diarrhea patients increased greatly. At the same time, the proportion of rotavirus-positive specimens in all diarrhea cases also increased remarkably, reaching 54 and 45% in September and October, respectively. An electrophoretic analysis of viral RNA revealed 17 distinct patterns of viral RNA (14 long and 3 short electropherotypes) and a considerable number of mixed electropherotypes, suggesting the simultaneous infection of some patients with more than two rotavirus strains. It was noteworthy that electropherotypes of rotavirus strains prevailing in the community changed considerably after the spreading of the flood and that the frequency of virus specimens showing mixed electropherotypes increased significantly during the flood period. These results suggest that sudden environmental change caused by the devastating floods seriously affected the epidemiology of rotavirus infections by increasing the opportunity of transmission of the virus and by reducing the resistance of the host to infection. In both pediatric and adult patient groups, serotypes 1 and 2 were the most frequent ones detected, followed by serotype 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Culture adaptation and characterization of group A rotaviruses causing diarrheal illnesses in Bangladesh from 1985 to 1986

Group A rotaviruses collected between 1985 and 1986 during comprehensive surveillance of treated diarrheal episodes occurring in a rural Bangladesh population were culture adapted and characterized by electropherotype, serotype, and subgroup. Of 454 episodes of rotavirus-associated diarrhea, rotaviruses were culture adapted from 381 (84%), and 335 contained 11 electrophoretically identical segments in unpassaged and cultured preparations. These 335 comprised 69 different electropherotypes with between 1 (32 isolates) and 79 representatives. The persistence of specific rotavirus strains within the study population, as defined by the detection of viruses with particular electropherotypes, was generally limited to a period of only a few months. All 335 isolates were serotyped by neutralization with hyperimmune antisera to prototype rotavirus strains representative of serotypes 1 to 4, i.e., Wa, DS-1, P, and ST-3. It was found that 80, 48, 119, and 88 isolates belonged to serotypes 1 to 4, respectively. The concentrations of hyperimmune antisera required to neutralize these isolates, however, were at least threefold greater than those needed to neutralize the homologous strains. Therefore, the isolates appeared to have altered neutralization epitopes from their prototype strains. Furthermore, the serotype 4 isolates were consistently shown to be much more closely related to the serotype 4B VA70 strain than the serotype 4A ST-3 strain. All but two isolates identified as serotypes 1, 3, or 4 had long electropherotypes and were subgroup II, and all but one serotype 2 isolate were subgroup I and had short electropherotypes. The three disparate strains appeared to be genetic reassortants. Evidence is presented that dual infections required for reassortant formation were not uncommon. Thus, formation of multiple reassortants may have been a cause for the observed rapid shift in viral strains within the study population.

Rotavirus-associated diarrhea in rural Bangladesh: two-year study of incidence and serotype distribution

Stools were evaluated from 5,811 patient visits for treatment of diarrhea in Matlab, Bangladesh, between June 1987 and May 1989. The stools were analyzed to determine the distribution of serotypes of group A rotaviruses (RV). A total of 898 stool samples (15.5%) contained RV, as determined by using an enzyme-linked immunosorbent assay. RV isolates from 855 of these samples were serotyped by using serotype-specific synthetic oligonucleotide probes. A total of 558 (65.3%) could be assigned to specific serotypes: 166 (19.4%), 228 (26.7%), 39 (4.6%), and 125 (14.6%) belonged to serotypes 1 through 4, respectively; 12 (1.4%) hybridized with more than one serotype; and 285 (33.3%) failed to hybridize. RV diarrhea was evident throughout the year, with peaks in the dry winter months and in September 1988, coinciding with a major flood. RV was isolated from 46.6% of patients between 7 and 12 months old. Among children under 24 months of age with RV diarrhea, 1.2% (10 of 828) died. The corresponding percentage for children with diarrhea from all causes is 0.9% (29 of 3,301).

Epidemiology of rotavirus serotypes in Melbourne, Australia, from 1973 to 1989

Fecal rotavirus strains collected between 1973 and 1989 from 943 children admitted with acute diarrhea to one hospital in Melbourne, Australia, were serotyped by using an enzyme-linked immunosorbent assay. The assay incorporated neutralizing monoclonal antibodies specific for VP7 of the four major human serotypes (1 through 4). A serotype could be assigned to 690 of 943 specimens (73.2%). Typeable strains comprised serotype 1 (72.5%), serotype 2 (6.8%), serotype 3 (2.9%), or serotype 4 (15.4%). Monotypes 1a and 1c comprised 52 and 44%, respectively, of serotype 1 strains. All serotypes and monotypes exhibited polymorphic genomic RNAs. Specimens reacting as mixed serotypes were rare (3.2%) and included intertypic strains (0.7%) and mixed infections (1.0%). Nontypeable strains for which an electropherotype could be determined appeared to be identical with typeable strains present concurrently in the community. Serotypes exhibited various epidemiological patterns. Serotype 1 strains were dominant except during three successive winters when 60 to 90% of the disease was caused by serotype 2. Serotype 4 strains showed an episodic pattern of appearance, recurring at peak incidence approximately every 3 years. Fecal rotavirus strains collected from 145 newborn babies housed in Melbourne obstetric hospitals between 1974 and 1986 were also serotyped. All 135 typeable strains (93.1%) belonged to serotype 3. It is hypothesized that endemic infection with serotype 3 rotaviruses in nurseries for the newborn influenced the epidemiology of rotavirus serotypes responsible for severe clinical disease in young children in the same community.

Reactivities of serotyping monoclonal antibodies with culture-adapted human rotaviruses

Rotaviruses collected in Bangladesh during 1985 to 1986 were culture adapted and used in a comparative serotyping study with three groups of monoclonal antibodies, all of which reacted with the major neutralization protein (VP7) of serotype 1, 2, 3, or 4. The goals were to determine which monoclonal antibodies most accurately predicted the serotype and why large variations in serotyping efficiencies have occurred with these monoclonal antibodies in previous studies. The 143 rotavirus isolates used in this study belonged to 69 different electropherotypes; and 44, 23, 21, and 55 isolates were identified as serotype 1 through 4, respectively, by neutralization with serotype-specific hyperimmune antisera. Serotyping specificity by enzyme-linked immunosorbent assay with monoclonal antibodies was 100% consistent with results found by neutralization with polyclonal antisera, but large differences were observed in the sensitivities of the different monoclonal antibodies. Monoclonal antibodies 5E8 (serotype 1), 1C10 (serotype 2), 159 (serotype 3), RV3:1 (serotype 3), ST-3:1 (serotype 4), and ST-2G7 (serotype 4) reacted with all the isolates of the corresponding serotype for which there were sufficient infectious particles. Monoclonal antibody 2F1 (serotype 2) was much less sensitive and reacted with only five serotype 2 isolates, but these were among those with the highest titers. Monoclonal antibodies RV4:2 (serotype 1), KU6BG (serotype 1), RV5:3 (serotype 2), and S2-2G10 (serotype 2), on the other hand, failed to react with between one and three isolates of the corresponding serotypes which had high titers, apparently because of epitope changes in these isolates. Effects of epitope variation were, however, most apparent with monoclonal antibodies 2C9 (serotype 1) and YO-1E2 (serotype 3), which reacted with one and no isolates of the corresponding serotypes, respectively. Cross-neutralization of escape mutants indicated that the serotype 1 monoclonal antibodies 5E8, 2C9, and RV4:2 reacted with different but probably overlapping epitopes, as did serotype 2 monoclonal antibodies 2F1, 1C10, and RV5:3, finding that were consistent with the enzyme-linked immunosorbent assay data. Because of epitope variations between rotavirus strains, serotyping with several monoclonal antibodies directed at different epitopes may increase the sensitivity of the method.

Importance of rotavirus and adenovirus types 40 and 41 in acute gastroenteritis in Korean children

To examine the role of rotavirus (Rv) and adenovirus types 40 and 41 (Ad40/41) in Korean children with acute gastroenteritis, we evaluated 345 children with acute gastroenteritis and 90 children without acute gastroenteritis in Seoul, Korea, during a 29-month period. Stools were tested for group A Rv antigen and for Ad40/41 by using monoclonal antibody (MAb)-based assays. Rv was found in 68% of the ill children and 19% of the controls (P less than 0.001), whereas Ad40/41 was detected in 9% of the ill children and 2% of the controls (P less than 0.05). Also, 6% of the ill children and 0.01% of the controls excreted Rv and Ad40/41 simultaneously. Among the ill children, 96% of children with Rv and 94% of those with Ad40/41 were younger than 24 months. Although a peak of Rv infection was detected in early winter in both years of the study, there was no apparent seasonal trend with Ad40/41. Diarrhea with more than 10 stools per day, vomiting, or fever was most strongly associated with Rv shedding, whereas the first two manifestations were associated with coinfection of Rv and Ad40/41. To investigate the genetic and serotypic diversity of Rv strains, we tested 195 and 144 fecal Rv specimens isolated from the gastroenteritis cases, respectively, by polyacrylamide gel electrophoresis of the segmented RNA genome and by an enzyme-linked immunosorbent assay with serotype-specific MAbs. Of the 195 specimens, 154 yielded RNA patterns characteristic of group A Rv: 18% had short electrophoretic migration patterns, 81% had long patterns, and 1% had a mixture of short and long patterns. Of the 144 specimens, serotype specificity was determined in 51%: 89% were serotype 1, 10% were serotype 2, and 1% were serotype 3. Analysis of the specimens for which electropherotypes and serotypes were available indicated that a given RNA pattern corresponded to a particular serotype, except in one strain that showed short patterns but serotype 1. We suggest that Rv and Ad40/41 in stools be accepted critically as an important cause of diarrhea among young children in Korea.

Evidence for natural reassortants of human rotaviruses belonging to different genogroups

Of 335 rotavirus isolates associated with diarrheal disease in Bangladesh that were culture adapted and subsequently characterized for electropherotype, subgroup, and serotype, 9 had properties that suggested they may be natural reassortants between human rotaviruses belonging to different "genogroups." Two of these were examined in greater detail by RNA-RNA hybridization with prototype strains representative of each of the three proposed human rotavirus genogroups. One subgroup II isolate, 248, with a "long" electrophoretic pattern was neutralized by hyperimmune antisera to both serotype 2 and 4 strains. Consistent with these results, seven RNA segments of this isolate formed hybrids with human strains belonging to the Wa genogroup and four segments hybridized with strains belonging to the DS-1 genogroup. The second isolate examined, 456, belonged to subgroup II and had a long electrophoretic pattern but was found to be a serotype 2 strain. This isolate also appeared to be an intergenogroup reassortant because three of its segments formed hybrids with strains belonging to the Wa genogroup and eight hybridized with viruses of the DS-1 genogroup. On the basis of the relative migration rates of these RNA-RNA hybrids during gel electrophoresis, a suggested origin for each gene segment was proposed which was consistent with the results expected from electrophoretic, subgroup, and serotypic analyses.

Serotype 3 human rotavirus strains with subgroup I specificity

During an epidemiological study on human rotavirus (HRV) infections in Italy, three subgroup I strains not associated with serotype 2 reactivity were detected. All three strains were serotype 3, each with a distinct RNA pattern showing fast-moving tenth and eleventh segments (long electropherotype). Following successful adaptation to growth in cell cultures, the serotype 3 strains (MZ58, PCP5, and PA710) were further characterized by neutralization and by RNA-RNA (Northern blot) hybridization. Antiserum to reference HRV strain YO (subgroup II, serotype 3), as well as a monoclonal antibody to VP7 of YO neutralized, at comparable titers, the homologous virus, the three unusual HRV strains, and two reference simian strains (SA11 and RRV-2, both subgroup I, serotype 3), whereas SA11 antiserum and a monoclonal antibody to VP7 of SA11 neutralized simian strains more efficiently. However, antiserum to PCP5 neutralized the three unusual isolates and the simian strains at significantly higher titers than it did with reference strain YO. With 32P-labeled RNA from MZ58 as a probe, a high degree of homology was detected by Northern blot hybridization with strains PCP5, PA710, SA11, and UK (bovine rotavirus) at the level of several segments and with strain YO only at the level of genes 7 to 9. Conversely, labeled RNA of strain YO hybridized extensively with Wa (subgroup II, serotype 1 HRV strain) but only at the level of genes 7 to 9 with MZ58, PCP5, PA710, SA11, and UK. Finally, the labeled SA11 probe hybridized at the level of RNA segments 1 to 3 and 6 to 11 to the three unusual strains. These findings suggest that the unusual subgroup I, serotype 3, strains isolated from humans are more likely to be animal rotaviruses rather than natural reassortants between different HRV strains.

Isolation in Europe of 69 M-like (serotype 8) human rotavirus strains with either subgroup I or II specificity and a long RNA electropherotype

During an epidemiological study on the prevalence of human rotavirus (HRV) serotypes 1-4 in Europe, we found that some strains could not be typed. However, when a monoclonal antibody directed to serotype 8 HRV was included in the typing assay, we detected seven 69 M-like (serotype 8) strains, six from Finland and one from Italy. The previously reported serotype 8 HRV strains, 69 M, B 37, and B 38 isolated in Indonesia, were of subgroup I specificity and presented a peculiar "super short" RNA electropherotype. In contrast, all the seven European strains possessed a long RNA pattern, and one of them had subgroup II specificity. Three of these strains were adapted to growth in cell cultures and were further characterized by neutralization and by Northern blot hybridization. They appeared to be closely related to serotype 8 HRV strain 69 M by neutralization, but showed partial homology with several human and animal strains by hybridization. The epidemiological importance of these serotype 8 strains circulating in Europe should be investigated, in view of their possible inclusion in a rotavirus vaccine.

Evaluation of three panels of monoclonal antibodies for the identification of human rotavirus VP7 serotype by ELISA

Three panels of monoclonal antibodies used for rotavirus serotype identification by enzyme-linked immunosorbent assay (ELISA) were evaluated at the National Institutes of Health, USA, to identify antibodies suitable for distribution to laboratories involved in WHO-sponsored trials of rotavirus vaccines. Two of the panels were comparably effective in identifying the serotype of each of the human rotavirus reference strains of serotype 1, 2, or 3. In addition, one of the panels included a monoclonal antibody that was effective in identifying strains of serotype 4. However, two different lots of a third, commercially available panel were not effective in identifying the eight strains representing the four serotypes. A third shipment of this panel was therefore tested using revised instructions and, under these conditions, it was effective in serotyping seven of the eight reference strains. It appears that a battery of monoclonal antibodies for each serotype may be required to identify antigenic variants within a serotype. Additional studies are needed to assess the extent of antigenic variation in rotavirus field strains.