Dr. C. Kannan, Post Graduate, MGMCRI, Pudhucherry, India

1. Journal club
Presentation by Dr. C.Kannan,
1st year PG
MGMCRI

2. Rotavirus and other Diarrheal Disease in a Birth Cohort
from Southern Indian Community
From Indian pediatrics
Received: May 15, 2015;
Initial review: October 09, 2015;
Accepted: May 05, 2016.

3. AUTHORS
R SARKAR, BP GLADSTONE, JP WARIER,SL SHARMA, U RAMAN,
J MULIYIL AND G KANG
(From Division of Gastrointestinal Sciences, and *Community
Health Department, Christian Medical College, Vellore, TamilNadu,
India.)
Correspondence to:
Dr Gagandeep Kang,
(Division of Gastrointestinal Sciences, Christian Medical College,
Vellore 632 004)

4. Objective is to describe
 Incidence,
 Severity and
 Etiology of diarrheal disease
In infants and young children residing in an urban slum
community in Southern India.

5. Diarrhoea
 Passage of 3 or more loose watery stools in a 24-
hour period or
 Change in the number or consistency of the stools.
An Episode of Diarrhoea
 At least one day of diarrhoea, preceded and
followed by two or more days without diarrhoea

6. Acute diarrhoea
 Defined as an episode lasting for less than 14 days
Persistent diarrhoea
 Defined as an episode lasting for 14 days or more

7. The Vesikari scale
 Severity of diarrhoea was assessed using the Vesikari scale,
 Originally designed for assessing rotavirus disease presenting to
hospital.
 An episode was considered
 mild - 5 or less,
 moderate - 6-10 and
 severe - 11 or more.

8. Setting
Three contiguous urban slums in Vellore, Tamil Nadu.
Participants
Children participating in a birth cohort study on diarrheal
disease are 452
Children completed three years of follow-up are 373

9. Work done on
 Diarrheal incidence (obtained by twice weekly home visits)
 Severity of diarrhea (assessed by the Vesikari scoring system)
 Etiological agents associated with diarrhea
 Examination of stool specimens by bacteriologic culture,
 Rotavirus enzyme immunoassay,
 PCR for norovirus and
 Microscopy for parasites).

10. Methods applied on work
 452 newborn infants were recruited from three contiguous urban slums
in Vellore between March 2002 and August 2003.
 They were followed up with twice weekly home visits by field workers.
 Stool samples were collected whenever a child was found to have an episode
of diarrhea.
 During a diarrheal episode, the child was visited on alternate days until resolution.
 Detailed clinical data was collected on the
 onset, duration, frequency,
 color and consistency of stools,
 associated vomiting and fever,
 presence and severity of dehydration, and treatment.

11. Results and interpretations
 1856 episodes in 373 children,
 Samples collected are 1829
 Frequency in age
 1.6 episodes / child on average,
 2.76 episodes in infancy,
 1.28 episodes in 2nd year,
 0.94 episodes in 3rd year,
 Frequency in year
 95 % have one episode in 3 years,
 28 % have more than 6 episodes by the time they reach 3 years
 in 4 months 50% have one episode,
 at 6 months 75 % have more than 1 episode ,
 increased incidence b/w 3-8 months,
 Median duration is 3 days (2-4),
 42%of episodes in 1st year are >3 days,
 29% of episodes in 2nd year are >3 days,
 22%of episodes in 3rd year are >3 days

12.  1833(98.8%)episodes are acute,
 23(1.2%)are persistant,
 Associated symptoms
 vomitting seen in 297 (16%)episodes,
 fever seen in 317(17%)episodes,
 mucus in stool seen in 250(13.5%)episodes,
 bloody in 41(2.2%) episodes,
 Treatments
 antibiotics used in 27.5%,
 antimotility in 14.6%
 ORS given in 1564(87.4%) episodes,
 In 1793 episodes
 58.4%are mild,
 33.4% are moderate,
 8.2% are severe

13.  Antibiotics used
 in 19.1% of mild,
 38% moderate
 and 54.2% of severe episodes,
 Proportion of highest severity is seen in age <6 months is 12%,
 Out of 1829 episodes
 635(35.7%) are a/w 1 or >1 pathogens
 in that 28 % in infancy and
 45% are in late years,
 coinfection with 2 organisms is 88(4.8%)
 with 3 or more organisms is 9(0.5%)
 Out of positive samples
 rotavirus (18%),
 giardia(8%),
 aeromonas(4%),
 cryptosporosis(3%),
 shigella (2%),
 vibrio(1%),

14. Seasonal pattern of diarrheal incidence among children
in the birth cohort, followed from March 2002 to August
2006.

15. WHAT IS ALREADY KNOWN?
• The etiology of diarrhea in hospitalized children is well documented, but community
estimates from longitudinal studies are lacking.
WHAT THIS STUDY ADDS?
• Poor and very poor hygiene status showed a higher risk of getting severe diarrhoea
• Good hygiene practices within the home, such as washing hands with soap before
feeding a child, can reduce the risk of 33% of childhood diarrhea
• Incidence rate of diarrhea was 1.66 episodes per child year for first 3 years of life;
highest incidence (2.76episodes per child year) is seen in infancy.
• As with hospitalized children, rotavirus was the commonest etiological agent
associated with 18% of childhood diarrhea in the community.

16. THANK YOU!!