Rare Rotavirus Strains in Children with Severe Diarrhea , Malaysia

neck rigidity (2 patients) were also observed. Signs and symptoms at the time of hospitalization and at followup for 6 months (at 3-month intervals) were similar for persons infected with JEV and those infected with WNV. Neurologic sequelae observed at <6 months follow-up were impaired memory (6 patients), irritable behavior (5 patients), impaired hearing (3 patients), incoherent speech and disorientation (1 patient), breathing diffi culty (1 patient), impaired speech (1 patient), and quadriparesis (1 patient). We identifi ed WNV in regions of Assam to which JEV is endemic. The fi nding indicates that WNV might be the cause of a substantial number of acute encephalitis syndrome cases in this region. Fever and headache were the most common signs and symptoms, as reported (7). There were 3 deaths (all children) in 13 patients. Our results corroborate a similar observation in the Kolar District of Karnataka (8). In contrast, in western countries, the attack rate and casefatality rate for WNV infection are higher among immunocompromised elderly patients (9). Our fi ndings may be caused by strain variations and host susceptibility to the virus. Identifi cation of circulating genotypes of WNV and its vectors and epidemiologic studies are needed to obtain additional information on WNV infection in this region and identify WNV as a cause of acute encephalitis syndrome. Acknowledgments We thank Milind Gore for providing cell lines and helping with the neutralization test and Niranjan Kumar Barua, Robin Doloi, and Joy Prasanna Gogoi for excellent assistance in the laboratory and the fi eld.