Rotavirus may re-infect a child with or without producing disease. Of the 352 children

who were selleck screening library ever infected, 293 (83%) had a re-infection at the end of three years. There was a higher rate of re-infection (234/334, 70%) at the end of two years than described in the other two cohort studies, 62% in Mexico [13] and 19% in Guinea-Bissau [14]. Re-infections occurred at a slower pace and developed lesser disease than primary infections. This finding is in line with the other two cohorts where there was a significant reduction in severity with increase in order of infection, although as demonstrated by analysis including serology, protection in the Indian cohort was much lower than reported in Mexico [10] and [13]. Unlike temperate climates, tropical countries display mild seasonality of rotavirus

infections [30]. In this study, rotavirus was prevalent this website all through the year although there were small peaks during cooler months. A fallacious crude season specific incidence rate, possibly due to contamination by the age effect of the birth cohort may be unmasked to a certain extent by age adjusted estimates. With this adjustment, marked seasonality was found with higher incidence of rotavirus infections during October–March and less marked seasonality of rotavirus diarrhea in January–March, the relatively cooler months of the year. In a closed cohort design, it would not be appropriate to look for cyclical patterns due to the aging of the cohort as well as the lower number of children at the beginning and end of the study period. With presence of any rotavirus infection Idoxuridine in the first year as the dependent dichotomous outcome,

religion, education of the mother and birth order were found to influence rotavirus infection. It is likely that more Hindu families had working mothers, with the children left with an elderly or very young caretaker, usually a sibling and were at higher risk of infection. Another possible explanation would be nutrition including micro-nutrients, where diet pattern of Muslims differ from that of Hindus. It is established that education of the mother determines the well-being of the family and is also reflective of the literacy status of a society [31] and [32]. Nutrition and hygiene may be biological pathways linking education and health. Maternal education was found to be an important determinant of the risk of both rotavirus infection and diarrhea, with children of educated mothers less likely to be infected. Another significant covariate was gender with male children at a higher risk for a symptomatic rotavirus infection. Some of these factors may be more reflective of the risk of developing diarrhea [33] and [34] in general rather than specifically rotavirus diarrhea. For example, male gender and mother’s education were also found to be associated with general gastrointestinal symptoms during infancy [35].