Rotavirus infection among hospitalized children under five years of age with acute watery diarrhea in Sri Lanka Paba Palihawadana a , Gagandeep Kang b , Janakan Navaratnasingam c , Geethani Galagoda d , Janaki Abeynayake d , Madhava Gunasekera a , Shilanthi Seneviratne a,⇑ a Epidemiology Unit, Ministry of Health, Sri Lanka b Regional Reference Laboratory (RRL) participating in the World Health Organization (WHO)-coordinated Global Rotavirus Surveillance Network (GRSN) in India, India c World Health Organization Country Office, Sri Lanka d Medical Research Institution (MRI) in Colombo, Sri Lanka article info Article history: Available online xxxx Keywords: Rotavirus associated acute watery diarrhea Rotavirus genotypes Rotavirus vaccine Children less than 5 years abstract Background: Rotavirus is the leading cause of acute watery diarrhoea among children and is vaccine pre- ventable. The aim of this hospital-based sentinel surveillance was to study the prevalence, demographic and clinical characteristics of rotavirus infections and to describe rotavirus genotype distribution pat- terns among children under five years of age hospitalized for acute watery diarrhea during the period of 2009–2016. Methods: Prospective, sentinel hospital-based surveillance was conducted in Lady Ridgeway Hospital (LRH) from 2009 to 2016. Stool samples of children admitted with acute watery diarrhea were tested by rotavirus antigen detection ‘ProSpecT’ Enzyme Immunoassay (EIA) at Department of Virology, Medical Research Institute, Colombo. Specimens that tested positive for rotavirus were further analyzed at the Regional Reference Laboratory (RRL) participating in the World Health Organization (WHO)- coordinated Global Rotavirus Surveillance Network (GRSN) to determine the genotype of strains by reverse-transcriptase polymerase chain reaction. Results: Of the 6090 children with diarrhea admitted, 1801 (29.5%) had stools taken and tested. In years with at least 11 months of data (2010 and 2013) rotavirus was detected in 36.5% (228/624) of specimens. Genotype G1P[8] was the most common genotype detected throughout the surveillance period (30.1%; 123/408) with G2P [8], G9P[8] and G3P[8] also detected. Conclusions: Rotavirus is a common cause of pediatric diarrhea hospitalizations in Sri Lanka. National introduction of rotavirus vaccine could reduce the burden of pediatric diarrhea. Ó 2018 Elsevier Ltd. All rights reserved. 1. Introduction Globally, rotavirus infection is the leading cause of severe diar- rhea in children aged less than five years and [1] estimates 215,000 deaths per year in children under five. It is also responsible for mil- lions of hospitalizations and clinic visits [2]. In Asia, rotavirus takes the lives of around 188,000 children under five years of age each year, accounting for more than 40 percent of the total of 45 rota- virus deaths that occur globally [2]. Among 43 countries participating in the World Health Organi- zation (WHO) Global Rotavirus Surveillance Network (GRSN), a median of 36% (range: 25–47% among the six WHO regions) of children less than five years hospitalized for diarrhea were positive for rotavirus [3]. These data illustrate the important etiologic role of rotavirus in hospitalizations for diarrhea among children worldwide. A systematic review of studies on rotavirus infection published after 1990 showed that rotavirus accounts for approxi- mately 40% of hospitalizations for diarrhea in India [4]. From July 2012 to June 2015, rotavirus was detected in 2432 (64%) of 3783 children hospitalized for acute gastro enteritis in Bangladesh [24]. Other studies conducted in India, Myanmar, Nepal, Bangladesh and Sri Lanka estimated the prevalence of rotavirus infections among hospitalized children less than 5 years of age to be in the range of 1/4 and 1/3 of the stool samples tested [5–9]. Rotavirus is highly contagious and spreads easily from person to person through contaminated hands and objects. Even though antimicrobial therapies are effective against some bacterial and parasitic causes of diarrhea, no specific treatment for rotavirus https://doi.org/10.1016/j.vaccine.2018.03.062 0264-410X/Ó 2018 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: Epidemiology Unit, Ministry of Health, 231, De Saram Place, Colombo 10, Sri Lanka. E-mail address: chepid@sltnet.lk (S. Seneviratne). Vaccine xxx (2018) xxx–xxx Contents lists available at ScienceDirect Vaccine journal homepage: www.elsevier.com/locate/vaccine Please cite this article in press as: Palihawadana P et al. Rotavirus infection among hospitalized children under five years of age with acute watery diarrhea in Sri Lanka. Vaccine (2018), https://doi.org/10.1016/j.vaccine.2018.03.062