3). In the next phase of analyses we

attempted to identify if different scientific, economic, societal and ethical perspectives led the discussants to arrive at dissimilar conclusions from available evidence base. This required referring to the original articles that the discussants used in building their arguments. Part of this exploration included identifying if same evidence was interpreted differently by different discussants. Wnt inhibitor We also took recent and emerging evidence into account. Of the 177 articles resulting from the data screening process (Fig. 2), 117 were from the domain of ‘epidemiology’, 39 from ‘vaccine’ and 21 from ‘debate’. Articles retrieved under ‘debate’ comprised efficacy, adverse events and immunization performance related discussion, perceptions of pediatricians toward immunization against

rotavirus, as well as policy matters. ‘Vaccine’ articles encompassed clinical trials, mechanisms of action, and inhibitory factors related to oral live vaccines, vaccine uptake by general population in urban and rural settings, as well as economic issues. Most of the articles in ‘epidemiology’ were on hospital based studies, and only 14 out of 117 articles (12%) BYL719 mw described community based investigations. While 10 community based studies were carried out over the last decade, the rest were from an earlier time. Apart from articles referring to rotavirus group A, group B rotavirus studies (occurring rarely and mostly in adults) also featured in our search. Nine articles dealing with infrequent rotavirus genotypes of group A and five about group

B were not included during detailed analysis and thus a total of 163 articles (103 from ‘epidemiology’, Phosphatidylinositol diacylglycerol-lyase 39 from ‘vaccine’ and 21 from ‘debate’) were analyzed in-depth. Original research and review articles were used in the citation for the present write-up, as deemed appropriate. The earliest article documenting rotavirus in children in India appeared from Vellore in Tamilnadu [15] within a year of its first detection in Australia [16]. We noticed that articles on rotavirus diarrhea subsequently started appearing from various parts of the country, including north-eastern states [17], [18] and [19], all of which appeared under ‘epidemiology’. Cognitive contents in articles used for detailed analyses were arranged into themes as shown in Fig. 3 for synthesizing arguments. The six emerging themes were – (a) disease burden, (b) host factors (mother and child), (c) macro-social environment, (d) the agent (rotavirus) and the vaccine, (e) immunization program issues, and (f) economic issues. Disease burden is presented here under two major headings, (a) morbidity and (b) mortality due to rotavirus diarrhea in India. Most of the information under this topic came from facility based studies [20], and we identified scarcity of data on morbidity and mortality in communities.