# Burden of rotavirus and other microorganisms in hospitalized children with acute gastroenteritis in Yangon, Myanmar, before the introduction of rotavirus vaccine

## TL;DR

This study found that rotavirus is the main cause of severe stomach infections in hospitalized children in Myanmar before the rotavirus vaccine was introduced.

## Contribution

The study identifies the dominant rotavirus genotypes and the burden of multiple pathogens in Myanmar's pre-vaccine era.

## Key findings

- Rotavirus was the most common pathogen in hospitalized children with acute gastroenteritis in Myanmar.
- The most frequently detected rotavirus genotypes were G1P[8] and G2P[4].
- Multiplex PCR detected multiple pathogens in 88% of stool samples, with Enteroaggregative E. coli being the most common bacterial pathogen.

## Abstract

•Multiplex polymerase chain reaction was useful for detecting microorganisms of acute gastroenteritis.•Multiple microorganisms were detected from the stool samples by multiplex polymerase chain reaction.•Rotavirus was the dominant microorganism in Myanmar in the pre-rotavirus vaccine era.•The most frequently detected rotavirus genotypes were G1P [8] and G2P [4].

Multiplex polymerase chain reaction was useful for detecting microorganisms of acute gastroenteritis.

Multiple microorganisms were detected from the stool samples by multiplex polymerase chain reaction.

Rotavirus was the dominant microorganism in Myanmar in the pre-rotavirus vaccine era.

The most frequently detected rotavirus genotypes were G1P [8] and G2P [4].

In developing countries, acute gastroenteritis (AGE) is a leading cause of death in children younger than 5 years. In Myanmar, no comprehensive study has been done to investigate the microorganisms responsible for AGE among hospitalized children. Multiplex polymerase chain reaction (PCR) was used to identify the microorganisms responsible for AGE in children hospitalized in Myanmar before the introduction of the rotavirus vaccine.

This prospective study enrolled children younger than 12 years with AGE who were hospitalized at the Yankin Children's Hospital in Yangon, Myanmar, between September 2019 and February 2020. Multiplex PCR (FilmArrayTM GI panel, BioFire Diagnostics, Salt Lake City, USA) and genotyping with Sanger sequencing of rotavirus were performed. Clinical data, including disease severity, were collected from the medical records.

We collected stool samples from 92 patients. Multiple microorganisms (median 3; interquartile range 2-4) were detected in 81 patients (88%). Rotavirus and norovirus were detected in 77 (84%) and 33 patients (36%), respectively. The most frequent bacterial pathogen detected was Enteroaggregative E. coli (n = 62/92, 67%). The most common rotavirus genotypes were G1P [8] (19/73; 26%) and G2P [4] (19/73; 26%).

Rotavirus is the predominant pathogen associated with AGE in hospitalized children in Myanmar. The introduction of a rotavirus vaccine will reduce the morbidity and mortality of children with rotavirus-associated AGE in Myanmar.