Impact of Wasting on the Severity of Rotavirus and Non-rotavirus Diarrhea in Children Aged Under 5 Years Hospitalized with Acute Gastroenteritis in Kerala, India.

Abstract

Objectives: This analysis assessed the relationship between wasting and severity of rotavirus and non-rotavirus diarrhea among children hospitalized with acute gastroenteritis in Kerala.

Methods: Children aged under 5 y admitted to sentinel hospitals in North, Central, and South Kerala with acute gastroenteritis between November 2020 and December 2023 were prospectively enrolled. Sociodemographic, anthropometric, and clinical data were collected using a case report form, and stool samples were tested for rotavirus using an enzyme-linked immunosorbent assay. Anthropometry was performed according to World Health Organization guidelines.

Results: Of the 1,142 children aged under 5 y admitted to the sentinel hospitals with acute gastroenteritis during the study period, 666 were enrolled in the study. Of the 643 children with stool samples tested for rotavirus, 115 (17.7%) were positive for rotavirus. Compared with children with wasting, children without wasting were (significantly more likely to have received ≥ 1 dose of rotavirus vaccine (69.5% vs. 60.2%; p = 0.022). In a subgroup analysis of children with wasting, compared with rotavirus-negative children, rotavirus-positive children were significantly more likely to develop severe to very severe disease (odds ratio: 5.31, 95% confidence interval: 2.28-12.34; p = 0.001).

Conclusions: In children with wasting, rotavirus diarrhea was more severe than non-rotavirus diarrhea. Strategies to prevent and treat diarrhea should target children with wasting, who are at greater risk of severe disease. Maintaining high rotavirus vaccination coverage and measures to reduce the incidence of wasting are necessary to reduce incidence of severe diarrhea.