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Sifuna P, Shaw AV, Lucas T, Ogutu B, Otieno W, Larsen DA. Deployment of Rotavirus Vaccine in Western Kenya Coincides with a Reduction in All-Cause Child Mortality: A Retrospective Cohort Study. Vaccines (Basel) 2023; 11:1299. [PMID: 37631867 PMCID: PMC10458991 DOI: 10.3390/vaccines11081299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Rotavirus is an important cause of fatal pediatric diarrhea worldwide. Many national immunization programs began adding rotavirus vaccine following a 2009 World Health Organization recommendation. Kenya added rotavirus vaccine to their immunization program at the end of 2014. From a cohort of 38,463 children in the Kisumu health and demographic surveillance site in western Kenya, we assessed how the implementation of the rotavirus vaccine affected mortality in children under 3 years of age. Following its introduction in late 2014, the span of rotavirus vaccine coverage for children increased to 75% by 2017. Receiving the rotavirus vaccine was associated with a 44% reduction in all-cause child mortality (95% confidence interval = 28-68%, p < 0.0001), but not diarrhea-specific mortality (p = 0.401). All-cause child mortality declined 2% per month following the implementation of the rotavirus vaccine (p = 0.002) among both vaccinated and unvaccinated children, but diarrhea-specific mortality was not associated with the implementation of the rotavirus vaccine independent of individual vaccine status (p = 0.125). The incidence of acute diarrhea decreased over the study period, and the introduction of the rotavirus vaccine was not associated with population-wide trends (p = 0.452). The receipt of the rotavirus vaccine was associated with a 34% reduction in the incidence of diarrhea (95% confidence interval = 24-43% reduction). These results suggest that rotavirus vaccine may have had an impact on all-cause child mortality. The analyses of diarrhea-specific mortality were limited by relatively few deaths (n = 57), as others have found a strong reduction in diarrhea-specific mortality. Selection bias may have played a part in these results-children receiving rotavirus vaccine were more likely to be fully immunized than children not receiving the rotavirus vaccine.
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Affiliation(s)
- Peter Sifuna
- Kenya Medical Research Institute (KEMRI), Kisumu 40100, Kenya; (P.S.); (T.L.); (B.O.); (W.O.)
- US Army Medical Research Directorate–Africa (USAMRD-A), Kisumu 00200, Kenya
| | - Andrea V. Shaw
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Tina Lucas
- Kenya Medical Research Institute (KEMRI), Kisumu 40100, Kenya; (P.S.); (T.L.); (B.O.); (W.O.)
- US Army Medical Research Directorate–Africa (USAMRD-A), Kisumu 00200, Kenya
| | - Bernards Ogutu
- Kenya Medical Research Institute (KEMRI), Kisumu 40100, Kenya; (P.S.); (T.L.); (B.O.); (W.O.)
- US Army Medical Research Directorate–Africa (USAMRD-A), Kisumu 00200, Kenya
| | - Walter Otieno
- Kenya Medical Research Institute (KEMRI), Kisumu 40100, Kenya; (P.S.); (T.L.); (B.O.); (W.O.)
- US Army Medical Research Directorate–Africa (USAMRD-A), Kisumu 00200, Kenya
| | - David A. Larsen
- Department of Public Health, Syracuse University, Syracuse, NY 13244, USA
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Karakusevic A, Devaney P, Enstone A, Kanibir N, Hartwig S, Carias CDS. The burden of rotavirus-associated acute gastroenteritis in the elderly: assessment of the epidemiology in the context of universal childhood vaccination programs. Expert Rev Vaccines 2022; 21:929-940. [PMID: 35535677 DOI: 10.1080/14760584.2022.2066524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rotaviruses (RVs) cause acute gastroenteritis (AGE) in infants and young children worldwide and also in older adults (≥60 years), however the burden among this age group is not well understood. Herd immunity through pediatric RV vaccination may reduce the burden of RVGE across all ages, however the impact of pediatric vaccination on burden in older adults is poorly understood. AREAS COVERED This systematic review was undertaken to identify studies related to the following objectives: understand the burden of RV in older adults, RV seroprevalence, and the impact of pediatric vaccination on this burden and highlight evidence gaps to guide future research. Of studies identified, 59 studies from two databases were included in this analysis following a review by two reviewers. EXPERT OPINION RV is an understudied disease in older adults. We found that 0-62% of patients with AGE tested positive for RV, with results varying by setting, country, and patient age. Results also suggest that pediatric vaccination benefits older adults through herd protection. Several studies showed a reduction in RV incidence after vaccination. However, there was variety in results and lack of consistency in outcomes reported. Further studies targeting older adults are needed to better characterize RV burden.
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Affiliation(s)
| | | | | | - Nabi Kanibir
- Global Medical and Scientific Affairs, Msd International GmbH, Luzern, Switzerland
| | - Susanne Hartwig
- Biostatistical and Research Decision Sciences Epidemiology, MSD Vaccins, France
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Tian Y, Gao Z, Li W, Liu B, Chen Y, Jia L, Yan H, Wang Q. Group A rotavirus prevalence and genotypes among adult outpatients with diarrhea in Beijing, China, 2011-2018. J Med Virol 2021; 93:6191-6199. [PMID: 34028862 DOI: 10.1002/jmv.27100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
Group A rotavirus (RVA) is one of the most common causes of severe diarrhea in children worldwide. However, RVA is also an important pathogen causing adult diarrhea, with higher infection rates in older patients. To provide evidence for rotavirus epidemic control and to inform vaccine development, we analyzed the molecular epidemiology of RVA among adult outpatients with diarrhea in Beijing from 2011 to 2018. Stool specimens were collected monthly from 14 districts. RVA was detected using enzyme-linked immunosorbent assay and real-time reverse-transcription polymerase chain reaction (RT-PCR). Genotyping of rotavirus was performed using multiplex semi-nested RT-PCR. Phylogenetic analysis was performed using maximum likelihood methods implemented in MEGA software (version 6.06). Logistic regression and chi-square tests were used to assess differences among age groups, districts, years, and genotype distributions. The prevalence of rotavirus was 10.16% (1310 of 12,893) among adult outpatients with diarrhea from 2011 to 2018 in Beijing. The highest prevalence (13.74%, 600 of 4367) was observed among those aged 41 to 65 years. November, December, and January had the highest positive detection rates. In 2011, G3P[8] and G9P[8] were the dominant genotypes. Starting from 2012, G9P[8] became the dominant genotype. Most G9 strains belonged to the G9-VI clade. Most P[8] strains belonged to the P[8]-III clade. RVA is a major cause of adult diarrhea in Beijing. Continuous molecular surveillance is needed, and transmission of rotavirus between children and adults should be investigated further.
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Affiliation(s)
- Yi Tian
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Zhiyong Gao
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Weihong Li
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Baiwei Liu
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Yanwei Chen
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Lei Jia
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Hanqiu Yan
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control and Beijing Research Center for Preventive Medicine, Beijing, China
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Yandle Z, Coughlan S, Dean J, Hare D, De Gascun CF. Indirect impact of rotavirus vaccination on viral causes of acute gastroenteritis in the elderly. J Clin Virol 2021; 137:104780. [PMID: 33647802 DOI: 10.1016/j.jcv.2021.104780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rotavirus is considered a childhood infection causing acute gastroenteritis however, it also causes disease in adults which may be underestimated due to less frequent testing in this age-group. OBJECTIVES To determine if paediatric rotavirus vaccination, introduced into Ireland in December 2016, affected the viral aetiology in those aged ≥65 yrs presenting with gastroenteritis in the pre- and post-vaccination years. Additionally, rotavirus genotypes in this age-group will be described. METHODS Faecal samples from 2015 to 2019 for the investigation of gastroenteritis were tested by real-time (RT-) PCR for norovirus, adenovirus, rotavirus, Rotarix, astrovirus and sapovirus. Rotaviruses were genotyped by multiplex real-time RT-PCR or hemi-nested RT-PCR and a proportion confirmed by sequencing. RESULTS 22,593 samples from adults aged ≥65 yrs were tested and 2566 (11 %) had ≥1 virus detected. Of 2566 positive samples, norovirus was detected in 82 %, rotavirus 9 %, sapovirus 6 %, astrovirus 3 % and adenovirus 1 %. Rotavirus and norovirus infections decreased between pre and post-vaccine year groups p < 0.001, whereas sapovirus, astrovirus and adenovirus remained unchanged. Between 2015-16 and 2018-19, G2P[4] increased and G4P[8] decreased, p < 0.001. In 2015-2019 there were 37 rotavirus outbreaks. Five geriatric outbreaks were genotyped and caused by G4P[8] (n = 1), G1P[8] (n = 1), G2P[4] (n = 2) and G12P[8] (n = 1). CONCLUSION Rotavirus causes acute gastroenteritis in older people. Paediatric vaccination may have contributed to a decline in infections in the elderly; nevertheless, rotavirus continued to circulate in older people following vaccine introduction. Genotype distribution changed between the pre- and post-vaccine era however genotypes in outbreak and endemic settings were comparable.
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Affiliation(s)
- Z Yandle
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland.
| | - S Coughlan
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - J Dean
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - D Hare
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
| | - C F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Dublin 4, Ireland
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Wikswo ME, Parashar UD, Lopman B, Selvarangan R, Harrison CJ, Azimi PH, Boom JA, Sahni LC, Englund JA, Klein EJ, Staat MA, McNeal MM, Halasa N, Chappell J, Weinberg GA, Szilagyi PG, Esona MD, Bowen MD, Payne DC. Evidence for Household Transmission of Rotavirus in the United States, 2011-2016. J Pediatric Infect Dis Soc 2020; 9:181-187. [PMID: 30753568 DOI: 10.1093/jpids/piz004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/15/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rotavirus is a leading cause of acute gastroenteritis (AGE) in children and is highly transmissible. In this study, we assessed the presence of AGE in household contacts (HHCs) of pediatric patients with laboratory-confirmed rotavirus. METHODS Between December 2011 and June 2016, children aged 14 days to 11 years with AGE were enrolled at 1 of 7 hospitals or emergency departments as part of the New Vaccine Surveillance Network. Parental interviews, medical and vaccination records, and stool specimens were collected at enrollment. Stool was tested for rotavirus by an enzyme immunoassay and confirmed by real-time or conventional reverse transcription-polymerase chain reaction assay or repeated enzyme immunoassay. Follow-up telephone interviews were conducted to assess AGE in HHCs the week after the enrolled child's illness. A mixed-effects multivariate model was used to calculate odds ratios. RESULTS Overall, 829 rotavirus-positive subjects and 8858 rotavirus-negative subjects were enrolled. Households of rotavirus-positive subjects were more likely to report AGE illness in ≥1 HHC than were rotavirus-negative households (35% vs 20%, respectively; P < .0001). A total of 466 (16%) HHCs of rotavirus-positive subjects reported AGE illness. Of the 466 ill HHCs, 107 (23%) sought healthcare; 6 (6%) of these encounters resulted in hospitalization. HHCs who were <5 years old (odds ratio, 2.2 [P = .004]) were more likely to report AGE illness than those in other age groups. In addition, 144 households reported out-of-pocket expenses (median, $20; range, $2-$640) necessary to care for an ill HHC. CONCLUSIONS Rotavirus-associated AGE in children can lead to significant disease burden in HHCs, especially in children aged <5 years. Prevention of pediatric rotavirus illness, notably through vaccination, can prevent additional illnesses in HHCs.
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Affiliation(s)
- Mary E Wikswo
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Benjamin Lopman
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Parvin H Azimi
- Children's Hospital Research Center, Oakland, California
| | | | | | | | | | | | | | - Natasha Halasa
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - James Chappell
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Mathew D Esona
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael D Bowen
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Beck-Friis T, Andersson M, Gustavsson L, Lindh M, Westin J, Andersson LM. Burden of rotavirus infection in hospitalized elderly individuals prior to the introduction of rotavirus vaccination in Sweden. J Clin Virol 2019; 119:1-5. [PMID: 31421292 DOI: 10.1016/j.jcv.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/22/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rotavirus gastroenteritis (GE) in the elderly has been much less studied than in children. OBJECTIVES The aim of this study was to determine the morbidity and mortality for elderly hospitalized patients with rotavirus GE prior to the introduction of rotavirus vaccination in Sweden, and to investigate the epidemiology of rotavirus genotypes in these patients. STUDY DESIGN All patients 60 years or older who were hospitalized at Sahlgrenska University Hospital, Gothenburg, Sweden, and were rotavirus positive in a clinical diagnostic test from 2009 to 2016, were included. Medical records were reviewed and rotavirus genotyping real-time PCR was performed. RESULTS One hundred and fifty-nine patients were included, corresponding to an annual incidence of hospitalization due to rotavirus GE of 16/100 000 inhabitants aged 60 years or older. G2P[4] was the most common genotype, followed by G1P[8] and G4P[8]. The majority of patients had community-onset of symptoms and no or few pre-existing health disorders. Four patients (2.5%) died within 30 days of sampling. Patients with hospital-onset rotavirus GE had a longer median length of stay following diagnosis compared with patients with community-onset of symptoms (19 vs. 5 days, p = 0.001) and higher 30-day mortality (8.6% (3/35) vs. < 1% (1/124), p = 0.03). CONCLUSIONS Hospitalization due to rotavirus GE among the elderly seems to mainly affect otherwise healthy individuals and is associated with low 30-day mortality.
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Affiliation(s)
- Thomas Beck-Friis
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden.
| | - Maria Andersson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden
| | - Lars Gustavsson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Diagnosvägen 21, 41650 Gothenburg, Sweden
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