|Year : 2022 | Volume
| Issue : 1 | Page : 43-47
Demographical and clinical features of suspected cases of rotavirus gastroenteritis at Al-Baha region, Saudi Arabia
Shaia Saleh Rajab Almalki1, Waled A M Ahmed2, Yagoub Hamadt Allah Elhaj1, Naseem Akhter1, Raed A Alharbi1, Hanan E Alyahyawi1, Saleha Kheder Alatawi3, Hamdi Katar4
1 Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
2 Department of Nursing, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
3 Department of Optometry, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
4 Department of Pediatric and Neonatology, King Fahad Hospital, Al-Baha, Saudi Arabia
|Date of Submission||24-Mar-2022|
|Date of Acceptance||24-Mar-2022|
|Date of Web Publication||2-May-2022|
Shaia Saleh Rajab Almalki
Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha
Source of Support: None, Conflict of Interest: None
Background/Objective: Rotavirus is the main reason of diarrhea with gastroenteritis during childhood. This study aims to identify the demographical and clinical features of rotavirus (RV) suspected cases at Al-Baha Region. Materials and Methods: This is a cross-sectional study, it was conducted on selected 298 suspected cases with RV gathered from three noteworthy hospitals in Al-Baha area (King Fahd Hospital, Prince Meshari Hospital, and Aqiq General Hospital). The selected cases had been included based on case definition of the World Health Organization for rotavirus gastroenteritis. The data were collected from existing data in the selected hospitals' records, it was then analyzed using SPSS software. Results: The findings of this study expressed that male children are somewhat more than females (55% to 45%), the majority of them are under 2 years and most commonly are at infancy period (53.4%) and the greater part of them were admitted to Aqiq General Hospital (56.4%). The study showed that the clinical features of the hospitalized children with suspected rotavirus as 65.5% had stool motions at least twice a day, about 66.5% had no vomiting, while 59.1% with mild dehydration and 30.5% with moderate dehydration, 42.3% with lethargy, 35.2% with irritability, 53.4% with sunken eyes, and 48.3% unable to drink water. The children of the age group (≤2 years old) had significantly severe dehydration and diarrhea and were more febrile compared to other children. Conclusion: The rotavirus is a major reason of diarrhea with gastroenteritis among under 5 years children in Al-Baha region. Rotavirus suspected cases have been featured by severe diarrhea, vomiting, fever, and mild dehydration among suspected case in the governmental hospitals at Al-Baha region.
Keywords: Clinical features, gastroenteritis, rotavirus, suspected cases
|How to cite this article:|
Almalki SS, Ahmed WA, Allah Elhaj YH, Akhter N, Alharbi RA, Alyahyawi HE, Alatawi SK, Katar H. Demographical and clinical features of suspected cases of rotavirus gastroenteritis at Al-Baha region, Saudi Arabia. Saudi J Health Sci 2022;11:43-7
|How to cite this URL:|
Almalki SS, Ahmed WA, Allah Elhaj YH, Akhter N, Alharbi RA, Alyahyawi HE, Alatawi SK, Katar H. Demographical and clinical features of suspected cases of rotavirus gastroenteritis at Al-Baha region, Saudi Arabia. Saudi J Health Sci [serial online] 2022 [cited 2022 May 21];11:43-7. Available from: https://www.saudijhealthsci.org/text.asp?2022/11/1/43/344489
| Introduction|| |
Several microbes such as viruses, bacteria, and parasites could cause gastroenteritis accompanying with severe diarrhea. Intense gastroenteritis remains a common public medical issue in numerous nations including Saudi Arabia. Based on the World Health Organization (WHO) statistics, two million cases of diarrhea are isolated and about 1.9 million under-five children counted deaths each year worldwide due to gastroenteritis. The viral reason of gastroenteritis is the most predominant reason of this condition and its deaths. There are more than twenty kinds of viruses have been identified as infectious agents for gastroenteritis. Rotavirus is accountable for around 20% of deaths related to diarrhea in children under 5 years of age globally., A review conducted by Almalki, 2018, investigating the rotavirus strains after vaccination in Eastern Mediterranean Region (EMR), which reflected that rotavirus strains prevalence in EMR countries has changed postvaccination, when some strains have increased.
The WHO expressed that the under-five youngsters' mortality because of rotavirus disease is high and afterward it suggested the utilization of rotavirus immunization., In spite of the earlier beginning time of rotavirus immunization in some communities, the rotavirus gastroenteritis (RVGE) is still more dominant among under-five kids causing high morbidity and mortality. Rotavirus is a main cause of acute epidemic and outbreaks gastroenteritis, happening primarily among children below 5 years of age.
Several studies on viral gastroenteritis in Saudi Arabia demonstrated that rotavirus is the most frequently accompanying intense gastroenteritis in under less than five youngsters., In Saudi Arabia, the mortality rate from diarrhea among children was estimated as 1530 per year and about 474 of them from RV gastroenteritis. Over the three decades, several studies were published as an effort to describe the epidemiology of RV diarrhea in Saudi Arabia,,,,,,,, however, only around four studies were published in the most recent years,,, which indicated a need for updating RV epidemiological statistics in Saudi Arabia.
However, the rotavirus immunizations are introduced more than 7 years ago in Saudi Arabia, and presently, there are numerous kinds of industrially utilized rotavirus vaccines, the RV has been reported in different areas. The RV gastroenteritis keeps on infecting under 5 years children regardless the developments in diagnostic strategies and preventive measures against this disease. In particular cases, the common diagnostic methods for RV are not accessible, lead to the use of case definition-based diagnosis, or failure to sufficiently manage suspected cases. These suspected cases in this study with RV gastroenteritis were distinguished based on the WHO RV case definition. Despite the fact, the prevalence of RV is not dramatically diminished, there might be a higher related infection with demographical factors.
Little information is available about the demographical and clinical features of rotavirus infection in Al-Baha, Saudi Arabia. This study aimed to evaluate the demographical and clinical features of rotavirus (RV) suspected cases at Al-Baha region.
| Materials and Methods|| |
This is a retrospective cross-sectional study recruited 298 suspected cases of RV collected from three major hospitals in Al-Baha region. It was conducted retrospectively on the available data on diarrhea with gastroenteritis among under-five children.
This study was enrolled in three major governmental hospitals in Al-Baha region (King Fahd Hospital, Prince Meshari Hospital, and Aqiq General Hospital).
this study was done in the period from November 1, 2017, to December 30, 2018 to collect data from previous records of under 5 years children who were admitted to the selected three hospitals during the period of study.
Sampling and sample size
This study recruited 298 suspected cases of RV collected from three major hospitals in Al-Baha region on data available on children revealing symptoms of diarrhea and/or vomiting admitted to the King Fahd Hospital, Prince Meshari Hospital, and Aqiq General Hospital, from January 1, 2016, to December 31/12/, 2016, the data collection included patients' demographic data and clinical features of rotavirus suspected cases.
These cases have been selected based on case definition of WHO which defined suspected case of RV as “any child admitted for management of acute watery gastroenteritis/diarrhea to a sentinel hospital conducting surveillance.” Exclusion of children with bloody or mucoid diarrhea resulted in finally inclusion of only 298 suspected cases in this study.
Data collection technique and tools
Data about demographic characteristics of children including age, gender, and residence were collected, in addition to, data regarding clinical features of these suspected cases. All cases treated as RV cases and the response for this treatment was reported. The immunization status was nonreported in the patients' records.
The data were recorded on a standardized format by the study team. The clinical features (diarrhea, vomiting, fever, dehydration, and general level of activity) for each child were reported. In addition, the tests used for diagnosis, if available, were recorded.
The main variable was binary variable (RV or not). The final analyses were conducted using statistical packages such as SPSS, version 23 (IBM Corp., Armonk, New York, USA). The Chi-square crosstabs were used for rotavirus and other attributes such as age, sex, clinical features, and education as predictors.
A written authorization was taken from the Ministry of Health by sending a request letter with the proposal and the tools to be used. A proposal presentation was delivered in each hospital, and the ethical clearance was gotten from King Fahad Hospital's Academic Affairs.
| Results|| |
The finding of this study reflected that about half or more of children are males (55%), many of them are <2 years and mainly at infancy age (53.4%) and more than half of them from Aqiq General Hospital (56.4%), [Table 1].
The clinical features of included suspected RV cases include about 65.5% of them have stool frequency more than twice a day, about 66.5% have no vomiting associated, while 59.1% have mild dehydration and 30.5% have moderate dehydration. The results also showed that 42.3% have lethargy, 35.2% were irritable, 53.4% with sunken eyes, and 48.3% unable to drink water, [Table 2]. The diarrhea was continued for about 3.2 ± 1.8 days and the body temperature ranged from 34c to 39.7c, [Table 3].
The relationship between demographic variables and clinical features of RV suspected cases displayed that age group (≤2 years old) has more severity dehydration compared to other age group. The children (≤2 years old) were more febrile than other group, but the length of diarrhea was insignificantly lower (≤4 days of diarrhea) among this age group. The children from King Fahad Hospital have significantly higher occurrence of vomiting and more severity of dehydration compared to children from other two hospitals [Table 4].
|Table 4: Associations between patient's demographics and clinical features of rotavirus suspected cases|
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| Discussion|| |
The epidemiological studies on RVGE in Saudi Arabia indicate high rate (average: 33.7%), In the Middle East countries and the gulf countries, there was rotavirus seasonal highest rate in especially November. While in others countries, the seasonal highest rate was in July., Similarly, rotavirus was also identified to be a leading infectious cause of viral gastroenteritis among children in some communities of Saudi Arabia., Furthermore, a most recent systematic review by Almalki 2018, on circulating strains of rotavirus in EMR, showed that the prevalence of rotavirus strain in this region has been changed after introduction of rotavirus vaccine, while some strains have been more common. In particular, in Saudi Arabia, there is a change in specific strains dissemination at postvaccination period. Furthermore, one study conducted in Aseer region for identification of Rotavirus features from children after vaccination in Aseer region which showed that fever, vomiting, and continuous diarrhea are the main features of positive cases, it also reflected that some strains have decreased after vaccination. In Al-Baha area, the under-five youngsters hospitalized with diarrhea were more probably to have RV throughout the year, endorsing that RV infection is still high in this area.
Actually, demographical features of under-five children with suspected RV in this study conveyed that a greater part of children were males similar to another study conducted in Saudi Arabia in 2015, about half of them were at infancy age and greater part were hospitalized in Aqiq General Hospital. Children <2 years of age were the most susceptible group to RV infection in this study and in other studies of Saudi Arabia communities,,,,,,, and in different nations such as Jordan, Netherlands, Qatar, and Turkey.
The clinical highlights of admitted children with suspected RV infection include more frequent stool motions (no less than twice per day) which is lower than the frequency of stool per day in one study directed in Netherlands which was between 4 and 7 times, and less vomiting associated in this study in contrast to previous studies,, while mild dehydration was most commonly associated and it was severed among children in study conducted in Jordan. The study also expressed that about half of children have lethargy, less irritability, half of them with sunken eyes, and about half unable to drink water similar to previous studies.,,,,,,,, The diarrhea was continued for average of 3 days and the body temperature was normal to slightly high as same as studies conducted in other countries such as Netherlands and Jordan.
The children of age group (≤2 years old) has more severity dehydration contrasted to other group (P = 0.014), they also were more febrile than other group (P = 0.001). We found that fever was essentially associated with rotavirus infection although we found only one study in Jordan affirmed this affiliation. The children from King Fahad Hospital have significantly higher frequency of vomiting than children from other two hospitals (P = 0.001) and more severity of dehydration compared to children from other two hospitals (P = 0.004).
In this study, the prevalence of RVGE in under-five children in Al-Baha was marginally higher than in the other areas of Saudi Arabia as distinguished by Kheyami et al. Al-Ayed et al. Paul E. et al., and Ghazi et al. This difference could be due to variety between the populations, discrepancy in the time of the study or to the identification method used. Although no significant association was distinguished between sex of children and rotavirus disease in this study, the male-to-female proportion of cases with rotavirus was 1:1 with slightly higher males.
There are numerous inadequacies identified in this study; the secondary approach of data gathering, it was only based on retrospective data. The method utilized for diagnosing RV was the WHO case definition, since no demonstrative test has been utilized. A small-scale study on Al-Baha region only was taken, so the study only can reflect internal validity of study findings. Nonetheless, this study has several strengths; this study is the first descriptive study in Al-Baha region, Saudi Arabia on demographic and clinical features of RV gastroenteritis among under-five children, and it was conducted on the three major hospitals in Al-Baha area. Further, large-scale studies may need to be conducted among different age groups.
| Conclusion|| |
The suspected RV is the main cause of diarrhea with gastroenteritis among under 5 years children in Al-Baha area. Rotavirus suspected cases have been characterized by fever, severe diarrhea, vomiting, and mild dehydration among RV suspected cases in Al-Baha governmental hospitals.
The researchers are grateful to the Health Affairs in Al-Baha region and acknowledge the included hospitals for generous support in data collection process.
Financial support and sponsorship
The authors extend their appreciation to the Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia for funding this research work through the project number MOE- BU- 1- 2020.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Celik C, Gozel MG, Turkay H, Bakici MZ, Güven AS, Elaldi N. Rotavirus and adenovirus gastroenteritis: Time series analysis. Pediatr Int 2015;57:590-6.
Almalki SS. Circulating rotavirus G and P
strains post rotavirus vaccination in Eastern Mediterranean Region. Saudi Med J 2018;39:755-66.
Money NN, Maves RC, Sebeny P, Kasper MR, Riddle MS; AFHSC-GEIS Enteric Surveillance Writing Group, et al.
Enteric disease surveillance under the AFHSC-GEIS: Current efforts, landscape analysis and vision forward. BMC Public Health 2011;11 Suppl 2:S7.
Jaff DO, Aziz TA, Smith NR. The incidence of rotavirus and adenovirus infections among children with diarrhea in Sulaimani Province, Iraq. J Biosci Med 2015;4:124.
Nguyen TV, Le Van P, Le Huy C, Weintraub A. Diarrhea caused by rotavirus in children less than 5 years of age in Hanoi, Vietnam. J Clin Microbiol 2004;42:5745-50.
Khalil I, Colombara DV, Forouzanfar MH, Troeger C, Daoud F, Moradi-Lakeh M, et al.
Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. Am J Trop Med Hyg 2016;95:1319-29.
Aly M, Al Khairy A, Al Johani S, Balkhy H. Unusual rotavirus genotypes among children with acute diarrhea in Saudi Arabia. BMC Infect Dis 2015;15:192.
Kheyami AM, Nakagomi T, Nakagomi O, Dove W, Hart CA, Cunliffe NA. Molecular epidemiology of rotavirus diarrhea among children in Saudi Arabia: First detection of G9 and G12 strains. J Clin Microbiol 2008;46:1185-91.
Malek MA, Teleb N, Abu-Elyazeed R, Riddle MS, Sherif ME, Steele AD, et al.
The epidemiology of rotavirus diarrhea in countries in the Eastern Mediterranean Region. J Infect Dis 2010;202 Suppl: S12-22.
Kheyami AM, Cunliffe NA, Hart CA. Rotavirus infection in Saudi Arabia. Ann Saudi Med 2006;26:184-91.
] [Full text]
Arif M, El-Hazmi MM. Viral gastroenteritis in Saudi children. Saudi Med J 2005;26:1017-8.
Tayeb HT, Balkhy HH, Aljuhani SM, Elbanyan E, Alalola S, Alshaalan M. Increased prevalence of rotavirus among children associated gastroenteritis in Riyadh Saudi Arabia. Virol J 2011;8:548.
Tayeb HT, Dela Cruz DM, Al-Qahtani A, Al-Ahdal MN, Carter MJ. Enteric viruses in pediatric diarrhea in Saudi Arabia. J Med Virol 2008;80:1919-29.
Ghazi HO, Khan MA, Telmesani AM, Idress B, Mahomed MF. Rotavirus infection in infants and young children in Makkah, Saudi Arabia. J Pak Med Assoc 2005;55:231-4.
Obeid OE. Characterization of human rotavirus subgroups and serotypes in children under five with acute gastroenteritis in a Saudi Hospital. J Family Community Med 2011;18:22-5.
Paul E, Alzaydani IA, Al-Hakami A, Hawan AA, Shati AA, Abdelrahim IM, et al. Identification and genotypic characterization of Rota-virus from children post vaccination in Aseer region of Southwestern Saudi Arabia â€”An ephemeral experience. Rev Argent Clín Psicol 2021;30:368.
Centers for Disease Control and Prevention (CDC). Rotavirus surveillance – Worldwide, 2009. MMWR Morb Mortal Wkly Rep 2011;60:514-6.
Benhafid M, Elomari N, Elqazoui M, Meryem AI, Rguig A, Filali-Maltouf A, et al.
Diversity of rotavirus strains circulating in children under 5 years of age admitted to hospital for acute gastroenteritis in Morocco, June 2006 to May 2009. J Med Virol 2013;85:354-62.
Howidi M, Balhaj G, Yaseen H, Gopala K, Van Doorn LJ, DeAntonio R. Burden and genotyping of rotavirus disease in the United Arab Emirates: A multicenter hospital-based surveillance. Hum Vaccin Immunother 2014;10:2284-9.
Nafi O. Rotavirus gastroenteritis among children aged under 5 years in Al Karak, Jordan. East Mediterr Health J 2010;16:1064-9.
Arya SC, Agarwal N. Rotavirus gastroenteritis and strain diversity in Saudi Arabia. Current status and future prospects. Saudi Med J 2010;31:1281.
de Wit MA, Koopmans MP, Kortbeek LM, van Leeuwen NJ, Vinjé J, van Duynhoven YT. Etiology of gastroenteritis in sentinel general practices in the Netherlands. Clin Infect Dis 2001;33:280-8.
Mathew S, Al Ansari K, Al Thani AA, Zaraket H, Yassine HM. Epidemiological, molecular, and clinical features of rotavirus infections among pediatrics in Qatar. Eur J Clin Microbiol Infect Dis 2021;40:1177-90.
Kurugöl Z, Geylani S, Karaca Y, Umay F, Erensoy S, Vardar F, et al.
Rotavirus gastroenteritis among children under five years of age in Izmir, Turkey. Turk J Pediatr 2003;45:290-4.
Al-Ayed MS, Asaad AM, Qureshi MA, Hawan AA. Epidemiology of group A rotavirus infection after the introduction of monovalent vaccine in the National Immunization Program of Saudi Arabia. J Med Virol 2017;89:429-34.
[Table 1], [Table 2], [Table 3], [Table 4]