An outbreak of group C rotavirus gastroenteritis among children attending a day-care centre in Belém, Brazil

In August 1993, an outbreak of group C rotavirus-associated gastroenteritis occurred among children attending a day-care centre in Belém, Brazil. Of the 64 children, 21 (33%) became ill. Group C rotavirus was identified in faecal specimens from 8 (38%) children with diarrhoea by electron microscopy (EM) and an enzyme immunoassay (EIA), using antibodies specific to the Cowden strain of porcine group C rotavirus. By polyacrylamide gel electrophoresis (PAGE), a pattern similar to that of group C rotavirus was observed in 5 (62.5%) of the 8 EM- and EIA-positive samples. These 5 faecal samples were confirmed to be positive for group C rotavirus by reverse transcriptase-polymerase chain reaction, using specific VP6 and VP7 primers. This is the first report of an outbreak of diarrhoea in North Brazil associated with group C rotavirus. These findings suggest that group C rotavirus may be an important aetiological agent of diarrhoea in this region, which requires further study.

Rotavirus subgroups, G serotypes, and electrophoretypes in cases of nosocomial infantile diarrhoea in Belém, Brazil

From November 1992 to November 1994 stool samples were obtained from 237 children admitted to a public hospital in Belém. Rotaviruses were detected in 19.3 per cent (60/310) of faecal samples. Of these, 32.1 per cent (18/56), 20.9 per cent (38/181), and 5.4 per cent (4/73) were recorded in cases of nosocomial diarrhoea, community-acquired diarrhoea, and controls, respectively. Fifty-two (86.7 per cent) of the 60 rotavirus-positive specimens were subgrouped and the G serotypes of 55 (91.7 per cent) of them were determined. Subgroups I and II were detected in 50 per cent each of the 52 subgrouped strains. G type 2 was present in 46 (83.6 per cent) of the 55 serotyped samples; serotypes G1 and (mixed) G1 and G4 were found in 14.5 per cent and 1.8 per cent, respectively, of these specimens. Viral RNA electrophoresis showed 14 distinct patterns, including 56.7 per cent (34/60) and 43.3 per cent (26/60) of long and short profiles, respectively. In 40 (66.6 per cent) of the 60 rotavirus-positive faecal samples no enteropathogens other than rotavirus were detected. There was an increased incidence of rotavirus infection from July 1993 to February 1994. The rotavirus-related episodes of diarrhoea were more severe than those of other aetiology and greater clinical severity was not related to a specific G type, subgroup, or electrophoretype.

An outbreak of group C rotavirus gastroenteritis among adults living in Valentim Gentil, São Paulo State, Brazil

An outbreak of gastroenteritis affecting adults and children occurred in the small city of Valentim Gentil, São Paulo, Brazil, in 1993. Nineteen faecal samples (from 10 cases and 9 contracts) were examined by direct electron microscopy (DEM), immune electron microscopy (IEM), polyacrylamide gel electrophoresis (PAGE), and enzyme-linked immunosorbent assay (ELISA) for group A and C rotaviruses. DEM detected rotavirus in 6 of the 10 cases and in none of the contacts. All of the samples were negative for group A rotavirus by ELISA. Analysis by PAGE showed an electrophoretic profile suggestive of group C rotavirus in two cases. Group C rotavirus was identified by IEM in 4 of the cases and in 1 of the contacts. All of the samples were submitted to ELISA for group C rotavirus. This resulted in a total of 10 positives-7 for diarrhoeal cases and 3 for contacts. This outbreak was strongly associated with group C rotavirus. The importance of combining different diagnostic methods is emphasised.

Rotavirus G and P types in children from Belém, northern Brazil, as determined by RT-PCR: occurrence of mixed P type infections

Fifty-four group A rotavirus-positive stool samples, obtained from children aged less than three years during a longitudinal (December 1982 to March 1986) study in Belém, Brazil, were re-examined. The samples were tested by reverse-transcription and polymerase chain reaction to determine their G-type and P-type specificity. Only 17 (32%) of these rotavirus strains could be successfully G- and P-genotyped. While 10 (59%) of the 17 strains showed single G- and P-type specificity, the remaining belonged to single G- and mixed P-genotypes. Rotavirus strains P[8], G1 and P[4], G1 predominated, accounting for 29% and 18% of the typed strains respectively. Mixed P-type infections caused by rotaviruses classified as P[8] + P[4], G1 were identified in 23% of cases. All but 3 of the 54 rotavirus strains displayed long genomic profiles, as demonstrated by the analysis of RNA by polyacrylamide gel electrophoresis. Most (70%) rotavirus strains with single G- and P-type specificity were detected during the first year of life, whereas 5 (71%) of the seven mixed P-type infections occurred throughout the second or third year of age. Reinfections were noted in two children, both of them being infected with P[8] + P[4], G1 rotavirus strains when aged 20 months. The high proportion of untypeable rotavirus strains suggests that unusual types may be circulating in Belém. In addition, the occurrence of mixed P-type infections in our region indicates the potential for reassortment between different rotavirus genogroups. Monitoring of these rotavirus strains may have important implication in the context of future strategies of rotavirus vaccination in Brazil.

Concomitant rotavirus serotypes 1 and 4 infections in a diarrhoeic child from Belém, Brazil

Concomitant serotypes 1 and 4 infections were detected in a 15-month old female child with community-acquired diarrhoea which lasted 7 days and coursed with moderate dehydration. The evidence for dual rotavirus infection was offered by the following findings: a) enzyme-linked immunosorbent assay (ELISA) positive reactions to both 1 and 4 serotypes; and b) extra-migrating bands at electrophoresis of RNA in polyacrylamide gel (PAGE). These results suggest that children living under poor sanitation conditions are heavily exposed to rotavirus infections; in addition, the co-circulation of different serotypes in the same setting sustains the current concept that a rotavirus vaccine should be multivalent, in order to protect children against the four epidemiologically important rotavirus G serotypes.

Immunogenicity, safety and efficacy of tetravalent rhesus-human, reassortant rotavirus vaccine in Belém, Brazil

A tetravalent rhesus-human reassortant rotavirus (RRV-TV) vaccine (4 x 10(4) plaque-forming units/dose) was evaluated for safety, immunogenicity and efficacy in a prospective, randomized, double-blind, placebo-controlled trial involving 540 Brazilian infants. Doses of vaccine or placebo were given at ages 1, 3 and 5 months. No significant differences were noted in the occurrence of diarrhoea or vomiting in vaccine and placebo recipients following each dose. Low-grade fever occurred on days 3-5 in 2-3% of vaccinees after the first dose, but not after the second or third doses of vaccine. An IgA antibody response to rhesus rotavirus (RRV) occurred in 58% of vaccinees and 33% of placebo recipients. Neutralizing antibody responses to individual serotypes did not exceed 20% when measured by fluorescent focus reduction, but exceeded 40% when assayed by plaque reduction neutralization. There were 91 cases of rotavirus diarrhoea among the 3-dose (vaccine or placebo) recipients during two years of follow-up, 36 of them among children given the vaccine. Overall vaccine efficacy was 8% (P = 0.005) against any diarrhoea and 35% (P = 0.03) against any rotavirus diarrhoea. Protection during the first year of follow-up, when G serotype 1 rotavirus predominated, was 57% (P = 0.008), but fell to 12% in the second year. Similar results were obtained when analysis was restricted to episodes in which rotavirus was the only identified pathogen. There was a tendency for enhanced protection by vaccine against illness associated with an average of 6 or more stools per day. These results are sufficiently encouraging to warrant further studies of this vaccine in developing countries using a higher dosage in an attempt to improve its immunogenicity and efficacy.

Rotaviruses as a cause of nosocomial, infantile diarrhoea in northern Brazil: pilot study

Faecal samples were obtained from 190 children, aged 0 to 5 years, admitted to a public hospital in Belém, Pará, Brazil. These patients were placed in a pediatric ward with 40 beds distributed in six rooms. Cases were classified into three groups: (a) nosocomial: children who developed gastroenteritis 72 hr or later after admission; (b) community-acquired: patients admitted either with diarrhoea or who had diarrhoea within 72 hr following admission; (c) non-diarrhoeic: those children who had no diarrhoea three days before and three days after collection of formed faecal sample. Specimens were routinely processed for the presence of rotaviruses, bacteria and parasites. Rotaviruses were detected through enzyme-linked immunosorbent assay (ELISA) and subsequently serotyped/electrophoretyped. Rotaviruses were the most prevalent enteropathogens among nosocomial cases, accounting for 39% (9/23) of diarrhoeal episodes; on the other hand, rotaviruses occurred in 8.3% (11/133) and 9% (3/34) of community-acquired and non-diarrhoeic categories, respectively. Mixed infections involving rotavirus and Giardia intestinalis and rotavirus plus G. intestinalis and Entamoeba histolytica were detected in frequencies of 8.6 and 4.3%, respectively, in the nosocomial group. The absence of bacterial pathogens in this category, and the unusual low prevalence of these agents in the other two groups may reflect the early and routine administration of antibiotics following admission to this hospital. Rotavirus serotype 2 prevailed over the other types, accounting for 77.8% of isolates from nosocomial diarrhoeal episodes. In addition, at least five different genomic profiles could be observed, of which one displayed an unusual five-segment first RNA cluster. Dehydration was recorded in all cases of hospital-acquired, rotavirus-associated diarrhoea, whereas in only 57% of nosocomial cases of other aetiology. It was also noted that nosocomial, rotavirus-associated diarrhoeal episodes occur earlier (7 days), following admission, if compared with those hospital-acquired cases of other aetiology (14 days).

[Prospective study of rotavirus infections in Belém, Pará, Brazil: clinical and epidemiological features]

A prospective study of acute diarrhoeal diseases was carried out from April 1990 to September 1992 with the purpose of assessing the immunogenicity, safety and efficacy of a Rhesus-human reassortant rotavirus ("RRV-TV") vaccine, involving 540 children living in Belém, Pará, Brazil. As half of the children received placebo, this trial provided the opportunity of broadening the knowledge on both clinical and epidemiological aspects of rotavirus infection in the Amazon region. There were 2,789 diarrhoeal episodes during the above mentioned period, of which 86 (3.1%) associated with rotavirus; serotype 1 was the more prevalent, accounting for 67.9% of serotyped strains. Rates of 5.9 and 0.2 episodes of diarrhoea per child/year were noted for all cases and the rotavirus-related ones, respectively. This agent was the only pathogen found in 70.9% of the 86 rotavirus-related episodes of acute diarrhoea, whereas the most frequent associations involved Giardia intestinalis and enteropathogenic Escherichia coli, accounting for 7.0% and 11.6% of mixed infections,respectively. The monthly rates of rotavirus-related episodes of diarrhoea ranged from 0.8% to 9.6%, reaching the highest peaks during the dry months of the year. Means of clinical severity scores of 9.4 and 5.3 were recorded for the rotavirus-related episodes of diarrhoea and those of other aetiology, respectively.

Nosocomial transmission of an avian-like rotavirus strain among children in Belém, Brazil

An atypical group-A rotavirus strain, with an electrophoretype displaying 5 segments in the first dsRNA size class, was detected among 3 hospitalized children less than 2 years old. Detection occurred initially 24 h after admission in a non-diarrhoeic child hospitalized because of acute respiratory infection. The second detection involved a child who occupied a different room within the same ward and who developed nosocomial diarrhoea 48 h later. A third case, also of hospital-acquired diarrhoea, was recorded in a child who occupied a bed in the same room as the second case and developed gastroenteritis 24 h following the second case's detection. In addition to the unusual, avian-like genomic profile, the strain was classified as serotype 2, based on a human VP7-specific enzyme-linked immunosorbent assay (ELISA). The question of whether these events reflect either a genomic rearrangement of a human rotavirus strain or a possible interspecies transmission will be further investigated through hybridization assays.

Prevalence of antibodies to Norwalk virus among Amerindians in isolated Amazonian communities

The seroepidemiology of Norwalk virus infections was examined among Amerindians belonging to eight relatively isolated communities in the Amazon region by means of a new enzyme immunoassay using recombinant Norwalk virus antigen. The seroprevalence of antibodies to Norwalk virus ranged from 39% in the Maiogong to 100% in the Kubenkrankrein. The distribution of antibody levels varied greatly among groups; five of the eight communities had an antibody prevalence greater than 90% with many high values (> 100 units), while three had both a low seroprevalence and a preponderance of low values (< 100 units). While few children less than 5 years of age were sampled, no significant differences in antibody prevalence were noted among age groups, and the prevalence of antibody among children 5-10 years of age approached that of the older age groups. The low prevalence of titers of antibodies to Norwalk virus in several tribes living in these isolated Indian communities suggests that Norwalk virus may have been only recently introduced.

Neutralizing antibody immune response in children with primary and secondary rotavirus infections

We have characterized the neutralizing antibody immune response to six human rotavirus serotypes (G1 to G4, G8, and G9) in Brazilian children with primary and secondary rotavirus infections and correlated the response with the G serotype of the infecting rotavirus strain. Twenty-five children were studied: 17 had a single rotavirus infection, 4 were reinfected once, and 4 experienced three infections. Two of the reinfections were by non-group A rotaviruses. Among the 25 primary infections, we observed homotypic as well as heterotypic responses; the serotype G1 viruses, which accounted for 13 of these infections, induced mostly a homotypic response, while infections by serotype G2 and G4 viruses induced, in addition to the homotypic, a heterotypic response directed primarily to serotype G1. Two of the primary infections induced heterotypic antibodies to 69M, a serotype G8 virus that by RNA electrophoresis analysis was found not to circulate in the population during the time of the study. The specificity of the neutralizing antibody immune response induced by a virus of a given serotype was the same in primary as well as secondary infections. These results indicate that the heterotypic immune response induced in a primary rotavirus infection is an intrinsic property of the virus strain, and although there seem to be general patterns of serotype-specific seroconversion, these may vary from serotype to serotype and from strain to strain within a serotype.

Rotavirus serotypes and electrophoretypes among children attending three paediatric hospitals in Belem, Brazil

From March to September 1988 stool specimens of 101 hospitalized diarrhoeic infants and children, aged 1-24 months were examined by enzyme-linked immunosorbent assay (ELISA) for the presence of rotavirus antigen. This agent was found in 40 (40 per cent) of the 101 episodes of acute diarrhoea, and strains were both characterized by analysis of RNA in polyacrilamide gel and serotyped by ELISA using serotype-specific monoclonal antibodies. The highest frequency of rotavirus positivity was 80 per cent in the 16-18 month age group. All 11 (28 per cent) serotyped strains belonged to serotype 3 whereas absence of Vp7, the major outer capsid glycoprotein, did not allow serotyping in 29 (73 per cent) of the 40 rotavirus-positive specimens. Four distinct electrophoretypes were detected and the predominant one had the IbIIbIIIgIV a profile, accounting for 62 per cent of the classified strains. Unclear patterns did not allow us to determine the electrophoretype of six rotavirus strains. The clinical picture in study children was in general of moderate/severe nature.

Naturally occurring serotype 2/subgroup II rotavirus reassortants in northern Brazil

Nine serotype 2 human rotavirus strains were isolated in a community-based longitudinal study in Northern Brazil. Five of these strains had a 'long' RNA electrophoretic pattern and all five strains were determined to belong to subgroup II by ELISA assay, in contrast to properties common to serotype 2 human rotaviruses previously characterized. Hybridization studies of one of these unusual strains with 32P-labelled mRNAs derived from the prototype human strains Wa (serotype 1, subgroup II) and S2 (serotype 2, subgroup I) suggested that it was generated by a reassortment event in nature, in which a subgroup II, 'long' electropherotype rotavirus exchanged its serotype-specific gene and gene number 10 for the equivalent genes from a serotype 2, 'short' electropherotype virus.

Longitudinal study of rotavirus infections among children from Belém, Brazil

From December 1982 to March 1986 a group of 80 children between 0 and 3 years old who lived in the peripheral area of Belém, Brazil, were followed up for episodes of diarrhoea. A total of 441 diarrhoeal episodes were recorded and 36 (8.2%) were associated with rotavirus. This agent was the only pathogen in 50% of rotavirus-related episodes of acute diarrhoea, and strains were characterized by analysis of RNA in polyacrylamide gels. Forty-one belonged to subgroup II (long pattern) and five to subgroup I. Reinfections by rotavirus were noted in 12 children involving either the same or different subgroups. Ten distinct electrophoretypes were detected in the study period and the predominant one had the '1N2L' profile. The cumulative age-specific attack rate for diarrhoea reached 2.8 by the end of the first year of life; a frequency of 2.3 episodes of diarrhoea per child per year was observed throughout the complete investigation. In comparing the age-specific attack rates for diarrhoea between breast-fed and bottle-fed children, a peak at 6 months of age was noted in the former, and at 1 month in the latter. A comparison by Fischer's exact test (P = 0.21) provided no evidence for protection against clinical rotavirus disease by maternal milk. By the same test, however (P = 0.021), we found significant evidence that early rotavirus infections were more likely to be asymptomatic and that infections after 4 months were more likely to be symptomatic. The clinical picture in children with rotavirus-related diarrhoea was more severe than in those suffering from acute diarrhoea due to another agent.

Atypical rotavirus among diarrhoeic children living in Belém, Brazil

Atypical rotaviruses were detected in faeces from two diarrhoeic children living in Belém, Pará, Brazil. Rotavirus particles were detected by electron microscopy and the RNA electrophoresis showed patterns which were compatible with group C rotaviruses. Tests for the presence of group A antigen by enzyme-linked-immunosorbent assay (ELISA) were negative. The two children had three successive rotavirus infections and in both cases the atypical strains were excreted at the time of the third infection, causing a mild and short-lasting disease.

Pattern of acquisition of rotavirus antibody in children followed up from birth to the age of three years

Nine hundred and forty-eight serum samples from 83 children living in Belem, Brazil, collected within their first three years of life, were tested for the presence of group-specific rotavirus-antibody by an enzyme-linked immunosorbent assay (ELISA) blocking-test. Passively transferred maternal antibody lasted about two and half months; subsequently, low levels of rotavirus antibody started to appear at seven months, reaching a peak at eleven months of age. From one year onwards positivity gradually increased, reaching highest values at 34 months of life. Individual responses were examined in sera from 61 children who were followed up since birth to three years of age: 38 (62.3%) of them developed a long-term immunity following first infection; eleven (18.0%) children developed a short-term immunity after first infection by rotavirus; seven (11.5%) had no antibody response within their first three years of life; and 5 (8.2%) showed positive antibody response from birth to three years old.

[Temporal distribution of electrophoretic profiles of nucleic acid from rotavirus in the feces of children in Belém, Pará, Brazil]

Electrophoresis of rotavirus RNA in polyacrylamide gel was carried out by using faecal samples collected from children living in the peripheral area of Belém, Brazil. Typical rotavirus profiles (eleven bands) were noted in 46(76.7%) out of 60 ELISA rotavirus positive specimens. According to the electrophoretic patterns, 5(10.9%) were classified as subgroup I, while 41(89.1%) of them as subgroup II. Lacking of bands 10 and 11 in 14(23.3%) samples did not allow us to classify their electropherotypes. The profile coded as "1N2L" was the predominant one, accounting for 65.2% of the classified strains.

Reinfections and rotavirus serotypes in Belém, Brazil (preliminary report)

Repeated infections involving different rotavirus serotypes were detected in four children living in Belém, who were followed up since birth to three years of age. In one child (Reg. 23.983) three successive symptomatic infections (one of them associated with serotype 2) were noted: the first, at four months of age, the second at 20 months and the third at 27 months. Another child had two subsequent infections, the first one by rotavirus serotype 1, and the second by a not identified rotavirus serotype. In this case two episodes of rotavirus-related diarrhoea were recorded, occurring eight months apart. Apparent infections were detected on two occasions involving the same child (Reg. 24.004), the first being associated with serotype 1, and the second with serotype 2. The fourth child (Reg. 24.097) had two successive infections by not determined rotavirus serotypes, without clinical manifestations; the first occurred at 24 months and the second at 28 months.

Epidemiology of rotavirus subgroups and serotypes in Belem, Brazil: a three-year study

Rotavirus subgroups and serotypes were determined in 61 rotavirus-positive faecal samples obtained from children living in Belém, Brazil, followed up from birth to 3 years of age. Fifty-five (90%) of the specimens were subgrouped and the serotypes of 30 (49%) of them were determined. Subgroup II was detected in 49 (89%) of the 55 subgrouped strains. Serotype 1 was present in 15 (50%) of the 30 serotyped samples; serotypes 2, 3 and 4 were found in 30%, 3.3% and 16.7% respectively, of these specimens. Absence of Vp7, the major outer capsid glycoprotein, did not allow serotyping in 21 (34.4%) of the 61 rotavirus-positive specimens, and an unidentifiable new serotype was found in faeces of one child. In addition, 4 samples were classified as subgroup II serotype 2 (which is very unusual). Twelve (80%) of the 15 serotype 1 (subgroup II) specimens were collected from children (5 of them asymptomatic) during their first year of life. All 9 serotype 2 (subgroups I, II, or not determined) samples were detected during the second and third years of life, 7 (77.8%) of them were related to apparent infections. The 5 serotype 4 (subgroup II) samples were obtained throughout the study period, and were associated with both symptomatic (3 cases) and asymptomatic infections. Thirteen children had more than 1 rotavirus infection. Three had 3 successive infections. In 3 cases, the initial infection (either symptomatic or asymptomatic) caused by serotype 1, was followed by a subsequent diarrhoeic episode associated with serotype 2.