1. "Epidemiological Features of Rotavirus Infection among children below 5 years old in Jordan, Rationale for Vaccine Introduction,2015" Kareman Juma`ah Al-Zain Senior Community Medicine Specialist Ministry of Health/ Jordan Funded by the European Union The LOGO of your institute and/ o the funders of the Investigation (if any)

2. Background Jordan is cholera free country since 1981. Diarrheal surveillance system established since eighties. Despite control measures taken diarrhea still has high incidence rate among communicable diseases. Majority of admitted cases are among children under five years old.

3. Background Globally, rotaviruses are generally recognized as the most common enteropathogens identified among infants and young children hospitalized with dehydrating diarrhea. In 2007 rotavirus surveillance system was established in Jordan to monitor the rotavirus infection and define the circulating genotype to support vaccine introduction.

4. Objective of the study Estimation of incidence of hospitalizations associated with rotavirus. Determination of age and seasonal distribution of hospitalizations. Estimation of proportion of diarrhea hospitalizations attributable to rotavirus. Identification of prevalent strains of rotavirus in population under five years old.

5. Methods A Cross sectional hospital- based study. Data was collected by trained nurses and laboratory technicians. Stool specimens were collected for rotavirus testing and genotyping. Cases were described by age group, sex, clinical features and genotype.

6. Methods Sentinel Sites: Three hospitals were selected from different geographical areas: North, Middle and South covering approximately 32% of all population. Middle: Albashir hospital North: Princess Rahma hospital South: Alkarak hospital

7. Methods Using standardized Case Definition: A child under 5 years of age (< 60 months of age) and admitted to a designated sentinel hospital for treatment of gastroenteritis. Data Collection Methods: Questionnaire includes: Patient information: ID, name, age (by months), sex and address. Clinical information: duration of symptoms, symptoms (fever, diarrhea, No. of episodes of diarrhea, vomiting, No. of episodes of vomiting), dehydration status, treatment, duration of hospitalization, outcome. Laboratory information: EIA rotavirus identification in stool, genotype G and P.

8. Sample Size All children under 5 years of age (less than 60 months of age) presenting to the three selected hospitals with acute gastroenteritis and requiring hospitalization for treatment of gastroenteritis and fit the adopted case definition.

9. Methods Inclusion criteria: All the following criteria should be satisfied for enrolling the case: Child less five years of age (<60 months). Presence of gastroenteritis of less or equal to 7 days. Admitted for treatment of gastroenteritis as a primary illness. Exclusion Criteria: presence of any of the following – Child with bloody diarrhoea. – Patient acquired gastroenteritis during his hospitalization for treatment of other diseases (hospital acquired gastroenteritis).

10. Results: Starting in May 2007 to December 2014 a total number of 1345 stool samples were tested, 727 cases were positive for rotavirus (47%). Among confirmed cases, 138 cases (19%) aged between 6-11 months and 210 cases (29%) were male. Diarrhea was present in 99.5% of cases and vomiting in 42%. Mean stay duration of hospitalized cases was 3 days with average cost 150 $/ day. The prevalent combined genotype is G1P8, followed by G2P4 and G9PUT.

11. Results

12. Rotavirus Genotyping Results

13. Conclusions: Rotavirus infection represents a major cause of gastroenteritis in children less than 5 years old, especially in infants between 6-11 months. Disease usually presents with diarrhoea and vomiting and require admission to hospitals. Rotavirus infection can be prevented and vaccination should be implemented to effectively reduce the health and economic burden of rotavirus gastroenteritis in Jordan.

14. Thank you