Talk:WikiJournal of Medicine/Rotavirus
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WikiJournal of Medicine
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This article has been through public peer review.
It was adapted from the Wikipedia page Rotavirus and contains some or all of that page's content licensed under a CC BY-SA license. Post-publication review comments or direct edits can be left at the version as it appears on Wikipedia.
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DOI: 10.15347/wjm/2017.007
QID: Q43994531
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Suggested citation format:
Graham Beards (2017). "Rotavirus". WikiJournal of Medicine 4 (1). doi:10.15347/WJM/2017.007. Wikidata Q43994531. ISSN 2002-4436. https://upload.wikimedia.org/wikiversity/en/6/6a/Rotavirus.pdf.
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Wikipedia: This work is adapted from the Wikipedia article Rotavirus (CC BY-SA). Content has also subsequently been used to update that same Wikipedia article Rotavirus.
License: 
This is an open access article distributed under the Creative Commons Attribution ShareAlike License, which permits unrestricted use, distribution, and reproduction, provided the original author and source are credited.
Thomas Shafee 
(handling editor) contact
Tony Nelson
Article information
Plagiarism check
Pass. WMF copyvio tool using TurnItIn. Short phrases such as "Nearly every child in the world is infected with rotavirus at least once..." were similarly used in external pages, but not regarded as plagiarism. T.Shafee(Evo﹠Evo)talk 09:10, 2 April 2017 (UTC)
Initial editorial review
Comments by Thomas Shafee ,
These editorial comments were submitted on , and refer to this previous version of the article
There are a couple of minor edits needed to convert the article to a more journal style.
- The numbered figures should be each referred to in the main text.
- I gather from the commons that you are the creator of all the article's images, for any that I've missed, the creator should be noted in the
|attribution=parameter.
Otherwise, the article is ready to invite peer reviewers.
Comments from first peer reviewer
Following are comments emailed by a BSc in Biomedical Science. Mikael Häggström (discuss • contribs) 16:50, 14 April 2017 (UTC)
The reviewer has declared "No conflict of interests". Mikael Häggström (discuss • contribs) 16:04, 16 April 2017 (UTC)
reviewer-annotated pdf
Review by anonymous reviewer ,
These assessment comments were submitted on , and refer to this previous version of the article
This is an interesting review article presenting a concise overview of rotavirus. Since the content of this article was obtained from Wikipedia which was written by several contributors, it naturally poses some issues:
- Organization of the paper is not cohesive and should be rearranged. I suggest the organization of the paper as follow:
1. Virology
2. Transmission
3. Sign and symptom
4. Disease mechanism
5. Diagnosis and detection
6. Treatment and prognosis
7. Prevention
8. Epidemiology
9. In other animals
10.History
- I suggest moving section ’Virology’ to the very first section. In order to understand the disease mechanism, proteins and all structures involved should be mentioned at the beginning.
- ‘Disease mechanism’ section is too brief. It should be more detail oriented and deep into cellular/molecular pathways, i.e. how molecules in section 9.3 interact with each other or with the host, how do they give rise to symptoms. Steps such as 1. introduction of the virus to host (NSP4 as an enterotoxin) 2. host cellular response 3. host immune response (presence of virus specific IgA) and cell injury should also be mentioned. Also, I suggest 4 last paragraphs from 9.3.2 should be incorporated into ‘disease mechanisms’.
- Last paragraph of section 10. ‘History’ should be incorporated into ‘prevention’ section.
- All figures need to be cited in the text.
- Figure 4 lacks X-axis and units. Please edit and re-upload a new version of the file.
- Figure 8 should be explained more in the legend.
- For the reference, I suggest they all follow the same format, e.g. journal names are either abbreviated or spelled out.
Thanks for the review. I am working on the comments and I will respond in full later. Graham Beards (discuss • contribs) 08:10, 18 April 2017 (UTC)
This was a valuable review and I have amended and added to the article accordingly. I agree with the suggested reorganisation. Ironically, this is how I originally intended it to be. The Featured Article reviewers insisted that the format should follow the Manual of Style for medical articles, although I consider it a virology article. The corresponding medical article is w:Rotaviral enteritis.
I have expanded the Disease Mechanism section, (a whole paper article could be this alone!)
I disagree that the 4 last paragraphs from 9.3.2 should be incorporated into ‘disease mechanisms’. I think you meant Section 9.4. I have moved the first paragraph as suggested, but left the following three, which outline the virus replication cycle. Viral replication as such is not a disease mechanism. Some rotavirus infections are asymptomatic. And the replication of other viruses, e.g. JC and BK polyomaviruses, rarely cause symptoms in the immunocompetent.
I have cited the Figures in the text.
I have uploaded a new version of Figure 4 and expanded the legend for Figure 8.
The references should now be consistently formatted.
I have addressed the specific remarks on the annotated PDF.
Thanks once more. Graham Beards (discuss • contribs) 11:02, 20 April 2017 (UTC)
Comments from second peer reviewer
Following are comments submitted by a virologist and epidemiologist (MD). T.Shafee(Evo﹠Evo)talk 06:22, 27 April 2017 (UTC)
Review by anonymous peer reviewer ,
These assessment comments were submitted on , and refer to this previous version of the article
Content:
The content is accurate and reflects the current state of rotavirus from a pathophysiology standpoint, but also from a vaccine standpoint which is where the current issues in rotavirus are really being explored.
References:
The references were great - they cited key work from the CDC as well as PATH, both organizations that have fantastic teams of scientists working on rotavirus.
Style:
I thought that the style was clear and easy to follow, the overall structure of the paper was great.
Thank you for finding the time to review the paper and your kind words. Graham Beards (discuss • contribs) 13:53, 27 April 2017 (UTC)
Comments from third peer reviewer
Following are comments submitted by a paediatrician (MD). T.Shafee(Evo﹠Evo)talk 06:43, 30 August 2017 (UTC)
Review by Dr. Tony Nelson 
,
These assessment comments were submitted on , and refer to this previous version of the article
It is not clear to me what length of article is optimal i.e. this is potentially a vast topic so the amount of details may need to be limited in certain aspects.
Given my biases, I found the article to be somewhat too focused on the basic virology. I am unable to critically review this aspect of the article.
In terms of the epidemiological, clinical and vaccine parts of the article, the content was generally factually correct and the references appropriate. However, I felt there were some important gaps.
Clinically rotavirus infection, is recognised to cause a viraemia, and has been linked to convulsions and other CNS manifestations. This is not a rare complication as indicated in Section 7. As part of safety monitoring in US after rotavirus vaccine introduction there was an unexpected 20% reduction in both febrile and afebrile convulsions in vaccinated children. The herd protective effect of rotavirus vaccine is mentioned but this is a very important added benefit of this vaccine that could be expanded on. An important study known as the GEMS study that has prospectively followed up children with diarrhoea in low income countries. This study shows that children admitted with diarrhoea are 8.5x more likely to die in the following 2 months. Also post-diarrhoea there is significant reduction in growth in children, which has important implications. Some mention of these additional vaccine benefits and GEMS study should be considered.
In section 5.3 there is a brief mention of correlates of protection but some expansion on this would be important in relation to how this impacts and is or is not relevant t vaccine efficacy studies.
Some expension of the importance vaccine cost-effectiveness for decision-making for inclusion in National Immunisation Programmes can be considered
Mention is made of three nationally licensed vaccine. The one from Vietnam should be Rotavin-M1 and not Motavin-M1.
Figure 3 is mentioned in the text before Figure 2.
Reference 5- incomplete.
Comments from fourth peer reviewer
Following are comments submitted by a paediatric gastroenterologist (MD). T.Shafee(Evo﹠Evo)talk 06:43, 30 August 2017 (UTC)
Review by anonymous peer reviewer ,
These assessment comments were submitted on , and refer to this previous version of the article
General Comments:
I would recommend considering re-ordering the sections if possible as it seemed awkward and repetitive in parts particularly to have history and epidemiology listed last. There are some areas particularly as the text relates to clinical and global health aspects that would benefit from input from a co-author who has a clinical and global experience. There needs to editing to make clear distinction between infection and disease as this is confused in parts but important to understand the concepts important in rotavirus infection, immunity and symptoms – which is the basis of vaccination.
Specific recommendations:
Abstract: “immunity develops with each infection….” Is probably correct, but here the distinction between infection and disease could be made.
Symptomatic disease with re-exposure to rotavirus infection is less severe – adults are re-infected but tend not to develop disease although when immunity wanes in the elderly disease rates increase again, particularly in care settings.
Sentence “Although rotavirus was discovered..” is too long has too many concepts and should be divided into 2 parts.
The 3rd paragraph needs to be significantly revised. “Rotavirus is usually an easily managed disease..” is not correct and underscores the reason why so many children die worldwide, even occasionally in high income countries. An emphasis on the US is not ideal here when data is available for a broader global community. The sentence commencing “Public health..” needs to be re-worded as oral rehydration is for treatment of symptoms of dehydration due to rotavirus disease but not strictly for infected children.
Replication: This section and Figure 4 legend is difficult to follow and potentially provides too much detail. Abbreviations need to be introduced (ie dsRNA, siRNA or even RNA). There is nothing here regarding the role of histo-blood group antigens and rotavirus attachment to intestinal cells, the role of trypsin in virus replication and factors that might interfere with virus uptake and replication (ie enteropathy, microbiome etc)
Signs and symptoms: Infection in newborn children is NOT common. There needs to be re-wording for clarity as “most adults are not susceptible to rotavirus {?symptoms due to rotavirus infection)….”but asymptomatic infections in adults may maintain the transmission of infection in the community”. This referenced to a 2004 paper before introduction of rotavirus vaccination and the concepts of herd immunity have changed since then and need to be updated here.
Immune responses: The primary immune protection from rotavirus disease is through secretory IgA released from the gut mucosa. However this is not given appropriate reference here.
Sentence “Specific antibodies of the classes …” is not clear. The role of maternal transplacental IgG in neonatal protection remains contentious and could be deleted here.
Diagnosis and detection: Although ELISA has been the traditional detection method many commercial labs now use PCR routinely due to lack of sensitivity and specific of commercial ELISA kits. The accurate identification of serotypes is not as straight forward as indicated here and sequencing may be required to identify strains that cross react – such as some G9s and equine-like G3. This section needs to be revised.
Treatment: The first sentence should be reduced to say that the treatment of rotavirus gastroenteritis is based on the correction of dehydration and any associated electrolyte abnormalities. It is important that the words used to describe the oral rehydration solution does not encourage non-medically trained people to use water with “small amounts of salt and sugar” – the use of home made oral rehydration solutions with inaccurate or inappropriate compositions has been associated with a number of deaths. The use of probiotics in the treatment of diarrhea remains contentious and not accepted by all. I would reword the last sentence to remove “well managed”
There is nothing here about the risk benefit of rotavirus vaccines. The ongoing concern about intussusception risk remains a barrier to introduction in some countries (particularly in Europe). More information could be provided about the vaccine – ie oral, volume, age administered, perhaps a map of current introductions. Also the difference in vaccine efficacy in high vs low income countries or some of the remaining challenges to rotavirus vaccine implementation.
Prevention: Reword second sentence. The data on reduction of deaths and hospitalisations with vaccination can be summarised for ease of reading (see ROTACouncil website). The last sentence needs to be re-worded or deleted as it is confusing, too encompassing and not strictly accurate.
Epidemiology: Delete sentences “ Boys are twice as likely as girls to be admitted hospital with rotavirus – this may be due to cultural differences and nothing to do with the disease. The season relationship of rotavirus disease only occurs in temperate regions and not in tropics. There is no specific value of the sentence on the unknown food contamination sentence. The issue of vaccination “helping” vaccine escape is not agreed by all (including CDC US).
Since this is a very virological focused review it may be of interest to high light the difference in serotypes across global regions. The WHO Global rotavirus surveillance network might also be interesting to mention.
Author response to reviewers 3 and 4
The article is called "Rotavirus", which is a virus that causes a disease called rotaviral enteritis in humans, scours in cattle, EDIM in mice and so on. I would expect an article called Rotavirus to contain the basic virology and I have devoted about 50% of the article to this.
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
If the article’s scope is virology then the sections on clinical relevant aspects including signs and symptoms and prevention (including rotavirus vaccines) should be deleted as these sections do not provide sufficient scope or contain inconsistencies and opinions that could be avoided if readers were to be referred to other Wikipedia articles that focus on these clinical aspects. Indeed the Author states that “the Wikipedia article called Rotavirus Vaccine is the proper place for this information.”
The third reviewer also suggests that more information is needed regarding the vaccines. Again, there is a Wikipedia article (which I created) called Rotavirus vaccine, which is the proper place for this information.
With regard to the reviewers comments about viraemia "in Section 7" (there is no Section 7, by the way). This is still controversial as although viral proteins and viral RNA have been detected in blood and CSF, they have never been found together. In other words, there is no firm evidence of rotaviral replication anywhere other than the duodenum. (See: Alfajaro and Cho, "Evidences and consequences of extra-intestinal spread of rotaviruses in humans and animals" Virus Disease, 2014, 25(2):186-194)
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
I would disagree on a number of points – a number of articles refer to detection of rotavirus replication in non-intestinal tissue (examples include: Crawford et al 2006 J of Virology; Hyun-Jeong H Vet Micro 2011). Also I could find no reference provided to support the fact the duodenum as the only intestinal site of rotavirus replication –this is not consistent with the postulated mechanism of propagation of infection in the small intestine and subsequent shedding of virus and consistent with the biological mechanism proposed for intussusception as an adverse event following rotavirus vaccination
The fourth reviewer suggests shortening the legend for the replication figure, which I expanded in response to the first review and I can't see the point of introducing and the abbreviation to siRNA when these molecules are not mentioned in the article, put I agree that dsRNA might not be familiar to some readers.
With regard to the comment "Infection in newborn children is NOT common"- they are. (See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC273068/) I think the problem here is how we define "newborn". Neonates might be a better term. And, often these infections are asymptomatic.
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
I disagree with this comment. This paper reports an outbreak of diarrhea in obstetric newborn nurseries in the 1970s and links this with infection control procedures. This report coincides with the detection of a novel neonatal rotavirus vaccine strain which ha not been detected in these nurseries in recent times. In the current era rotavirus infection is uncommon in newborn babies. Asymptomatic newborn or nursery rotavirus strain can be present but relatively uncommon, particularly in developed country settings where babies do not share a newborn nursery. In community based studies measuring the acquisition of rotavirus infection suggest that the first infection is the most severe and protects against subsequent severe disease – the peak onset of first infection varies in different geographical regions but usually > 6months of age in low and low-middle income settings and later in low mortality regions.
This comment - "Although ELISA has been the traditional detection method many commercial labs now use PCR routinely due to lack of sensitivity and specific of commercial ELISA kits. The accurate identification of serotypes is not as straight forward as indicated here and sequencing may be required to identify strains that cross react – such as some G9s and equine-like G3. This section needs to be revised." The section in question refers to "detection" of rotavirus in clinical samples. I don't know of any labs, in Europe at least, that use expensive PCR-based methods for routine detection of the virus in faeces. All the EIA kits that I know of have a specificity and sensitivity of around 98%. And serotyping is usually fairly straight forward, but I concede the point that sequencing sometimes is needed. I think the reviewer might be confusing detection and serotyping by EIA. The latter does lack sensitivity and specificity, and we use rtPCR for this.
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
Although this may be true that ELISA is used most frequently in clinical setting there is a rapidly increasing trend worldwide for the use of RT-PCR, which is highly sensitive and specific. An increasing number of commercial and hospital laboratories are moving to molecular methods for primary diagnosis so that some statement should be made here regarding the comparability of traditional and molecular methods and the relative advantages and disadvantages.
On this point, " Delete sentences “ Boys are twice as likely as girls to be admitted hospital with rotavirus – this may be due to cultural differences and nothing to do with the disease." It is not, this has been shown in many settings and it is also seen with other viral infections such as RSV. (See: https://www.ncbi.nlm.nih.gov/pubmed/20503287).
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
I don’t think that this sentence adds anything and should be deleted.
Here in the fourth review it says; "There is nothing here regarding the role of ...of trypsin in virus replication." Whereas in the article I have clearly written, "VP4 has to be modified by the protease enzyme trypsin, which is found in the gut, into VP5* and VP8* before the virus is infectious."
This were some very helpful comments which I have addressed:
- Mention is made of three nationally licensed vaccine. The one from Vietnam should be Rotavin-M1 and not Motavin-M1.
Review by Reviewer 4 ,
These assessment comments were submitted on , and refer to this previous version of the article
I think this can be deleted and readers referred to the Rotavirus vaccine Wikipedia article. To emphasise this point there is another vaccine licensed in India not mentioned here - RotaSIIL
- Figure 3 is mentioned in the text before Figure 2.
- Reference 5- incomplete.
- There is nothing here regarding the role of histo-blood group antigens
- The primary immune protection from rotavirus disease is through secretory IgA released from the gut mucosa. However this is not given appropriate reference here.
- Since this is a very virological focused review it may be of interest to high light the difference in serotypes across global regions.
Graham Beards (discuss • contribs) 15:19, 15 October 2017 (UTC)
Post-review editorial comments
Comments by Thomas Shafee ,
These editorial comments were submitted on , and refer to this previous version of the article
Several of the points made by reviewers 3 and 4 refer to the scope of the article and expansion of its sections on its disease and its vaccine. Given that the focus of the article is on the virology of Rotavirus, I think that it is reasonable that only summaries of these topics are given. The "Prevention" section already includes {{Main article}} link to w:rotavirus vaccine. The "Signs and symptoms" section should have a {{Main article}} link added to w:rotaviral enteritis.
- Indeed, the author should edit or respond so to make reviewers more satisfied with the content. An option for this is to reduce the material about enteritis and vaccine, which are already linked to their main articles. Mikael Häggström (discuss • contribs) 15:38, 27 October 2017 (UTC)
I have edited the article to address the further comments from the fourth reviewer. With regard to the comment "the sections on clinical relevant aspects including signs and symptoms and prevention (including rotavirus vaccines) should be deleted", I disagree with the reviewer. I think the summaries I have given are appropriate in content and length. I would be interested to know, what are considered as "opinions". I have deleted the statement (albeit true) that boys are twice as likely to be hospitalised. I have also deleted the statement on infections in neonates. I have removed the paragraph that named the individual vaccines. I have added a sentence on extraintestinal spread of rotavirus and added the citation suggested. But, I must stress that this was a primary study using (a small number of) rats. With regard to the comment "An increasing number of commercial and hospital laboratories are moving to molecular methods for primary diagnosis"; I would need to see a citation to support the addition of this. At the moment I remain unconvinced. Graham Beards (discuss • contribs) 15:08, 29 October 2017 (UTC)
- Thank you. We expect to have an editorial board decision on this article this week. A board member with expertise in the field agreed with the mention of admission rates of boys vs girls, so this is now reinserted [1]. Mikael Häggström (discuss • contribs) 20:28, 6 November 2017 (UTC)
Comments by Thomas Shafee ,
These editorial comments were submitted on , and refer to this previous version of the article
I would like to note that a large impact on the time between submission and final publication of this manuscript was in finding peer reviewers, rather than in the time taken for revision. The PDF will be formatted up in the coming week.