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DeAntonio R, Hess-Holtz M, Abrego L, Capitan-Barrios Z, Donoso LH, De León T, Sáez Llorens X, Moreno B, Weil JG. Norovirus in children under 2 years of age: an epidemiological study in Panama during the COVID-19 pandemic. Front Pediatr 2024; 12:1292967. [PMID: 38425667 PMCID: PMC10902054 DOI: 10.3389/fped.2024.1292967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Norovirus infection is a common cause of acute gastroenteritis (AGE). Surveillance activities are important to aid investigation into effective norovirus control strategies, including vaccination. Here, we report ancillary findings related to the incidence, prevalence, and etiology of AGE caused by norovirus in Panama after adjustment of study methodology to comply with national coronavirus disease 2019 (COVID-19) mandates. Methods In January 2020, children aged <2 years began enrolling into an epidemiological study in Panama to estimate the burden of norovirus in preparation for evaluating upcoming prevention strategies. This included an observational, longitudinal, community-based AGE surveillance study and a hospital-based AGE surveillance study. For the longitudinal study, healthy children aged 5-18 months were enrolled from January 6 through March 23, 2020, with a follow-up of approximately 6 months. The last participant was contacted on September 23, 2020. For the hospital-based study, starting on January 21, 2020, children aged <2 years who were admitted to the Hospital del Niño Dr. José Renán Esquivel in Panama City due to AGE were evaluated. The last sample was collected on September 29, 2020. Collected stool samples were tested for norovirus as well as astrovirus, sapovirus, and various enteropathogens. Unfortunately, this study was disrupted by the subsequent implementation of disease transmission control procedures for the COVID-19 pandemic, and the study methodology was revised to comply with COVID-19 mandates. Results In the longitudinal surveillance cohort [N = 400 (Chiriquí, n = 239; Panama, n = 161)], a total of 185 AGE episodes were documented (Chiriquí, n = 85; Panama, n = 100) resulting in an overall AGE incidence of 11.6 (95% CI: 9.99-13.4) episodes per 100 child-months. The norovirus-related AGE incidence was 0.3 (95% CI: 0.10-0.73) episodes per 100 child-months (5/185 AGE episodes) and the prevalence of norovirus was 4.6% (13/282 stool samples collected). In the hospital-based surveillance cohort, at least one pathogen was detected in 50% of samples (44/88 stool samples collected) and norovirus prevalence was 6.8% (6/88 stool samples collected). Discussion This report demonstrates how the occurrence of the COVID-19 pandemic hindered the conduct of clinical trials. However, this also created unique research opportunities to investigate the potential impact of pandemic control measures on the etiology of infectious diarrheal disease.
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Affiliation(s)
- Rodrigo DeAntonio
- Centro de Vacunación e Investigación CEVAXIN, The Panama Clinic, Panama City, Panama
| | - Morgan Hess-Holtz
- Centro de Vacunación e Investigación CEVAXIN, The Panama Clinic, Panama City, Panama
| | - Leyda Abrego
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Departamento de Investigacion en Virologia y Biotecnologia, Panama City, Panama
- Departamento de Microbiología y Parasitología, Facultad de Ciencias Naturales, Exactas y Tecnología, Universidad de Panama, Panama City, Panama
| | - Zeuz Capitan-Barrios
- Departamento de Microbiología y Parasitología, Facultad de Ciencias Naturales, Exactas y Tecnología, Universidad de Panama, Panama City, Panama
| | | | - Tirza De León
- Centro de Vacunación e Investigación CEVAXIN, The Panama Clinic, Panama City, Panama
- Hospital Materno Infantil José Domingo de Obaldia, David, Panama
| | - Xavier Sáez Llorens
- Centro de Vacunación e Investigación CEVAXIN, The Panama Clinic, Panama City, Panama
- Infectious Disease Department, Hospital del Niño Dr José Renán Esquivel, Panama City, Panama
| | - Brechla Moreno
- Instituto Conmemorativo Gorgas de Estudios de la Salud, Departamento de Investigacion en Virologia y Biotecnologia, Panama City, Panama
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Bose T, Borrow R, Arkwright PD. Impact of rotavirus vaccination on diarrheal disease burden of children in South America. Expert Rev Vaccines 2024; 23:606-618. [PMID: 38813689 DOI: 10.1080/14760584.2024.2360212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Rotavirus is a leading cause of severe diarrheal disease and death in children under five years of age worldwide. Vaccination is one of the most important public health interventions to reduce this significant burden. AREAS COVERED This literature review examined vaccination coverage, hospitalization rate, mortality, genotypic distribution, immunogenicity, cost-effectiveness, and risk versus benefit of rotavirus vaccination in children in South America. Nine out of twelve countries in South America currently include a rotavirus vaccine in their national immunization program with coverage rates in 2022 above 90%. EXPERT OPINION Introduction of the rotavirus vaccination has led to a marked reduction in hospitalizations and deaths from diarrheal diseases in children under 5 years, particularly infants under 1 year, in several South American countries. In Brazil, hospitalizations decreased by 59% and deaths by 21% (30-38% in infants). In Peru, hospitalizations in infants fell by 46% and deaths by 37% (56% in infants). Overall, data suggest that rotavirus vaccination has reduced rotavirus deaths by 15-50% in various South American countries. There is some evidence that immunity wanes after the age of 1-year old. Ongoing surveillance of vaccine coverage and changes in morbidity and mortality is important to maximize protection against this disease.
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Affiliation(s)
- Tanmoy Bose
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Manchester, UK
| | - Peter D Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
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Debbag R, Torres JR, Falleiros-Arlant LH, Avila-Aguero ML, Brea-del Castillo J, Gentile A, Saez-Llorens X, Mascarenas A, Munoz FM, Torres JP, Vazquez L, Safadi MA, Espinal C, Ulloa-Gutierrez R, Pujadas M, Lopez P, López-Medina E, Ramilo O. Are the first 1,000 days of life a neglected vital period to prevent the impact on maternal and infant morbimortality of infectious diseases in Latin America? Proceedings of a workshop of experts from the Latin American Pediatric Infectious Diseases Society, SLIPE. Front Pediatr 2023; 11:1297177. [PMID: 38098643 PMCID: PMC10720332 DOI: 10.3389/fped.2023.1297177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
While the first 1,000 days of life are a critical period in child's development, limited information on the main determinants affecting this period in the Latin America and the Caribbean (LAC) region is available. Therefore, the Latin American Pediatric Infectious Diseases Society (SLIPE) held an ad hoc workshop in May 2022 with an expert panel designed to analyze the main factors impacting the development of childhood in the region during this period and the main causes of maternal infant morbimortality. The aim was to identify priorities, generate recommendations, and advise practical actions to improve this situation. Considerations were made about the challenges involved in bridging the gap that separates the region from more developed countries regarding an optimal early childhood and maternal care. Extensive discussion was conducted to reach consensus recommendations on general strategies intended to reduce maternal and infant mortality associated with infections and immune-preventable diseases during the first 1,000 days of life in LAC.
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Affiliation(s)
- Roberto Debbag
- President of Sociedad Latinoamericana de Infectología Pediátrica, SLIPE, Buenos Aires, Argentina
| | - Jaime R. Torres
- Infectious Diseases Section, Tropical Medicine Institute, Universidad Central De Venezuela, Caracas, Venezuela
| | - Luiza H. Falleiros-Arlant
- Department of Children’s Health, Faculdade De Medicina, Universidade Metropolitana De Santos, Santos, Brazil
| | - Maria L. Avila-Aguero
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
- Affiliated Researcher Center for Infectious Disease Modeling and Analysis (CIDMA) at Yale University, New Haven, CT, United States
| | - Jose Brea-del Castillo
- Associated Researcher, Investigador Asociado Hospital Dr. Hugo Mendoza, Santo Domingo, Republic Dominicana
| | - Angela Gentile
- Epidemiology Department, Hospital de Niños “Ricardo Gutiérrez”, Buenos Aires University, Buenos Aires, Argentina
| | - Xavier Saez-Llorens
- Head of Infectious Diseases and Director of Clinical Research, Hospital del Niño “Dr. José Renán Esquivel”, Panama City, Panama
| | - Abiel Mascarenas
- Department of Pediatric Infectious Diseases, Hospital Universitario “José E. Gonzalez”, Universidad Autónoma De Nuevo León, Nuevo Leon, México
| | - Flor M. Munoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Juan P. Torres
- Department of Pediatrics and Children Surgery, Universidad de Chile, Santiago, Chile
| | - Liliana Vazquez
- Pediatric Infectious Diseases, Clinica y Maternidad Suizo Argentina, Sanatorio Finochietto, Buenos Aires, Argentina
| | - Marco A. Safadi
- Department of Pediatrics, Faculda de de Ciências Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil
| | - Carlos Espinal
- Global Health Consortium, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | - Rolando Ulloa-Gutierrez
- Infectious Diseases Service, Hospital Nacional De Niños “Dr. Carlos Sáenz Herrera”, Caja Costarricense De Seguro Social (CCSS), San José, Costa Rica
| | - Monica Pujadas
- Department of Epidemiology and Pediatric Infectious Diseases, Centro Hospitalario Pereira Rossell, Faculty of Medicine, Universidad de la República, Montevideo, Uruguay
| | - Pio Lopez
- Department of Pediatrics, Hospital Universitario del Valle, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica CEIP, Department of Pediatrics, Universidad del Valle, Clinica Imbanaco Grupo Quironsalud, Cali, Colombia
| | - Octavio Ramilo
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, TN, United States
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Plantener E, Nanthan KR, Deding U, Damkjær M, Marmolin ES, Hansen LH, Petersen JJH, Pinilla R, Coia JE, Wolff DL, Song Z, Chen M. Impact of COVID-19 Restrictions on Acute Gastroenteritis in Children: A Regional, Danish, Register-Based Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050816. [PMID: 37238364 DOI: 10.3390/children10050816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
This study aimed to evaluate the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) restrictions such as social distancing on the occurrence of acute gastroenteritis (AGE) among children. This study is a register-based study, including every child seen in the departments of paediatrics with the initial diagnosis of AGE in three neighbouring hospitals in Denmark, from March 2018 through February 2021. The study also included every positive stool sample for AGE-causing pathogens analysed in these three hospitals from children during the same period. The Wilcoxon rank-sum test was used to determine differences between the period during the SARS-CoV-2 restrictions and before. In all, 222,157 children were seen in the three paediatric departments during this period. Of these, 3917 children were diagnosed with AGE. We found a decrease of 46.6% in AGE-related visits per month after the SARS-CoV-2 restrictions were introduced compared to before (p-value < 0.001). Positive stool samples decreased by 38.2% (p-value = 0.008) during the restrictions. This study found that cases of paediatric AGE decreased significantly the during COVID-19 restrictions, suggesting that studies should be conducted to determine whether this reduction was a result of good hand hygiene and social distancing or just a result of altered health-seeking behaviour among children.
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Affiliation(s)
- Eva Plantener
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Kumanan Rune Nanthan
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Ulrik Deding
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Surgery, Odense University Hospital, 5700 Svendborg, Denmark
| | - Mads Damkjær
- Department of Pediatrics, Lillebaelt Hospital, 6000 Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Ea Sofie Marmolin
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6000 Kolding, Denmark
| | - Lotte Høeg Hansen
- Department of Pediatrics, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Jens J H Petersen
- Department of Pediatrics, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Roberto Pinilla
- Department of Pediatrics, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - John E Coia
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Donna Lykke Wolff
- Institute of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
- Department of Clinical Research, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
| | - Zhijun Song
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark
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Laboratory-based surveillance of Shigella spp. from human clinical cases in Colombia, 1997-2018. ACTA ACUST UNITED AC 2021; 41:65-78. [PMID: 33761190 PMCID: PMC8055590 DOI: 10.7705/biomedica.5113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Shigellosis is endemic in low-and middle-income countries, causing approximately 125 million episodes of diarrhea and leading to approximately 160 .000 deaths annually one-third of which is associated with children. OBJECTIVE To describe the characteristics and antimicrobial resistance profiles of Shigella species recovered in Colombia from 1997 to 2018. MATERIALS AND METHODS We received isolates from laboratories in 29 Colombian departments. We serotyped with specific antiserum and determined antimicrobial resistance and minimal inhibitory concentrations for ten antibiotics with Kirby-Bauer tests following the Clinical and Laboratory Standards Institute recommendations. RESULTS We analyzed 5,251 isolates of Shigella spp., most of them obtained from stools (96.4%); 2,511 (47.8%) were from children under five years of age. The two most common species were S. sonnei (55.1%) and S. flexneri (41.7%). The highest resistance rate was that of tetracycline (88.1%) followed by trimethoprim-sulfamethoxazole (79.3%) and ampicillin (65.5%); 50.8% of isolates were resistant to chloramphenicol, 43.6% to amoxicillin/clavulanic acid, and less than 1% to cefotaxime, ceftazidime, gentamicin, and ciprofloxacin. In S. sonnei, the most common resistance profile corresponded to trimethoprim-sulfamethoxazole (92%) whereas in S. flexneri the most common antibiotic profiles were multidrug resistance. CONCLUSIONS In Colombia, children under five years are affected by all Shigella species. These findings should guide funders and public health officials to make evidence based decisions for protection and prevention measures. The antimicrobial resistance characteristics found in this study underline the importance of combating the dissemination of the most frequently isolated species, S. sonnei and S. flexneri.
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Etiology of acute gastroenteritis among children less than 5 years of age in Bucaramanga, Colombia: A case-control study. PLoS Negl Trop Dis 2020; 14:e0008375. [PMID: 32603324 PMCID: PMC7357789 DOI: 10.1371/journal.pntd.0008375] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 07/13/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background Acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children aged less than 5 years in low- and middle-income countries where limited access to potable water, poor sanitation, deficient hygiene, and food product contamination are prevalent. Research on the changing etiology of AGE and associated risk factors in Latin America, including Colombia, is essential to understand the epidemiology of these infections. The primary objectives of this study were to describe etiology of moderate to severe AGE in children less than 5 years of age from Bucaramanga, Colombia, a middle-income country in Latin American, and to identify the presence of emerging E. coli pathotypes. Methodology/Principal findings This was a prospective, matched for age, case-control study to assess the etiology of moderate to severe AGE in children less than 5 years of age in Bucaramanga, Colombia, South America. We tested for 24 pathogens using locally available diagnostic testing, including stool culture, polymerase chain reaction, microscopy and enzyme-linked immunoassay. Adjusted attributable fractions were calculated to assess the association between AGE and each pathogen in this study population. The study included 861 participants, 431 cases and 430 controls. Enteric pathogens were detected in 71% of cases and in 54% of controls (p = <0.001). Co-infection was identified in 28% of cases and in 14% of controls (p = <0.001). The adjusted attributable fraction showed that Norovirus GII explained 14% (95% CI: 10–18%) of AGE, followed by rotavirus 9.3% (6.4–12%), adenovirus 3% (1–4%), astrovirus 2.9% (0.6–5%), enterotoxigenic Escherichia coli (ETEC) 2.4% (0.4–4%), Cryptosporidium sp. 2% (0.5–4%), Campylobacter sp. 2% (0.2–4%), and Salmonella sp.1.9% (0.3 to 3.5%). Except for Cryptosporidium, all parasite infections were not associated with AGE. Three emergent diarrheagenic E. coli pathotypes were identified in cases (0.7%), including an enteroaggregative/enterotoxigenic E.coli (EAEC/ETEC), an enteroaggregative/enteropathogenic E.coli (EAEC/EPEC), and an emergent enteroinvasive E. coli with a rare O96:H19. No deaths were reported among cases or controls. Conclusions/Significance Norovirus and rotavirus explained the major proportion of moderate to severe AGE in this study. Higher proportion of infection in cases, in the form of single infections or co-infections, showed association with AGE. Three novel E. coli pathotypes were identified among cases in this geographic region. Acute gastroenteritis (AGE) is a leading cause of mortality in children under 5 years of age in low- and middle-income countries (LMIC). The highest burden of AGE disease is concentrated in tropical areas where populations lack access to clean water, adequate sanitation and hygiene, making this condition a neglected disease. Limited information on etiology, associated malnutrition, and mortality among underserved communities makes difficult the development of strategies for AGE prevention and treatment. This case-control study among children less than 5 years of age in Bucaramanga, Colombia, revealed that viral followed by bacterial organisms explained the larger proportion of AGE, being norovirus the most common organism. The higher rate of infections and co-infections among cases compared to controls was associated with AGE. This study also reports the identification of three new E. coli pathotypes among cases designated as biofilm-forming enteroinvasive E. coli (BF-EIEC), enteroaggregative/enteropathogenic E. coli, and enteroaggregative/enterotoxigenic E. coli (EAEC/ETEC).
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Mikounou Louya V, Nguekeng Tsague B, Ntoumi F, Vouvoungui C, Kobawila SC. High prevalence of norovirus and rotavirus co‐infection in children with acute gastroenteritis hospitalised in Brazzaville, Republic of Congo. Trop Med Int Health 2019; 24:1427-1433. [DOI: 10.1111/tmi.13317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Vivaldie Mikounou Louya
- Fondation Congolaise pour la Recherche Médicale Brazzaville Republic of Congo
- Faculty of Sciences and Technology University Marien Ngouabi Brazzaville Republic of Congo
| | - Boris Nguekeng Tsague
- Fondation Congolaise pour la Recherche Médicale Brazzaville Republic of Congo
- Faculty of Sciences and Technology University Marien Ngouabi Brazzaville Republic of Congo
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale Brazzaville Republic of Congo
- Faculty of Sciences and Technology University Marien Ngouabi Brazzaville Republic of Congo
- Institute of Tropical Medicine University of Tübingen Tübingen Germany
| | - Christevy Vouvoungui
- Fondation Congolaise pour la Recherche Médicale Brazzaville Republic of Congo
- Faculty of Sciences and Technology University Marien Ngouabi Brazzaville Republic of Congo
| | - Simon Charles Kobawila
- Faculty of Sciences and Technology University Marien Ngouabi Brazzaville Republic of Congo
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Pérez-Corrales C, Leandro-Sandí K. Diarrheagenic Escherichia coli in Costa Rican children: a 9-year retrospective study. BMC Res Notes 2019; 12:297. [PMID: 31138269 PMCID: PMC6537439 DOI: 10.1186/s13104-019-4313-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/11/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives This study aimed to estimate diarrheagenic Escherichia coli (DEC) prevalence among pediatric patients with diarrhea at the Costa Rican National Children’s Hospital-Social Security Service (Hospital Nacional de Niños-Caja Costarricense del Seguro Social; HNN-CCSS). DEC variations with respect to rainfall, presence of coinfections, and DEC antimicrobial resistance were also investigated. Results A retrospective observational study from January 2008 to December 2016 was conducted. A total of 12 247 gastroenteritis records were analyzed. Annual DEC prevalence ranged from 2.7% (2008) to 9.0% (2013). The most prevalent pathotypes were enteroaggregative E. coli (EAEC) [n = 189 (31%)], enteropathogenic E. coli (EPEC) [n = 145 (24%)] and enteroinvasive E. coli (EIEC) [n = 91 (15%)]. A reduction in the probability of EAEC gastroenteritis was detected as rainfall rose above 200 mm/mo. [(Generalized Additive Model (GAM), p = 0.04)]. Coinfections were observed mainly between EPEC and Campylobacter spp. (10%). Antimicrobial resistance occurred in 0.6%, 29%, and 42% of DEC for ciprofloxacin, trimethoprim/sulfamethoxazole, and ampicillin, respectively.
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Affiliation(s)
- Cristian Pérez-Corrales
- División de Diagnóstico Molecular, Laboratorio Clínico, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social, San José, Costa Rica.
| | - Kevin Leandro-Sandí
- División de Microbiología, Laboratorio Clínico, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Caja Costarricense del Seguro Social, San José, Costa Rica
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Muhsen K, Kassem E, Rubenstein U, Goren S, Ephros M, Shulman LM, Cohen D. No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel. Hum Vaccin Immunother 2019; 15:1284-1293. [PMID: 30945960 DOI: 10.1080/21645515.2019.1599522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Following the introduction of universal immunization against rotavirus, concerns were raised regarding pathogen-replacement of rotavirus by norovirus. The study aim was to examine the incidence and characteristics and norovirus gastroenteritis before and after the introduction of universal rotavirus immunization in Israel. We studied 1179 stool samples collected between November 2007 and December 2014 for a prospective hospital-based surveillance study of children aged 0-59 months hospitalized for gastroenteritis. A real-time RT-PCR assay was used to identify genogroup II (GII) norovirus in extracted fecal RNA samples. Overall, the weighted percentage of norovirus positive patients was 10.9%. Norovirus positivity was similar in the pre-universal rotavirus immunisation years (2008-2010) and the universal years (2011-2014), the respective average annual incidence of norovirus gastroenteritis was 1.6 (95% CI 0.6-2.3) per 1000 and 1.1 (95% CI 0.8-1.4) per 1000 children. Rotavirus was detected in 36.8% and 19.6% of the patients in the pre-vaccine years and the universal vaccine years, with an estimated incidence of 5.5 (95% CI 3.4-7.6) per 1000 and 2.1 (95% CI 1.6-2.7) per 1000 children, respectively. Most patients (59.1%) with norovirus gastroenteritis were infants aged 0-11 months. Norovirus was detected all year round with a significant 3-month peak from September through November. In conclusion, norovirus continues to be a leading cause of acute gastroenteritis associated with hospitalizations in young children. Future norovirus vaccines should target young infants. There was no evidence of pathogen-replacement by norovirus following the introduction of universal rotavirus immunization in Israel.
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Affiliation(s)
- Khitam Muhsen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Eias Kassem
- b Department of Pediatrics , Hillel Yaffe Medical Center , Hadera , Israel
| | - Uri Rubenstein
- c Department of Pediatrics , Laniado Medical Center , Netanya , Israel
| | - Sophy Goren
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
| | - Moshe Ephros
- d Department of Pediatrics , Carmel Medical Center , Haifa , Israel.,e Faculty of Medicine , Technion-Israel Institute of Technology , Haifa , Israel
| | - Lester M Shulman
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel.,f Central Virology Laboratory , Ministry of Health , Tel Hashomer , Israel
| | - Dani Cohen
- a Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Ramat Aviv, Tel Aviv , Israel
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Diez-Valcarce M, Lopez MR, Lopez B, Morales O, Sagastume M, Cadena L, Kaydos-Daniels S, Jarquin C, McCracken JP, Bryan JP, Vinjé J. Prevalence and genetic diversity of viral gastroenteritis viruses in children younger than 5 years of age in Guatemala, 2014-2015. J Clin Virol 2019; 114:6-11. [PMID: 30875613 DOI: 10.1016/j.jcv.2019.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Acute diarrhea is an important cause of morbidity and mortality in children and is associated with approximately 500,000 deaths/year globally. Rotavirus and norovirus are leading causes of acute diarrhea accounting for more than half of this burden. OBJECTIVE/STUDY DESIGN To determine the prevalence and genotype distribution of acute diarrhea caused by rotavirus, norovirus, sapovirus and astrovirus among children <5 years of age at two departments in Guatemala from January 2014 to December 2015, we tested 471 stool specimens (202 samples from hospitalized children and 269 samples from children in ambulatory clinics) by real-time reverse transcription-PCR and genotyped positive samples. RESULTS Rotavirus was detected in 20.4%, norovirus in 18.5%, sapovirus in 7% and astrovirus in 4.2% of the samples. Co-infection of rotavirus and norovirus was found in 2.6% of the samples. Most norovirus (87.4%) and rotavirus (81.3%) infections were detected in children in the 6-12 months age group. The proportion of patients with rotavirus (34%) and norovirus (23%) was higher in hospitalized patients compared to ambulatory patients, whereas the prevalence of sapovirus and astrovirus was similar in both settings. Of the 40 genotyped norovirus strains, 62.5% were GII.4 and 15% GII.3. Sapovirus genotypes included GI.1 (15.4%), GII.2 (15.4%), GII.5 (38.5%) and GIV.1 (30.8%). CONCLUSIONS Our data demonstrate that in 2014-2015, gastroenteritis viruses account for 50% of acute diarrhea in children younger than 5 years of age in Guatemala, highlighting the importance of continuous surveillance to guide impact of the current rotavirus vaccine and formulation of future norovirus vaccines.
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Affiliation(s)
| | | | - Beatriz Lopez
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Oneida Morales
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Manuel Sagastume
- Department of Epidemiology, Ministry of Public Health and Social Welfare, Guatemala City, Guatemala
| | - Loren Cadena
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA; Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Susan Kaydos-Daniels
- Influenza Program, US Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Claudia Jarquin
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Joe P Bryan
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, GA; Central American Regional Office, Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Jan Vinjé
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
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