Molecular epidemiology and clinical characterization of group a rotavirus infections in tunisian children with acute gastroenteritis

Canadian Journal of Microbiology

Volumn 57, Issue 10, 2011, Pages 810-819

  Sdiri Loulizi, Khira ^a,b   Ambert Balay, Katia ^b   Gharbi Khelifi, Hakima ^a   Hassine, Mouna ^a   Chouchane, Slaheddine ^c   Sakly, Nabil ^c   Neji Guédiche, Mohamed ^c   Pothier, Pierre ^b   Aouni, Mahjoub ^a  

^a UNIVERSITY OF MONASTIR   (Tunisia)

^b DIJON UNIVERSITY HOSPITAL   (France)

^c FATTOUMA BOURGUIBA UNIVERSITY HOSPITAL   (Tunisia)

Author keywords

Diarrhea; Genotyping; Rotavirus; Symptoms; Tunisia

Indexed keywords

DIARRHEA; GENOTYPING; ROTAVIRUSES; SYMPTOMS; TUNISIA;

DISEASES; MOLECULAR BIOLOGY; VIRUSES;

EPIDEMIOLOGY;

AGE STRUCTURE; CHILD HEALTH; DIARRHEAL DISEASE; DISEASE PREVALENCE; EPIDEMIOLOGY; INFECTIOUS DISEASE; MOLECULAR ANALYSIS; POLYMERASE CHAIN REACTION; REAL TIME; SPATIOTEMPORAL ANALYSIS; SYMPTOM;

ABDOMINAL PAIN; ACUTE GASTROENTERITIS; ARTICLE; CHILD; CONTROLLED STUDY; DEHYDRATION; FECES; FEMALE; FEVER; GENOTYPE; HOSPITAL PATIENT; HUMAN; INFANT; MALE; MOLECULAR EPIDEMIOLOGY; MULTIPLEX POLYMERASE CHAIN REACTION; NEWBORN; NONHUMAN; OUTPATIENT; PRESCHOOL CHILD; PREVALENCE; PRIORITY JOURNAL; PROSPECTIVE STUDY; ROTAVIRUS INFECTION; SAMPLING; SCHOOL CHILD; SEASON; TUNISIA; VIRUS CHARACTERIZATION; VIRUS STRAIN; VOMITING; WINTER;

CHILD; CHILD, PRESCHOOL; DIARRHEA; FECES; FEMALE; GASTROENTERITIS; GENOTYPE; HOSPITALIZATION; HUMANS; INFANT; INFANT, NEWBORN; MALE; MOLECULAR EPIDEMIOLOGY; PREVALENCE; PROSPECTIVE STUDIES; REVERSE TRANSCRIPTASE POLYMERASE CHAIN REACTION; RNA, VIRAL; ROTAVIRUS; ROTAVIRUS INFECTIONS; SEASONS; TUNISIA;

TUNISIA;

ROTAVIRUS; ROTAVIRUS A;

EID: 80053260974     PISSN: 00084166     EISSN: 14803275     Source Type: Journal    
DOI: 10.1139/w11-074     Document Type: Article

References (73)

1. Abe, M., Ito, N., Morikawa, S., Takasu, M., Murase, T., Kawashima, T., et al. 2009. Molecular epidemiology of rotaviruses among healthy calves in Japan: isolation of a novel bovine rotavirus bearing new P and G genotypes. Virus Res. 144(1-2): 250-257. doi:10.1016/j.virusres.2009.05.005.
2. Adah, M.I., Wade, A., and Taniguchi, K. 2001. Molecular epidemiology of rotaviruses in Nigeria: detection of unusual strains with G2P [6] and G8P[1] specificities. J. Clin. Microbiol. 39(11): 3969- 3975. doi:10.1128/JCM.39.11.3969-3975.2001.
3. Ahmed, K., Anh, D.D., and Nakagomi, O. 2007. Rotavirus G5P[6] in child with diarrhea, Vietnam. Emerg. Infect. Dis. 13(8): 1232-1235.
4. Albano, F., Bruzzese, E., Bella, A., Cascio, A., Titone, L., Arista, S., et al. 2007. Rotavirus and not age determines gastroenteritis severity in children: a hospital-based study. Eur. J. Pediatr. 166(3): 241-247. doi:10.1007/s00431-006-0237-6.
5. Armah, G.E., Steele, A.D., Binka, F.N., Esona, M.D., Asmah, R.H., Anto, F., et al. 2003. Changing patterns of rotavirus genotypes in Ghana: emergence of human rotavirus G9 as a major cause of diarrhea in children. J. Clin. Microbiol. 41(6): 2317-2322. doi:10. 1128/JCM.41.6.2317-2322.2003.
6. Ben Salem, K., Mandhouj, O., Letaief, M., Mtar, A., and Soltani, M. 2006. Distribution des paramètres anthropométriques des nourrissons dans la région de Monastir (Tunisie). La Revue de Santé de la Méditerranée orientale 12
7. Bon, F., Fromantin, C., Aho, S., Pothier, P., and Kohli, E.The AZAY Group. 2000. G and P genotyping of rotavirus strains circulating in France over a three-year period: detection of G9 and P[6] strains at low frequencies. J. Clin. Microbiol. 38(4): 1681-1683.
8. Cao, D., Santos, N., Jones, R.W., Tatsumi, M., Gentsch, J.R., and Hoshino, Y. 2008. The VP7 genes of two G9 rotaviruses isolated in 1980 from diarrheal stool samples collected in Washington, D. C., are unique molecularly and serotypically. J. Virol. 82(8): 4175-4179. doi:10.1128/JVI.02537-07.
9. Carlson, J.A.K., Middleton, P.J., Szymanski, M.T., Huber, J., and Petric, M. 1978. Fatal rotavirus gastroenteritis: an analysis of 21 cases. Am. J. Dis. Child. 132(5): 477-479.
10. Cascio, A., Vizzi, E., Alaimo, C., and Arista, S. 2001. Rotavirus gastroenteritis in Italian children: Can severity of symptoms be related to the infecting virus? Clin. Infect. Dis. 32(8): 1126-1132. doi:10.1086/319744.
11. Charles, M.D., Holman, R.C., Curns, A.T., Parashar, U.D., Glass, R. I., and Bresee, J.S. 2006. Hospitalizations associated with rotavirus gastroenteritis in the United States, 1993-2002. Pediatr. Infect. Dis. J. 25(6): 489-493. doi:10.1097/01.inf.0000215234.91997.21.
12. Chitambar, S.D., Arora, R., and Chhabra, P. 2009. Molecular characterization of a rare G1P[19] rotavirus strain from India: evidence of reassortment between human and porcine rotavirus strains. J. Med. Microbiol. 58(12): 1611-1615. doi:10.1099/jmm. 0.012856-0.
13. Chouchane, S., Fehri, H., Chouchane, C., Merchaoui, Z., Seket, B., Haddad, S., et al. 2005. La déshydratation hypernatrémique chez l'enfant: étude rétrospective de 105 cas. Arch. Pediatr. 12(12): 1697-1702. doi:10.1016/j.arcped.2005.07.019.
14. Chouikha, A., Fodha, I., Noomen, S., Bouzid, L., Mastouri, M., Peenze, I., et al. 2007. Group A rotavirus strains circulating in the eastern center of Tunisia during a ten-year period (1995-2004). J. Med. Virol. 79(7): 1002-1008. doi:10.1002/jmv.20919.
15. Cook, S.M., Glass, R.I., LeBaron, C.W., and Ho, M.S. 1990. Global seasonality of rotavirus infections. Bull.World Health Organ. 68(2): 171-177.
16. Cunliffe, N.A., Gondwe, J.S., Graham, S.M., Thindwa, B.D., Dove, W., Broadhead, R.L., et al. 2001. Rotavirus strain diversity in Blantyre, Malawi, from 1997 to 1999. J. Clin. Microbiol. 39(3): 836-843. doi:10.1128/JCM.39.3.836-843.2001.
17. Das, S., Sen, A., Uma, G., Varghese, V., Chaudhuri, S., Bhattacharya, S.K., et al. 2002. Genomic diversity of group A rotavirus strains infecting humans in eastern India. J. Clin. Microbiol. 40(1): 146-149. doi:10.1128/JCM.40.1.146-149.2002.
18. Das, S., Varghese, V., Chaudhury, S., Barman, P., Mahapatra, S., Kojima, K., et al. 2003. Emergence of novel human group A rotavirus G12 strains in India. J. Clin. Microbiol. 41(6): 2760-2762. doi:10.1128/JCM.41.6.2760-2762.2003.
19. de Rougemont, A., Kaplon, J., Lebon, P., Huet, F., Denis, F., Alain, S., et al. 2009. Unexpected substitution of dominant rotavirus G genotypes in French hospitalized children over five consecutive seasons. Eur. J. Clin. Microbiol. Infect. Dis. 28(4): 403-407. doi:10.1007/s10096-008-0640-1. 26.
20. Doan, L.T., Okitsu, S., Nishio, O., Pham, D.T., Nguyen, D.H., and Ushijima, H. 2003. Epidemiological features of rotavirus infection among hospitalized children with gastroenteristis in Ho Chi Minh City, Vietnam. J. Med. Virol. 69(4): 588-594. doi:10.1002/jmv. 10347.
21. Estes, M.K. 1996. Rotaviruses and their replication. In Fields virology. Edited by D.M. Knipe and P.M. Howley. 3rd ed. Lippincott-Raven, Philadelphia, Pa., USA. pp. 1640-1646
22. Fischer, T.K., Viboud, C., Parashar, U., Malek, M., Steiner, C., Glass, R., and Simonsen, L. 2007. Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993-2003. J. Infect. Dis. 195(8): 1117-1125. doi:10.1086/512863.
23. Fodha, I., Chouikha, A., Peenze, I., De Beer, M., Dewar, J., Geyer, A., et al. 2006. Identification of viral agents causing diarrhea among children in the Eastern Center of Tunisia. J. Med. Virol. 78(9): 1198-1203. doi:10.1002/jmv.20681.
24. Gentsch, J.R., Glass, R.I., Woods, P., Gouvea, V., Gorziglia, M., Flores, J., et al. 1992. Identification of group A rotavirus gene 4 types by polymerase chain reaction. J. Clin. Microbiol. 30(6): 1365-1373.
25. Gentsch, J.R., Woods, P.A., Ramachandran, M., Das, B.K., Leite, J. P., Alfieri, A., et al. 1996. Review of G and P typing results from a global collection of rotavirus strains: implications for vaccine develop pment. J. Infect. Dis. 174(Suppl. 1): S30-S36. doi:10.1093/ infdis/174.Supplement_1.S30.
26. Gomara, M.I., Simpson, R., Perault, A.M., Redpath, C., Lorgelly, P., Joshi, D., et al. 2008. Structured surveillance of infantile gastroenteritis in East Anglia, UK: incidence of infection with common viral gastroenteric pathogens. Epidemiol. Infect. 136: 23-33. doi:10.1017/S0950268807008059.
27. Gouvea, V., Glass, R.I., Woods, P., Taniguchi, K., Clark, H.F., Forrester, B., and Fang, Z.Y. 1990. Polymerase chain reaction amplification and typing of rotavirus nucleic acid from stool specimens. J. Clin. Microbiol. 28(2): 276-282.
28. Huet, F., Chouchane, M., Cremillieux, C., Aubert, M., Caulin, E., Pothier, P., and Allaert, F.A. 2008. Étude épidémiologique prospective de la gastroentérite à rotavirus en Europe (étude REVEAL). Résultats de la zone d'étude française. Arch. Pediatr. 15 (4): 362-374. doi:10.1016/j.arcped.2008.01.021.
29. Iturriza-Gómara, M., Isherwood, B., Desselberger, U., and Gray, J. 2001. Reassortment in vivo: driving force for diversity of human rotavirus strains isolated in the United Kingdom between 1995 and 1999. J. Virol. 75(8): 3696-3705. doi:10.1128/JVI.75.8.3696- 3705.2001.
30. Iturriza-Gómara, M., Anderton, E., Kang, G., Gallimore, C., Phillips, W., Desselberger, U., and Gray, J. 2003. Evidence for genetic linkage between the gene segments encoding NSP4 and VP6 proteins in common and reassortant human rotavirus strains. J. Clin. Microbiol. 41(8): 3566-3573. doi:10.1128/JCM.41.8.3566- 3573.2003.
31. Iturriza Gómara, M., Kang, G., Mammen, A., Jana, A.K., Abraham, M., Desselberger, U., et al. 2004. Characterization of G10P[11] rotaviruses causing acute gastroenteritis in neonates and infants in Vellore, India. J. Clin. Microbiol. 42(6): 2541-2547. doi:10.1128/ JCM.42.6.2541-2547.2004.
32. Jain, V., Das, B.K., Bhan, M.K., Glass, R.I., and Gentsch, J.R.Indian Strain Surveillance Collaborating Laboratories. 2001. Great diversity of group A rotavirus strains and high prevalence of mixed rotavirus infections in India. J. Clin. Microbiol. 39(10): 3524-3529. doi:10.1128/JCM.39.10.3524-3529.2001.
33. Kapikian, A.Z., Hoshino, Y., and Chanock, R.M. 2001. Rotaviruses. In Fields virology. Edited by D.M. Knipe and P.M. Howley. Lippincott Williams & Wilkins, Philadelphia, Pa., USA. pp. 1787-1833
34. Kheyami, A.M., Areeshi, M.Y., Dove, W., Nakagomi, O., Cunliffe, N.A., and Anthony Hart, C. 2008a. Characterization of rotavirus strains detected among children and adults with acute gastroenteritis in Gizan, Saudi Arabia. Saudi Med. J. 29(1): 90-93.
35. Kheyami, A.M., Nakagomi, T., Nakagomi, O., Dove, W., Hart, C.A., and Cunliffe, N.A. 2008b. Molecular epidemiology of rotavirus diarrhea among children in Saudi Arabia: first detection of G9 and G12 strains. J. Clin. Microbiol. 46(4): 1185-1191. doi:10.1128/ JCM.02244-07.
36. Lennon, G., Reidy, N., Cryan, B., Fanning, S., and O'Shea, H. 2008. Changing profile of rotavirus in Ireland: predominance of P[8] and emergence of P[6] and P[9] in mixed infections. J. Med. Virol. 80(3): 524-530. doi:10.1002/jmv.21084.
37. Lorrot, M., Bon, F., Balay, K., Marc, E., Moulin, F., Lebon, P., et al. 2005. Rotavirus: Quels génotypes en France et dans le monde? Arch. Pediatr. 12(6): 838-840. doi:10.1016/j.arcped.2005.04.067.
38. Malek, M.A., Curns, A.T., Holman, R.C., Fischer, T.K., Bresee, J.S., Glass, R.I., et al. 2006. Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000. Pediatrics, 117(6): 1887-1892. doi:10. 1542/peds.2005-2351.
39. Martella,V., Terio, V.,Arista, S., Elia,G., Corrente,M., Madio, A., et al. 2004. Nucleotide variation in the VP7 gene affects PCR genotyping of G9 rotaviruses identified in Italy. J. Med. Virol. 72(1): 143-148. doi:10.1002/jmv.10563.
40. Martella, V., Colombrita, D., Lorusso, E., Draghin, E., Fiorentini, S., De Grazia, S., et al. 2008. Detection of a porcine-like rotavirus in a child with enteritis in Italy. J. Clin. Microbiol. 46(10): 3501-3507. doi:10.1128/JCM.00983-08.
41. Mast, T.C., DeMuro-Mercon, C., Kelly, C.M., Floyd, L.E., and Walter, E.B. 2009. The impact of rotavirus gastroenteritis on the family. BMC Pediatr. 9(1): 11. doi:10.1186/1471-2431-9-11.
42. Matthijnssens, J., Ciarlet, M., Heiman, E., Arijs, I., Delbeke, T., McDonald, S.M., et al. 2008a. Full genome-based classification of rotaviruses reveals a common origin between human Wa-Like and porcine rotavirus strains and human DS-1-like and bovine rotavirus strains. J. Virol. 82(7): 3204-3219. doi:10.1128/JVI. 02257-07.
43. Matthijnssens, J., Rahman, M., and Van Ranst, M. 2008b. Two out of the 11 genes of an unusual human G6P[6] rotavirus isolate are of bovine origin. J. Gen. Virol. 89(10): 2630-2635. doi:10.1099/vir. 0.2008/003780-0.
44. Matthijnssens, J., Bilcke, J., Ciarlet, M., Martella, V., Banyai, K., Rahman, M., et al. 2009a. Rotavirus disease and vaccination: impact on genotype diversity. Future Microbiol. 4(10): 1303-1316. doi:10.2217/fmb.09.96.
45. Matthijnssens, J., Potgieter, C.A., Ciarlet, M., Parreno, V., Martella, V., Banyai, K., et al. 2009b. Are human P[14] rotavirus strains the result of interspecies transmissions from sheep or other ungulates that belong to the mammalian order Artiodactyla? J. Virol. 83(7): 2917-2929. doi:10.1128/JVI.02246-08.
46. Matthijnssens, J., Rahman, M., Ciarlet, M., Zeller, M., Heylen, E., Nakagomi, T., et al. 2010. Reassortment of human rotavirus gene segments into G11 rotavirus strains. Emerg. Infect. Dis. 16(4): 625-630.
47. McCormack, J.G. 1982. Clinical features of rotavirus gastroenteritis. J. Infect. 4(2): 167-174. doi:10.1016/S0163-4453(82)93777-X.
48. Modarres, S., Modarres, S., and Oskoii, N.N. 1995. Rotavirus infection in infants and young children with acute gastroenteritis in the Islamic Republica of Iran. East. Mediterr. Health J. 1: 210-214.
49. Nguyen, V.M., Nguyen, V.T., Huynh, P.L., Dang, D.T., Nguyen, T.H., Phan, V.T., et al.Vietnam Rotavirus Surveillance Network. 2001. The epidemiology and disease burden of rotavirus in Vietnam: sentinel surveillance at 6 hospitals. J. Infect. Dis. 183(12): 1707-1712. doi:10.1086/320733.
50. Nguyen, T.V., Le Van, P., Le Huy, C., and Weintraub, A. 2004. Diarrhea caused by rotavirus in children less than 5 years of age in Hanoi, Vietnam. J. Clin. Microbiol. 42(12): 5745-5750. doi:10. 1128/JCM.42.12.5745-5750.2004.
51. Parashar, U.D., Bresee, J.S., Gentsch, J.R., and Glass, R.I. 1998. Rotavirus. Emerg. Infect. Dis. 4(4): 561-570. doi:10.3201/ eid0404.980406.32.
52. Parashar, U.D., Hummelman, E.G., Bresee, J.S., Miller, M.A., and Glass, R.I. 2003. Global illness and deaths caused by rotavirus disease in children. Emerg. Infect. Dis. 9(5): 565-572.
53. Phan, T.G., Khamrin, P., Quang, T.D., Dey, S.K., Takanashi, S., Okitsu, S., et al. 2007. Detection and genetic characterization of group A rotavirus strains circulating among children with acute gastroenteritis in Japan. J. Virol. 81(9): 4645-4653. doi:10.1128/ JVI.02342-06.
54. Pietsch, C., Petersen, L., Patzer, L., and Liebert, U.G. 2009. Molecular characteristics of German G8P[4] rotavirus strain GER1H-09 suggest that a genotyping and subclassification update is required for G8. J. Clin. Microbiol. 47(11): 3569-3576. doi:10. 1128/JCM.01471-09.
55. Pothier, P., and Drouet, E. 1986. Development and evaluation of a rapid one-step ELISA for rotavirus detection in stool specimens using only monoclonal antibodies. Ann. Inst. Pasteur Virol. 137: 401-410. doi:10.1016/S0769-2617(86)80238-6.
56. Reidy, N., O'Halloran, F., Fanning, S., Cryan, B., and O'Shea, H. 2005. Emergence of G3 and G9 rotavirus and increased incidence of mixed infections in the southern region of Ireland 2001-2004. J. Med. Virol. 77(4): 571-578. doi:10.1002/jmv.20494.
57. Sánchez-Fauquier, A., Wilhelmi, I., Colomina, J., Cubero, E., and Roman, E. 2004. Diversity of group A human rotavirus types circulating over a 4-year period in Madrid, Spain. J. Clin. Microbiol. 42(4): 1609-1613. doi:10.1128/JCM.42.4.1609-1613. 2004.
58. Sánchez-Fauquier, A., Montero, V., Moreno, S., Sole, M., Colomina, J., Iturriza-Gomara, M., et al.Gegavi/VIGESS-Net Group. 2006. Human rotavirus G9 and G3 as major cause of diarrhea in hospitalized children, Spain. Emerg. Infect. Dis. 12(10): 1536-1541.
59. Santos, N., and Hoshino, Y. 2005. Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine. Rev. Med. Virol. 15(1): 29-56. doi:10.1002/rmv.448.
60. Schumann, T., Hotzel, H., Otto, P., and Johne, R. 2009. Evidence of interspecies transmission and reassortment among avian group A rotaviruses. Virology, 386(2): 334-343. doi:10.1016/j.virol.2009. 01.040.
61. Sdiri-Loulizi, K., Gharbi-Khelifi, H., de Rougemont, A., Chouchane, S., Sakly, N., Ambert-Balay, K., et al. 2008. Acute infantile gastroenteritis associated with human enteric viruses in Tunisia. J. Clin. Microbiol. 46(4): 1349-1355. doi:10.1128/JCM.02438-07.
62. Sharma, S., Ray, P., Gentsch, J.R., Glass, R.I., Kalra, V., and Bhan, M.K. 2008. Emergence of G12 rotavirus strains in Delhi, India, in 2000 to 2007. J. Clin. Microbiol. 46(4): 1343-1348. doi:10.1128/ JCM.02358-07.
63. Sharma, S., Paul, V.K., Bhan, M.K., and Ray, P. 2009. Genomic characterization of nontypeable rotaviruses and detection of a rare G8 strain in Delhi, India. J. Clin. Microbiol. 47(12): 3998-4005. doi:10.1128/JCM.00809-09.
64. Simpson, R., Aliyu, S., Iturriza-Gomara, M., Desselberger, U., and Gray, J. 2003. Infantile viral gastroenteritis: on the way to closing the diagnostic gap. J. Med. Virol. 70(2): 258-262. doi:10.1002/ jmv.10386.
65. Slim, A., Hadj, O.B., Arrouji, miologie moléculaire des rotavirus isolés en Tunisie: Résultats préliminaires. 5ème école franco-africaine de biologie moléculaire. 27 mars-4 avril 1986. Jerba, Tunisie.
66. Solberg, O.D., Hasing, M.E., Trueba, G., and Eisenberg, J.N. 2009. Characterization of novel VP7, VP4, and VP6 genotypes of a previously untypeable group A rotavirus. Virology, 385(1): 58-67. doi:10.1016/j.virol.2008.11.026.
67. Staat, M.A., Azimi, P.H., Berke, T., Roberts, N., Bernstein, D.I., Ward, R.L., et al. 2002. Clinical presentations of rotavirus infection among hospitalized children. Pediatr. Infect. Dis. J. 21(3): 221-227. doi:10.1097/00006454-200203000-00012.
68. Steele, A.D., Alexander, J.J., and Hay, I.T. 1986. Rotavirusassociated gastroenteritis in black infants in South Africa. J. Clin. Microbiol. 23(5): 992-994.
69. Steele, A.D., van Niekerk, M.C., and Mphahlele, M.J. 1995. Geographic distribution of human rotavirus VP4 genotypes and VP7 serotypes in five South African regions. J. Clin.Microbiol. 33(6): 1516-1519.
70. Trabelsi, A., Peenze, I., Pager, C., Jeddi, M., and Steele, D. 2000. Distribution of rotavirus VP7 serotypes and VP4 genotypes circulating in Sousse, Tunisia, from 1995 to 1999: emergence of natural human reassortants. J. Clin. Microbiol. 38(9): 3415-3419.
71. Ursu, K., Kisfali, P., Rigo, D., Ivanics, E., Erdelyi, K., Dan, A., et al. 2009. Molecular analysis of the VP7 gene of pheasant rotaviruses identifies a new genotype, designated G23. Arch. Virol. 154(8): 1365-1369. doi:10.1007/s00705-009-0439-0.
72. Van Damme, P., Giaquinto, C., Maxwell, M., Todd, P., and Van der Wielen, M. REVEAL Study Group. 2007. Distribution of rotavirus genotypes in Europe, 2004-2005: the REVEAL Study. J. Infect. Dis. 195(s1 Suppl 1): S17-S25. doi:10.1086/516715.
73. Zarnani, A.H., Modarres, S., Jadali, F., Sabahi, F., Moazzeni, S.M., and Vazirian, F. 2004. Role of rotaviruses in children with acute diarrhea in Tehran, Iran. J. Clin. Virol. 29(3): 189-193. doi:10. 1016/S1386-6532(03)00123-9.