86) Nosocomial

86). Nosocomial Epigenetics Compound Library datasheet infections were considered those occurring 72 hours after admission. From a total of 72 RVA-positive patients, 9 (12.5%) had diarrhea after this period. Of these, four patients

were hospitalized in the pediatric emergency and five in pediatric infectious disease settings. The median length of hospitalization was seven days (IQR four to 12.5 days) (Table 2). The introduction of the RVA vaccine in the national immunization schedule contributed to a significant reduction in the frequency of this infection in the pediatric population. However, this pathogen can be associated with severe disease, and the surveillance of its genotypic variability is crucial to monitor the emergence of new strains circulating in humans. The variation of G and P genotypes observed in different years highlights the mechanisms used by the RVA to escape immune selective pressure and thus maintain the pathogen

in nature. Analysis of combinations of genotypes G and P type have demonstrated that genotype G1 P[8] was predominant in 2001 and 2003, similar to previous findings.13 The genotype G3 P[8] was identified in only one sample in 2003. Regarding genotype G4 P[8], its occurrence was detected in 2001, as the second most frequent genotype, and in 2002 it prevailed; similar results were reported in Paraguay.16 The genotype G9 P[8] was identified in this study in the years 2002, 2004, and 2005. According to Dinaciclib some reports,17 this genotype is now circulating more widely. Genotype

G2 P[4] has re-emerged since 2006, and it has become Inositol monophosphatase 1 predominant in the samples analyzed in this study, as well as in other studies in Brazil and in other countries.18 In year 2007, no RVA was detected in the studied samples; however, some reports in Brazil showed the continuity of the detection of G2 P[4] genotype until 2008.19 These results demonstrate the ability of RVA genetic variation, and point out the need for constant surveillance of the circulating genotypes.20 After the introduction of universal vaccination in Brazil, the emergence of genotypes G2 P[4] and G9 P[8] was observed. The impact of these infections must be monitored in order to assess the effectiveness of the currently available vaccines. The predominance of genotype G2 P(4) in other countries using the Rotarix vaccine has been reported. It remains unclear whether this is due to selective pressure or changing epidemiology.21 However, an increase of the frequency of G2 P[4] genotype could be observed in periods previous to vaccine implementation and also in countries without RVA immunization,18 and 22 and thus its circulation was probably associated to the natural reemergence of this genotype.

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