Viral Agents of Diarrhea in Young Children in Two Primary Health Centers in Edo State, Nigeria

Hindawi Publishing Corporation International Journal of Microbiology Volume 2015, Article ID 685821, 5 pages http://dx.doi.org/10.1155/2015/685821 Research Article Viral Agents of Diarrhea in Young Children in Two Primary Health Centers in Edo State, Nigeria Paul Erhunmwunse Imade1 and Nosakhare Odeh Eghafona2 1 Department of Medical Microbiology, University of Benin Teaching Hospital, PMB 1111, Benin City 300283, Nigeria 2 Department of Microbiology, Faculty of Life Sciences, University of Benin, PMB 1154, Benin City 300283, Nigeria Correspondence should be addressed to Paul Erhunmwunse Imade; Received 27 February 2015; Revised 13 April 2015; Accepted 20 April 2015 Academic Editor: Jian-Wei Wang Copyright © 2015 P. E. Imade and N. O. Eghafona. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Enteric viruses have been shown to be responsible for diarrhea among children during their early childhood. This study was carried out to determine the prevalence of rotavirus, adenovirus, and norovirus infection in young children with diarrhea in two primary health centers in Edo State, Nigeria. A total of 223 stool specimens were collected from children aged 0–36 months with clinical signs of diarrhea and 59 apparently healthy age-matched children as control. These specimens were investigated for three viral agents using immunochromatographic technique (ICT). The overall results showed that at least one viral agent was detected in 95/223 (42.6%) of the children with diarrhea while the control had none. The prevalence of rotavirus was 28.3%, adenovirus 19.3%, and norovirus 3.6%. There was a significant association between age group and infection (𝑃 < 0.0001). Seasonal pattern of enteric viruses was not statistically significant (𝑃 = 0.17). The overall coinfection rate was 7.6% and rotavirus-adenovirus coinfection had the highest with 5.4%. Rotavirus was the most prevalent viral agent. Coinfections are not uncommon among the population studied. The most commonly associated clinical symptom of viral diarrhea in this study was vomiting. Viral diagnostic tests are advocated for primary health care facilities in this locality. 1. Introduction Enteric viruses are major etiologic agents of acute gastroenteritis among infants and young children worldwide. Rotavirus, norovirus, adenovirus, and astrovirus are the recognized viral causes of pediatric gastroenteritis [1]. The World Health Organization (WHO) data showed that each child practically has viral diarrhea irrespective of race and socioeconomic status within the first 5 years of life and this has great economic burden for the system of public health services and all society [2, 3]. Viral intestinal infections are the most common cause of acute infectious diarrhea in the pediatric group and accounted for approximately 70% of episodes of acute infectious diarrhea in children. Viral infections affect small bowel enterocytes and cause low grade fever and watery diarrhea [4]. There is paucity of information as regards viral enteropathogens of diarrhea in many developing countries including Nigeria. Many hospitals in Nigeria do not carry out routine diagnostic tests for viral diarrhea. Investigations on diarrheal infections are usually based on bacterial and parasitic agents. The reason(s) attributed to this may be as a result of the poor health care system in the country where important health issues are taken for granted such as the aforementioned case. Thus, as a result of the nonperformance of viral tests for diarrheal patients, information on viral enteropathogens is lost and thus measures to implement control strategies become difficult. Against this background, this study was carried out to ascertain the prevalence of rotavirus, adenovirus, and norovirus infection in young children with diarrhea in two primary health centers in Edo State, Nigeria. It also aimed at assessing the coinfection rates 2 of the viral agents, age, seasonal distribution of infection, and the association between clinical symptoms and viral diarrhea. 2. Patients and Methods 2.1. Study Area. This study was carried out in two primary health centers located in Ikpoba-Okha Local Government Area of Edo State, Nigeria. The health centers attend to the primary health needs of the people within and around the locality. Cases attended to include malaria, diarrhea, immunization of infants and children, antenatal and postnatal cases, and other minor health issues within the scope of the health personnel. The two primary health centers are Aduwawa and Evbomodu primary health centers and they are neighboring communities with a fast growing population made up of indigenes with new residents from the main city alongside other inhabitants from other parts of the country. 2.2. Study Population. A total of two hundred and eighty-two (282) stool specimens comprising 223 diarrhea and 59 nondiarrhea stool specimens were collected from children aged between 0 and 36 months attending two primary health centers. As regards children with diarrhea, males were 121 while females were 102. Similarly, for the control, males were 33 while females were 26. Verbal informed consent was obtained from patients or guardian of the children prior to sample collection. Demographic and clinical information were obtained by means of structured questionnaire. The study was carried out from January 2011 to June 2012. Ethical approval was obtained from the local government health ethics committee. 2.3. Specimen Collection and Processing. The samples were collected from patients at the time of clinic visit as well as other times when the child defecates. Sterile wide mouth specimen containers were used for specimen collection and they were processed within 6 hours of collection. Rotavirus, adenovirus, and norovirus were detected by the immunochromatographic technique (ICT). Rotavirus and adenovirus were detected using VIKIA Rota-Adeno rapid test device manufactured by BioMerieux, France. Briefly, 2 drops of liquid stool specimen was added to the specimen dilution buffer and shaken vigorously to homogenize. Two drops of the diluted sample was transferred to the sample well of the test device (cassette) and was timed for 10 minutes. Results were interpreted according to the manufacturer’s instructions. Similarly, norovirus was detected using RIDA Quick norovirus (NI403) test device manufactured by RBiopharm AG, Germany. Briefly, 1 mL of sample dilution buffer (diluent) was placed in a separate labeled test tube and 100 mL of liquid stool was added to it and shaken vigorously to homogenize. This was allowed to settle for 2 minutes and 250 𝜇L of the supernatant was placed in a clean labeled test tube. Six drops of conjugate 1 was added to the test tube and was shaken vigorously to homogenize. The mixture was emptied into the sample well (...truncated)