1
|
Thomas S, Donato CM, Covea S, Ratu FT, Jenney AWJ, Reyburn R, Sahu Khan A, Rafai E, Grabovac V, Serhan F, Bines JE, Russell FM. Genotype Diversity before and after the Introduction of a Rotavirus Vaccine into the National Immunisation Program in Fiji. Pathogens 2021; 10:358. [PMID: 33802966 PMCID: PMC8002601 DOI: 10.3390/pathogens10030358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 11/20/2022] Open
Abstract
The introduction of the rotavirus vaccine, Rotarix, into the Fiji National Immunisation Program in 2012 has reduced the burden of rotavirus disease and hospitalisations in children less than 5 years of age. The aim of this study was to describe the pattern of rotavirus genotype diversity from 2005 to 2018; to investigate changes following the introduction of the rotavirus vaccine in Fiji. Faecal samples from children less than 5 years with acute diarrhoea between 2005 to 2018 were analysed at the WHO Rotavirus Regional Reference Laboratory at the Murdoch Children's Research Institute, Melbourne, Australia, and positive samples were serotyped by EIA (2005-2006) or genotyped by heminested RT-PCR (2007 onwards). We observed a transient increase in the zoonotic strain equine-like G3P[8] in the initial period following vaccine introduction. G1P[8] and G2P[4], dominant genotypes prior to vaccine introduction, have not been detected since 2015 and 2014, respectively. A decrease in rotavirus genotypes G2P[8], G3P[6], G8P[8] and G9P[8] was also observed following vaccine introduction. Monitoring the rotavirus genotypes that cause diarrhoeal disease in children in Fiji is important to ensure that the rotavirus vaccine will continue to be protective and to enable early detection of new vaccine escape strains if this occurs.
Collapse
Affiliation(s)
- Sarah Thomas
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
| | - Celeste M. Donato
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Sokoveti Covea
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Felisita T. Ratu
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Adam W. J. Jenney
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Rita Reyburn
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Aalisha Sahu Khan
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji; (S.C.); (F.T.R.); (A.S.K.); (E.R.)
| | - Varja Grabovac
- Western Pacific Regional Office, World Health Organization, Manila 1000, Philippines;
| | - Fatima Serhan
- World Health Organization, 1202 Geneva, Switzerland;
| | - Julie E. Bines
- Enteric Diseases Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.M.D.); (J.E.B.)
- Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
- Department of Gastroenterology and Clinical Nutrition, Royal Children’s Hospital, Parkville, VIC 3052, Australia
| | - Fiona M. Russell
- Asia-Pacific Health Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.W.J.J.); (R.R.); (F.M.R.)
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3052, Australia
| |
Collapse
|
2
|
Donato CM, Thomas S, Covea S, T Ratu F, Sahu Khan A, Rafai E, Bines JE. Rotavirus surveillance informs diarrhoea disease burden in the WHO Western-Pacific region. MICROBIOLOGY AUSTRALIA 2021. [DOI: 10.1071/ma21046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The surveillance of enteric pathogens is critical in assessing the burden of diarrhoeal disease and informing vaccine programs. Surveillance supported by the World Health Organization in Fiji, Vietnam, the Lao People’s Democratic Republic, and the Philippines previously focussed on rotavirus. There is potential to expand surveillance to encompass a variety of enteric pathogens to inform vaccine development for norovirus, enterotoxigenic Escherichia coli and Shigella.
Collapse
|
3
|
The impact of the rotavirus vaccine on diarrhoea, five years following national introduction in Fiji. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100053. [PMID: 34327400 PMCID: PMC8315333 DOI: 10.1016/j.lanwpc.2020.100053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 11/23/2022]
Abstract
Background In 2012, Fiji became the first independent Pacific island country to introduce rotavirus vaccine. We describe the impact of rotavirus vaccine on all-cause diarrhoea admissions in all ages, and rotavirus diarrhoea in children <5 years of age. Methods An observational study was conducted retrospectively on all admissions to the public tertiary hospitals in Fiji (2007–2018) and prospectively on all rotavirus-positive diarrhoea admissions in children <5 years at two hospital sites (2006–2018, and 2010–2015), along with rotavirus diarrhoea outpatient presentations at one secondary public hospital (2010–2015). The impact of rotavirus vaccine was determined using incidence rate ratios (IRR) of all-cause diarrhoea admissions and rotavirus diarrhoea, comparing the pre-vaccine and post-vaccine periods. All-cause admissions were used as a control. Multiple imputation was used to impute missing stool samples. Findings All-cause diarrhoea admissions declined among all age groups except among infants ≤2 months old and adults ≥55 years. For children <5 years, all-cause diarrhoea admissions declined by 39% (IRR)=0•61, 95%CI; 0•57–0•65, p-value<0•001). There was an 81% (95%CI; 51–94%) reduction in mortality among all-cause diarrhoea admissions in children under <5 years. Rotavirus diarrhoea admissions at the largest hospital among children <5 years declined by 87% (IRR=0•13, 95%CI; 0•10–0•17, p-value<0•001). Among rotavirus diarrhoea outpatient presentations, the IRR was 0•39 (95%CI; 0•11, 1.21, p-value=0.077). Interpretations Morbidity and mortality due to rotavirus and all-cause diarrhoea in Fiji has declined in people aged 2 months to 54 years after the introduction of the RV vaccine. Funding Supported by WHO and the Australian Government.
Collapse
|
4
|
Tintle N, Heynen A, Van De Griend K, Ulrich R, Ojo M, Boven E, Brokus S, Wade R, Best AA. Evaluating the efficacy of point-of-use water filtration units in Fiji. Trop Med Health 2019; 47:48. [PMID: 31410085 PMCID: PMC6686492 DOI: 10.1186/s41182-019-0175-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/31/2019] [Indexed: 11/14/2022] Open
Abstract
Background To develop and evaluate a strategy for reducing the prevalence and impact of waterborne disease, a water quality intervention was developed for Fiji by Give Clean Water, Inc. in partnership with the Fiji Ministry of Health. Residents were provided and trained on how to use a Sawyer® PointONE™ filter, while also being taught proper handwashing techniques. At the time of the filter installation, all households were surveyed inquiring about the prior 2- to 4-week period. Households were measured a second time between 19 and 225 days later (mean = 66 days). Results To date, five economic and health outcomes have been tracked on 503 households to evaluate the efficacy of the intervention. When comparing baseline to follow-up among the 503 households, the 2-week diarrhea prevalence decreased in households from 17.5% at baseline to 1.8% at follow-up. Also, the 2-week prevalence of severe diarrhea decreased per household from 9.7% at baseline to 0.6% at follow-up. Finally, monthly diarrhea-related medical costs reduced by an average of Fijian (FJ) $3.54 per person, and monthly water expenses reduced by FJ $0.63 per person. All estimated values are obtained from general linear and logistic mixed-effect models, which adjusted for location, season, time to follow-up, household size, water source, and respondent changing. Changes in economic and health outcomes from installation to follow-up were statistically significant (p < 0.05) in all cases, in both unadjusted and adjusted models. Conclusions The installation of water filters shows promise for the reduction of diarrhea prevalence in Fiji, as well as the reduction of diarrhea-related medical costs and water expenses. Future work entails evaluation in other countries and contexts, long-term health monitoring, and comparison to alternative water quality interventions.
Collapse
Affiliation(s)
- Nathan Tintle
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA
| | - Adam Heynen
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA
| | - Kristin Van De Griend
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA
| | - Rachel Ulrich
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA.,2Department of Statistics, Montana State University, Bozeman, MT USA
| | - Matthew Ojo
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA
| | - Emma Boven
- Department of Mathematics and Statistics, Dordt University, 498 4th Ave NE, Sioux Center, IA 51250 USA
| | - Sarah Brokus
- 3Department of Biology, Hope College, Holland, MI USA
| | - Randall Wade
- 3Department of Biology, Hope College, Holland, MI USA
| | - Aaron A Best
- 3Department of Biology, Hope College, Holland, MI USA
| |
Collapse
|
5
|
Review of global rotavirus strain prevalence data from six years post vaccine licensure surveillance: is there evidence of strain selection from vaccine pressure? INFECTION GENETICS AND EVOLUTION 2014; 28:446-61. [PMID: 25224179 DOI: 10.1016/j.meegid.2014.08.017] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
Comprehensive reviews of pre licensure rotavirus strain prevalence data indicated the global importance of six rotavirus genotypes, G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]. Since 2006, two vaccines, the monovalent Rotarix (RV1) and the pentavalent RotaTeq (RV5) have been available in over 100 countries worldwide. Of these, 60 countries have already introduced either RV1 or RV5 in their national immunization programs. Post licensure vaccine effectiveness is closely monitored worldwide. This review aimed at describing the global changes in rotavirus strain prevalence over time. The genotype distribution of the nearly 47,000 strains that were characterized during 2007-2012 showed similar picture to that seen in the preceding period. An intriguing finding was the transient predominance of heterotypic strains, mainly in countries using RV1. Unusual and novel antigen combinations continue to emerge, including some causing local outbreaks, even in vaccinated populations. In addition, vaccine strains have been found in both vaccinated infants and their contacts and there is evidence for genetic interaction between vaccine and wild-type strains. In conclusion, the post-vaccine introduction strain prevalence data do not show any consistent pattern indicative of selection pressure resulting from vaccine use, although the increased detection rate of heterotypic G2P[4] strains in some countries following RV1 vaccination is unusual and this issue requires further monitoring.
Collapse
|
6
|
Abstract
BACKGROUND A substantial number of surveillance studies have documented rotavirus prevalence among children admitted for dehydrating diarrhea. We sought to establish global seasonal patterns of rotavirus disease before the introduction of widespread vaccination. METHODS We reviewed studies of rotavirus detection in children with diarrhea published since 1995. We assessed potential relationships between seasonal prevalence and locality by plotting the average monthly proportion of diarrhea cases positive for rotavirus according to geography, country development and latitude. We used linear regression to identify variables that were potentially associated with the seasonal intensity of rotavirus. RESULTS Among a total of 99 studies representing all 6 geographic regions of the world, patterns of year-round disease were more evident in low- and low-middle income countries compared with upper-middle and high-income countries where disease was more likely to be seasonal. The level of country development was a stronger predictor of strength of seasonality (P = 0.001) than geographic location or climate. However, the observation of distinctly different seasonal patterns of rotavirus disease in some countries with similar geographic location, climate and level of development indicate that a single unifying explanation for variation in seasonality of rotavirus disease is unlikely. CONCLUSION While no unifying explanation emerged for varying rotavirus seasonality globally, the country income level was somewhat more predictive of the likelihood of having seasonal disease than other factors. Future evaluation of the effect of rotavirus vaccination on seasonal patterns of disease in different settings may help understand factors that drive the global seasonality of rotavirus disease.
Collapse
|
7
|
Horwood PF, Luang-Suarkia D, Bebes S, Boniface K, Datta SS, Siba PM, Kirkwood CD. Surveillance and molecular characterization of group A rotaviruses in Goroka, Papua New Guinea. Am J Trop Med Hyg 2012; 87:1145-8. [PMID: 23128293 DOI: 10.4269/ajtmh.2012.12-0234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In this study, we investigated the molecular epidemiology of group A rotaviruses in cases of acute gastroenteritis in Goroka, Papua New Guinea. From April 2008 through November 2010, 813 diarrheal stool samples were collected from children < 5 years of age hospitalized with acute gastroenteritis. Rotavirus antigen was detected in 31.2% of samples using a commercial enzyme-linked immunosorbent assay. Genotyping revealed the presence of the globally circulating strains G1P[8] (50.0%), G3P[8] (23.0%), and G2P[4] (8.2%). The globally emerging strains G9 and G12 were detected in 1.2% and 6.1% of samples, respectively. Mixed infections were detected in a high proportion of samples (11.9%), with 9.0% and 3.7% of samples displaying multiple G and P genotypes, respectively.
Collapse
|
8
|
Desai R, Parashar UD, Lopman B, Helena de Oliveira L, Clark AD, Sanderson CFB, Tate JE, Matus CR, Andrus JK, Patel MM. Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America. Clin Infect Dis 2012; 54:1397-405. [DOI: 10.1093/cid/cis191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
9
|
Pitzer VE, Viboud C, Lopman BA, Patel MM, Parashar UD, Grenfell BT. Influence of birth rates and transmission rates on the global seasonality of rotavirus incidence. J R Soc Interface 2011; 8:1584-93. [PMID: 21508015 PMCID: PMC3177613 DOI: 10.1098/rsif.2011.0062] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rotavirus is a major cause of mortality in developing countries, and yet the dynamics of rotavirus in such settings are poorly understood. Rotavirus is typically less seasonal in the tropics, although recent observational studies have challenged the universality of this pattern. While numerous studies have examined the association between environmental factors and rotavirus incidence, here we explore the role of intrinsic factors. By fitting a mathematical model of rotavirus transmission dynamics to published age distributions of cases from 15 countries, we obtain estimates of local transmission rates. Model-predicted patterns of seasonal incidence based solely on differences in birth rates and transmission rates are significantly correlated with those observed (Spearman's ρ = 0.65, p < 0.05). We then examine seasonal patterns of rotavirus predicted across a range of different birth rates and transmission rates and explore how vaccination may impact these patterns. Our results suggest that the relative lack of rotavirus seasonality observed in many tropical countries may be due to the high birth rates and transmission rates typical of developing countries rather than being driven primarily by environmental conditions. While vaccination is expected to decrease the overall burden of disease, it may increase the degree of seasonal variation in the incidence of rotavirus in some settings.
Collapse
Affiliation(s)
- Virginia E Pitzer
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA.
| | | | | | | | | | | |
Collapse
|