In this study, most of the rotavirus positive children were from 6 to 12 months age groups (Fig. 2), suggesting that the post breast feeding age group is more prone to rotavirus infection. In this study, G9 was the most common strain (40%) responsible for severe diarrhea related hospitalizations (Table 2). Previous studies during 2003–2009, showed that, in the eastern part of India, G1 (>50%) and G2 strains (∼23–33%) were dominant, OSI-744 solubility dmso whereas G9 (2–10%) and G12 (8–17%) strains occurred at lower frequencies [19], [20] and [21], and similar trends were reported

in western, northern and southern parts of India [17], [18], [20], [21] and [22]. During the current study period, G9 Carfilzomib and G2 strains predominated, causing 75% and 62% of all RV infections among hospitalized and OPD cases, respectively. G1 genotypes were still observed at 16–25% (Table 2). Previously available two rotavirus

vaccines have shown high effectiveness against several strains not in the vaccine including G9 and G12 in countries like USA [13] and [15], suggesting there is a heterotypic protection. Still in countries like India, where genotypic diversity is very high, strains like G9 and G12 should be included in the vaccine. The high prevalence of G9 observed in this study suggests that it may be valuable to have a vaccine that includes serotype G9 such as strain 116E, that is currently in the pipeline. Nucleotide sequence based homology analysis with respect to previously reported G9 strains revealed close similarity of Kolkata G9 strains to previously reported lineage III strains from the Indian subcontinent (India, Bangladesh and Nepal) (Fig. 4A). The currently licensed vaccine from India (Rotavac) 116E, has G9P[11] Carnitine palmitoyltransferase II genotype and the G9 strains from Kolkata showed low amino acid homology (89.9–92.6%) with 116E vaccine strain (Table 3), but the vaccine strain was derived from a non-symptomatic neonatal infection and was adapted to cell culture several years ago [10], [11] and [12]. Similarly the circulating lineage II G1 and lineage IV G2 strains were also found to

be distant from the current vaccine strains (Rotarix and RotaTeq). VP7 antigenic domain of Kolkata G1and G2 strains also revealed mismatches with that of vaccine strains (Table 4). Knowledge of currently circulating strains is needed prior to vaccination, for comparison and evaluation during post vaccination studies. Fluctuation of genotypes due to accumulation of point mutations (genetic drift) in the antigenic domain of VP7 gene is one potential reason for changes in circulating strains [53] and [54]. The amino acid analysis of the VP7 antigenic domains compared with vaccine strain was not done earlier in this region. The antigenic variation observed between circulating strains and vaccine strains may influence vaccine efficacy in these settings.