The incorporation of G12 primers into RT-PCR testing kits since 2000 has helped establish prevalence data for G12 strains in India. Continued surveillance will be necessary to document an expected GSK-3 beta phosphorylation trend of expansion and reassortment in coming years. Nucleotide sequence of the VP7 gene from a 2005 community cohort study found 13 G12 strains with homology to the

G12 Kolkata ISO-5 strain (97–99% nucleotide level) as compared to the G12 L26 prototype strain lineage I or lineage II (89–90% nucleotide level) of the phylogenetic tree [66]. These results suggest a distinctly native G12 lineage III strain in India [66]. However, it appears the Indian G12 lineage is continually evolving, with multiple reassortment events and several new gene constellations.

A second study of all 11 genes from G12 strains in Bangladesh, Belgium, the Philippines, and Thailand characterized vast nucleotide variability from the original Kolkata strain [23]. Such reassortment ability is hypothesized to improve the ability of G12 to propagate within the human host and potentially launch it Enzalutamide on a similar path of rapid transmission as G9 [23]. Historically, Asia has birthed many new rotavirus strains, including the G10P[11] in 1993, a likely human-porcine reassortment (P[19]) in the early 1990s, and, most recently, G11P[25] [41], [51] and [64]. Oligonucleotide analysis of G11P[25] from Bangladesh found the VP7 gene to share the most similarity (95% amino acid identity, 87–91% nucleotide identity) with the porcine G11 rotavirus strains; however, the VP4 genotype presented low similarity Phosphoprotein phosphatase (54–71% nucleotide identity and 52–76% amino acid sequence identity) to the porcine isolate and thus likely indicates a new human-animal reassortment virus named Dhaka6 [64]. Dhaka6 has subsequently been identified in Vellore neonates with 98% (VP7) and <96% (VP4) nucleotide similarity [16]. Beyond

the common G1, G2, G3, G4, and G9 strains, 14% more unusual strains appear in Asia as compared to the US and Australia [22]. Mixed infections, along with human-animal reassortments, sustain an environment fit for such cases. Unusual G-types (G6 and G8) and strains (G3P[11] and G9P[10]) have been described through multiplex RT-PCR, nucleotide sequencing, and hybridization assay, highlighting the wide genetic and antigenic diversity of strains circulating in the region [22]. Such variation evokes the need for continued surveillance to serve two important functions. First, as new rotavirus vaccines are currently in development, it is important to assess and consider the strain variability in the design of the new vaccine candidates and in the clinical evaluation of the vaccines in regions with high strain diversity. Two philosophies exist regarding the need for neutralizing antigens in the vaccine construct to elicit specific neutralizing antibodies in the host.