Variance in rotavirus infection rates in different urban population groups in South Africa

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Abstract
Rotavirus infection in black infants contrasts markedly with that of white infants in being much less common and showing no seasonal variation. In this multicentre study in Johannesburg, the aetiology of winter infantile gastroenteritis in black, coloured, and white infants was investigated. Stools were examined by electron microscopy and also by enzyme‐immunoassay to detect subparticular antigen which may be missed by electron microscopy in patients presenting late in the course of the illness. Stools were also examined bacteriologically by conventional techniques. Rotavirus was the most common pathogen in all three population groups with bacteria playing a relatively minor role. Striking differences were observed in the rotavirus rates between the three groups. Infection in the whites was five times more common than in the blacks (60% versus 12%) with the coloureds intermediate at 40%. The hypothesis was put forward that the relative protection of the black population may be due to a greater degree of colonization of neonates, thus inducing protection against symptomatic infection at the target age of 6 to 34 months. This may well have important implications in immunoprophylaxis. The reason for the lack of seasonal variation in the black population is still unclear.