Clinico-epidemiological Profile and Genotype Distribution of Rotavirus Infection Among Children Under Five Years with Acute Gastroenteritis in Garhwal Region of Uttarakhand, India.

Background

Rotavirus remains a leading cause of acute gastroenteritis (AGE) among children under five years, particularly in low and middle-income countries. Despite the introduction of rotavirus vaccination under the Universal Immunization Programme in India, the disease continues to contribute significantly to pediatric morbidity. Region-specific data from Uttarakhand, especially in the post-vaccination era, remain limited.

Objectives

To evaluate the clinico-epidemiological profile, associated risk factors, and genotype distribution of rotavirus infection among children under five years presenting with AGE.

Methods

A hospital-based cross-sectional study was conducted from 2022 to 2024 at a tertiary care center in Uttarakhand. Stool samples from 202 children with AGE were screened using a rapid immunochromatographic test (ICT) and subsequently tested by enzyme immunoassay (EIA). EIA-positive specimens were subjected to RT-PCR-based genotyping of the VP7 (G type) and VP4 (P type) genes. Demographic, clinical, and environmental data were collected and analyzed using SPSS, with p<0.05 considered statistically significant.

Results

Rotavirus antigen was detected in 42/202 (20.8%) specimens by ICT and 37/202 (18.3%) by EIA; five weakly ICT-positive specimens were EIA-negative. The highest positivity was observed in children aged 7-24 months. A significantly higher proportion of rotavirus-positive cases had ≥6 episodes of diarrhea per day compared to negative cases (78.4% vs 42.4%, p<0.001). Bottle-feeding, mixed feeding, and lack of vaccination were significantly associated with infection (p<0.001). Environmental factors such as consumption of unboiled water (75.7% vs 46.1%, p=0.005) and tap water (67.6% vs 53.3%, p=0.018) were also significantly associated. Of the 37 EIA-positive samples, 31 were successfully genotyped, with G1P[6] identified as the predominant strain.

Conclusion

Rotavirus continues to be a significant cause of AGE among children under five years in Uttarakhand. The predominance of G1P[6] and strong association with modifiable risk factors highlight the need for improved vaccination coverage, better hygiene practices, and continuous molecular surveillance.