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Factors associated with dehydrating rotavirus diarrhea in children under five in Bangladesh: An urban-rural comparison. PLoS One 2022; 17:e0273862. [PMID: 36018895 PMCID: PMC9417038 DOI: 10.1371/journal.pone.0273862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Rotavirus is the leading cause of dehydrating diarrhea in young children worldwide. This study aimed to identify the factors associated with dehydrating rotavirus diarrhea in children under five years of age in urban and rural Bangladesh. Methods The study analyzed data from 7,758 children under five who presented with rotavirus diarrhea to Dhaka (urban) and Matlab (rural) hospital of icddr,b during 2009–2018, and were enrolled in the Diarrheal Disease Surveillance System. Cases were defined as children having rotavirus isolated in stool specimens presented with dehydrating diarrhea. Controls were children infected with rotavirus have no dehydration. Multivariable logistic regression models were built to identify the factors associated with dehydrating diarrhea. Results Among the rotavirus-infected children, 1,784 (34%) in Dhaka and 160 (6%) in Matlab had diarrhea with some or severe dehydration. The female children and age group 24–59 months age was found to be at higher risk of dehydration compared to 6–11 months age. In the multivariable logistic regression model, maternal illiteracy, vomiting, the onset of diarrhea less than 24 hours prior to presenting to the hospital, monsoon months, stunting, and wasting were significantly associated with dehydrating rotavirus diarrhea among children aged 0–59 months in Dhaka. In Matlab, monthly income, duration less than 24 hours prior to attending the hospital, and wasting had an independent significant association with dehydrating rotavirus diarrhea episodes. Conclusions Considering factors diversity, educating parents and proper counselling by health care personnel during diarrhea, could lessen the severity of dehydration and the number of hospital visits later on by eliminating the modifiable risk factors among the children, which needs further studies.
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Hygiene and Sanitation Practices and the Risk of Morbidity among Children 6–23 Months of Age in Kumbungu District, Ghana. ADVANCES IN PUBLIC HEALTH 2019. [DOI: 10.1155/2019/4313759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Poor hygiene and sanitation (WASH) practices are characterised by the manifestation of disease and infections, notably diarrhoea and respiratory tract infections (RTIs) among children. This study aimed to assess the influence of WASH practices on the occurrence of diarrhoea and RTIs among children 6–23 months of age.Methods. An analytical cross-sectional study design was conducted in June 2017. Systematic random sampling technique was used to select 300 mothers/caregivers with children aged 6–23 months from 9 communities in the Kumbungu District. We assessed the WASH practices, socio-demographic characteristics of the households and the occurrence of diarrhoea and RTIs among the children with a semi-structured questionnaire. The Hygiene Improvement Framework observational guide was adapted for household sanitation. Backward binary multiple logistic regression was used to determine the WASH practices that significantly predicted morbidity.Results. About 53% and 55.3% of the children reportedly experienced diarrhoea and RTIs, respectively, two weeks before the survey. Caregiver handwashing with soap after defecation [OR = 0.32 (95% C.I: 0.19, 0.52)] and before feeding [OR = 0.50 (95% C.I: 0.30, 0.84)] as well as washing the child’s hands with or without soap before feeding [OR = 0.21 (95% C.I: 0.04, 1.01)] were associated with lower odds of diarrhoea morbidity. The main determinants of RTI morbidity included caregiver handwashing with or without soap after defecation [OR = 0.29 (95% C.I: 0.10, 0.81)] and washing of the child’s hands with soap before feeding [OR = 0.60 (95% C.I: 0.37, 0.99)] However, we found no association between household sanitation and diarrhoea as well as RTI among the children.Conclusion. About a half each of the children had diarrhoea and RTI 2 weeks before the survey. The results emphasise the need for urgent targeting of handwashing and waste disposal programmes to avert the high burden of diarrhoea and RTIs among children.
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Gikonyo J, Mbatia B, Okanya P, Obiero G, Sang C, Nyangao J. Rotavirus prevalence and seasonal distribution post vaccine introduction in Nairobi county Kenya. Pan Afr Med J 2019; 33:269. [PMID: 31693717 PMCID: PMC6814910 DOI: 10.11604/pamj.2019.33.269.18203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/21/2019] [Indexed: 11/30/2022] Open
Abstract
Rotaviruses are one of the leading etiological agents of gastroenteritis in young children, for which a monovalent G1P(8) vaccine has been provided for free in Kenyan since July 2014. The main objective was to estimate the post vaccine prevalence and seasonal distribution of rotavirus diarrhea in children less than 5 years in Nairobi County, Kenya. Rotavirus positive samples were collected from children below 5 years of age in two hospitals within Nairobi County where vaccination status was card-confirmed. The children were examined and the demographic and clinical profiles of the children were recorded. Fecal specimens were analyzed for rotavirus antigen using an ELISA kit, followed by characterization by PAGE. Out of the total 323 samples, 49 had detectable rotavirus infection, representing 15.2% prevalence. Age distribution of rotavirus prevalence was as follows: ≤ 6 months-8.5%, 7-12 months-27.4%, 13-24 months - 41.4%, 25-36 months - 16.4% while 36-65 months had 6.3%. Rotavirus diarrhea was more common in wet and cold months of the year, the highest prevalence being observed in August (24.5%), 12.3% in both July and March, while April scored a prevalence of 10.2%. Out of the 49 rotavirus positive children, 48 had vomiting and abdominal cramps while all had fever and watery stool. The prevalence of Rotaviral diarrhea in children less than 5 years in Nairobi County Kenya has greatly reduced following the vaccine introduction and is more common during the wet and cold seasons of the year.
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Affiliation(s)
- Joshua Gikonyo
- Department of Biochemistry and Biotechnology, School of Biological and Life Sciences, Technical University of Kenya, Nairobi, Kenya
| | - Betty Mbatia
- School of Pharmacy and Health Sciences, United States International University Africa, Nairobi, Kenya
| | - Patrick Okanya
- Department of Biochemistry and Biotechnology, School of Biological and Life Sciences, Technical University of Kenya, Nairobi, Kenya
| | - George Obiero
- Department of Biochemistry and Biotechnology, School of Biological and Life Sciences, Technical University of Kenya, Nairobi, Kenya
| | - Carlene Sang
- Kenya Medical Research Institute, Nairobi, Kenya
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Philip CO, Koech M, Kipkemoi N, Kirera R, Ndonye J, Ombogo A, Kirui M, Kipkirui E, Danboise B, Hulseberg C, Bateman S, Flynn A, Swierczewski B, Magiri E, Odundo E. Evaluation of the performance of a multiplex reverse transcription polymerase chain reaction kit as a potential diagnostic and surveillance kit for rotavirus in Kenya. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:12. [PMID: 31346474 PMCID: PMC6631878 DOI: 10.1186/s40794-019-0087-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
Background Diarrhea is a serious concern worldwide, especially in developing countries. Rotavirus is implicated in approximately 400,000 infant deaths annually. It is highly contagious elevating the risk of outbreaks especially in enclosed settings such as daycare centers, hospitals, and boarding schools. Reliable testing methods are critical for early detection of infections, better clinical management, pathogen surveillance and evaluation of interventions such as vaccines. Enzyme immunoassays have proved to be reliable and practical in most settings; however, newer multiplex reverse transcription polymerase assays have been introduced in the Kenya market but have not been evaluated locally. Methods Stool samples collected from an ongoing Surveillance of Enteric Pathogens Causing diarrheal illness in Kenya (EPS) study were used to compare an established enzyme immunoassay, Premier™ Rotaclone® (Meridian Bioscience, Cincinnati, Ohio, U.S.A.), that can only detect group A rotavirus against a novel multiplex reverse transcription polymerase chain reaction kit, Seeplex® Diarrhea-V ACE Detection (Seegene, Seoul, Republic of Korea), that can detect rotavirus, astrovirus, adenovirus, and norovirus genogroups I and II. Detection frequency, sensitivity, specificity, turnaround time, and cost were compared to determine the suitability of each assay for clinical work in austere settings versus public health work in well-funded institutes in Kenya. Results The Premier™ Rotaclone® kit had a detection frequency of 11.2%, sensitivity of 77.8%, specificity of 100%, turnaround time of 93 min and an average cost per sample of 13.33 United States dollars (USD). The Seeplex® Diarrhea-V ACE Detection kit had a detection frequency of 16.0%, sensitivity of 100%, specificity of 98.1%, turnaround time of 359 min and an average cost per samples 32.74 United States dollars respectively. The detection frequency sensitivity and specificity of the Seeplex® Diarrhea-V ACE Detection kit mentioned above are for rotavirus only. Conclusions The higher sensitivity and multiplex nature of the Seeplex® Diarrhea-V ACE Detection kit make it suitable for surveillance of enteric viruses circulating in Kenya. However, its higher cost, longer turnaround time and complexity favor well-resourced clinical labs and research applications. The Premier™ Rotaclone®, on the other hand, had a higher specificity, shorter turnaround time, and lower cost making it more attractive for clinical work in low complexity labs in austere regions of the country. It is important to continuously evaluate assay platforms' performance, operational cost, turnaround time, and usability in different settings so as to ensure quality results that are useful to the patients and public health practitioners.
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Affiliation(s)
| | - Margaret Koech
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Nancy Kipkemoi
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Ronald Kirera
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Janet Ndonye
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Abigael Ombogo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Mary Kirui
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Erick Kipkirui
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | | | - Christine Hulseberg
- 3Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland USA
| | | | - Alexander Flynn
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | | | - Esther Magiri
- 6Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | - Elizabeth Odundo
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
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van Zyl WB, A Zhou N, Wolfaardt M, Matsapola PN, Ngwana FB, Symonds EM, Fagnant-Sperati CS, Shirai JH, Kossik AL, Beck NK, Komen E, Mwangi B, Nyangao J, Boyle DS, Borus P, Taylor MB, Meschke JS. Detection of potentially pathogenic enteric viruses in environmental samples from Kenya using the bag-mediated filtration system. WATER SCIENCE & TECHNOLOGY, WATER SUPPLY 2019; 19:1668-1676. [PMID: 33584163 PMCID: PMC7797634 DOI: 10.2166/ws.2019.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/14/2019] [Indexed: 05/18/2023]
Abstract
Enteric virus environmental surveillance via a highly sensitive method is critical, as many enteric viruses have low infectious doses and can persist in the environment for extended periods. This study determined the potential of the novel bag-mediated filtration system (BMFS) to recover human enteric viruses and pepper mild mottle virus (PMMoV) from wastewater and wastewater-impacted surface waters, examined PMMoV use as a fecal contamination indicator in Kenya, and identified potential BMFS process controls. From April 2015 to April 2016, BMFS samples were collected from seven sites in Kenya (n = 59). Enteroviruses and PMMoV were detected in 100% of samples, and human adenovirus, human astrovirus, hepatitis A virus, norovirus GI, norovirus GII, sapovirus, and human rotavirus were detected in the majority of samples. The consistent detection of enteroviruses and PMMoV suggests that these viruses could be used as indicators in similarly fecally contaminated sites and BMFS process controls. As contamination of surface water sources remains a global issue, enteric virus environmental surveillance is necessary. This study demonstrates an effective way to sample large volumes of wastewater and wastewater-impacted surface waters for the detection of multiple enteric viruses simultaneously.
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Affiliation(s)
- Walda B van Zyl
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
| | - Nicolette A Zhou
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Marianne Wolfaardt
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
| | - Peter N Matsapola
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
| | - Fhatuwani B Ngwana
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
| | - Erin M Symonds
- College of Marine Science, University of South Florida, 830 1st St S, St Petersburg, FL 33701, USA
| | - Christine S Fagnant-Sperati
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Jeffry H Shirai
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Alexandra L Kossik
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Nicola K Beck
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
| | - Evans Komen
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
| | - Benlick Mwangi
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
| | - James Nyangao
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
| | - David S Boyle
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | - Peter Borus
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
| | - Maureen B Taylor
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
- College of Marine Science, University of South Florida, 830 1st St S, St Petersburg, FL 33701, USA
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
| | - J Scott Meschke
- Department of Medical Virology, University of Pretoria, Faculty of Health Sciences, Private Bag X323, Arcadia 0007, South Africa
- (corresponding author) Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, USA
- College of Marine Science, University of South Florida, 830 1st St S, St Petersburg, FL 33701, USA
- Centre for Viral Research, Kenya Medical Research Institute, Mbagathi Road, P.O. Box 54628, Nairobi 00200, Kenya
- PATH, 2201 Westlake Ave, Suite 200, Seattle, WA 98121, USA
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Plants-Paris K, Bishoff D, Oyaro MO, Mwinyi B, Chappell C, Kituyi A, Nyangao J, Mbatha D, Darkoh C. Prevalence of Clostridium difficile infections among Kenyan children with diarrhea. Int J Infect Dis 2019; 81:66-72. [PMID: 30660798 DOI: 10.1016/j.ijid.2019.01.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/09/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diarrhea causes significant morbidity and mortality among children worldwide. Regions most affected by diarrhea include Sub-Saharan Africa and Southeast Asia, where antibiotics are in common use and can make children more vulnerable to Clostridium difficile and pathogens that are not affected by these drugs. Indeed, C. difficile is a major diarrhea-associated pathogen and poses a significant threat to vulnerable and immunocompromised populations. Yet, little is known about the role and epidemiology of C. difficile in diarrhea-associated illness among young children. As a result, C. difficile is often neglected in regions such as Sub-Saharan Africa that are most impacted by childhood diarrhea. The purpose of this study was to establish the frequency of C. difficile in young children (<5 years) with diarrhea. METHODS Children presenting with diarrhea at a national hospital in Kenya from 2015 to 2018 were enrolled consecutively. Following informed consent by a parent or legal guardian, stool samples were obtained from the children and demographic data were collected. The stools were examined for the presence of four common pathogens known to cause diarrhea: C. difficile, rotavirus, Cryptosporidium parvum, and Giardia lamblia. C. difficile was verified by toxigenic culture and PCR. The presence of C. parvum and/or G. lamblia was determined using the ImmunoCard STAT! Crypto/Giardia Rapid assay. Rotavirus was detected by ELISA. RESULTS The study population comprised 157 children; 62.4% were male and 37.6% were female and their average age was 12.4 months. Of the 157 stool specimens investigated, 37.6% were positive for C. difficile, 33.8% for rotavirus, 5.1% for Cryptosporidium, and 5.1% for Giardia. PCR analysis identified at least one of the C. difficile-specific - genes (tcdA, tcdB, or tcdC). Further, 57.6% of the stools had C. difficile colonies bearing a frame-shift deletion in the tcdC gene, a mutation associated with increased toxin production. The frequency of C. difficile was 32.6% in children ≤12 months old and increased to 46.6% in children 12-24 months old. CONCLUSIONS In Kenyan children presenting with diarrhea, C. difficile is more prevalent than rotavirus or Cryptosporidium, two leading causes of childhood diarrhea. These findings underscore the need to better understand the role of C. difficile in children with diarrhea, especially in areas with antibiotic overuse. Understanding C. difficile epidemiology and its relationship to co-infecting pathogens among African children with diarrhea will help in devising ways of reducing diarrhea-associated illness.
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Affiliation(s)
- Kimberly Plants-Paris
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, TX, USA
| | - Dayna Bishoff
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, TX, USA
| | - Micah O Oyaro
- University of Nairobi, School of Medicine, College of Health Sciences, Nairobi, Kenya
| | | | - Cynthia Chappell
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, TX, USA
| | | | - James Nyangao
- Centre for Viral Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Charles Darkoh
- University of Texas Health Science Center, School of Public Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, Center for Infectious Diseases, Houston, TX, USA; MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Microbiology and Infectious Diseases Program, Houston, TX, USA.
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Altan E, Aiemjoy K, Phan TG, Deng X, Aragie S, Tadesse Z, Callahan KE, Keenan J, Delwart E. Enteric virome of Ethiopian children participating in a clean water intervention trial. PLoS One 2018; 13:e0202054. [PMID: 30114205 PMCID: PMC6095524 DOI: 10.1371/journal.pone.0202054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The enteric viruses shed by different populations can be influenced by multiple factors including access to clean drinking water. We describe here the eukaryotic viral genomes in the feces of Ethiopian children participating in a clean water intervention trial. METHODOLOGY/PRINCIPAL FINDINGS Fecal samples from 269 children with a mean age of 2.7 years were collected from 14 villages in the Amhara region of Ethiopia, half of which received a new hand-dug water well. Feces from these villages were then analyzed in 29 sample pools using viral metagenomics. A total of 127 different viruses belonging to 3 RNA and 3 DNA viral families were detected. Picornaviridae family sequence reads were the most commonly found, originating from 14 enterovirus and 6 parechovirus genotypes plus multiple members of four other picornavirus genera (cosaviruses, saliviruses, kobuviruses, and hepatoviruses). Picornaviruses with nearly identical capsid VP1 were detected in different pools reflecting recent spread of these viral strains. Next in read frequencies and positive pools were sequences from the Caliciviridae family including noroviruses GI and GII and sapoviruses. DNA viruses from multiple genera of the Parvoviridae family were detected (bocaviruses 1-4, bufavirus 3, and dependoparvoviruses), together with four species of adenoviruses and common anelloviruses shedding. RNA in the order Picornavirales and CRESS-DNA viral genomes, possibly originating from intestinal parasites or dietary sources, were also characterized. No significant difference was observed between the number of mammalian viruses shed from children from villages with and without a new water well. CONCLUSIONS We describe an approach to estimate the efficacy of potentially virus transmission-reducing interventions and the first complete (DNA and RNA viruses) description of the enteric viromes of East African children. A wide diversity of human enteric viruses was found in both intervention and control groups. Mammalian enteric virome diversity was not reduced in children from villages with a new water well. This population-based sampling also provides a baseline of the enteric viruses present in Northern Ethiopia against which to compare future viromes.
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Affiliation(s)
- Eda Altan
- Blood Systems Research Institute, San Francisco, California, United States of America
- University of California San Francisco, Department of Laboratory Medicine, San Francisco, California, United States of America
| | - Kristen Aiemjoy
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Tung G. Phan
- Blood Systems Research Institute, San Francisco, California, United States of America
- University of California San Francisco, Department of Laboratory Medicine, San Francisco, California, United States of America
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, California, United States of America
- University of California San Francisco, Department of Laboratory Medicine, San Francisco, California, United States of America
| | | | | | | | - Jeremy Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, United States of America
| | - Eric Delwart
- Blood Systems Research Institute, San Francisco, California, United States of America
- University of California San Francisco, Department of Laboratory Medicine, San Francisco, California, United States of America
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Wandera EA, Mohammad S, Bundi M, Nyangao J, Galata A, Kathiiko C, Odoyo E, Guyo S, Miring'u G, Komoto S, Ichinose Y. Impact of rotavirus vaccination on rotavirus hospitalisation rates among a resource-limited rural population in Mbita, Western Kenya. Trop Med Int Health 2018; 23:425-432. [PMID: 29432666 DOI: 10.1111/tmi.13040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A two-dose oral monovalent rotavirus vaccine (RV1) was introduced into the Kenyan National Immunization Program in July 2014. We assessed trends in hospitalisation for rotavirus-specific acute gastroenteritis (AGE) and strain distribution among children <5 years in a rural, resource-limited setting in Kenya before and after the nationwide implementation of the vaccine. METHODS Data on rotavirus AGE and strain distribution were derived from a 5-year hospital-based surveillance. We compared rotavirus-related hospitalisations and strain distribution in the 2-year post-vaccine period with the 3-year pre-vaccine baseline. Vaccine administrative data from the Unit of Vaccines and Immunization Services (UVIS) for Mbita sub-county were used to estimate rotavirus immunisation coverage in the study area. RESULTS We observed a 48% (95% CI: 27-64%) overall decline in rotavirus-related hospitalisations among children aged <5 years in the post-vaccine period. Coverage with the last dose of rotavirus vaccine increased from 51% in year 1% to 72% in year 2 of the vaccine implementation. Concurrently, reductions in rotavirus hospitalisations increased from 40% in the first year to 53% in the second year of vaccine use. The reductions were most pronounced among the vaccine-eligible group, with the proportion of cases in this age group dropping to 14% in post-vaccine years from a high of 51% in the pre-vaccine period. A diversity of rotavirus strains circulated before the introduction of the vaccine with G1P[8] being the most dominant strain. G2P[4] replaced G1P[8] as the dominant strain after the vaccine was introduced. CONCLUSIONS Rotavirus vaccination has resulted in a notable decline in hospital admissions for rotavirus infections in a rural resource-limited population in Kenya. This provides early evidence for continued use of rotavirus vaccines in routine childhood immunisations in Kenya. Our data also underscore the need for expanding coverage on second dose so as to maximise the impact of the vaccine.
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Affiliation(s)
- Ernest Apondi Wandera
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Shah Mohammad
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Martin Bundi
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.,National Biosafety Authority, Nairobi, Kenya
| | | | - Amina Galata
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Cyrus Kathiiko
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Erick Odoyo
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Sora Guyo
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Gabriel Miring'u
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya
| | - Satoshi Komoto
- Department of Virology and Parasitology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoshio Ichinose
- Institute of Tropical Medicine, Kenya Research Station, KEMRI/Nagasaki University, Nairobi, Kenya.,Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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9
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Fidhow AM, Samwel A, Ng’ang’a Z, Oundo J, Nyangao J, Wences A. Molecular epidemiology and associated risk factors of rotavirus infection among children < 5 yrs hospitalized for acute gastroenteritis in North Eastern, Kenya, 2012. Pan Afr Med J 2017; 28:3. [PMID: 30167031 PMCID: PMC6113712 DOI: 10.11604/pamj.supp.2017.28.1.2486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Rotavirus is a leading cause of morbidity and mortality among children under five years worldwide. This study aimed to characterize the circulating genotypes of rotavirus and to determine risk factors of rotavirus infection in North Eastern, Kenya before the introduction of rotavirus vaccines. METHODS we conducted a cross sectional study among children < 5 years old hospitalized for acute gastroenteritis at the study hospital. Rotavirus was detected in stool specimens and further characterized using PAGE and RT-PCR. Socio-demographic and risk factor information was collected using a standard questionnaire. RESULTS we enrolled 237 children into the study hospitalized with acute gastroenteritis. Of these, 41 (17%) tested positive for group A rotavirus in stool specimens. Age < 2 years, unboiled tap water, underweight and low birth weight were identified as independent risk factors of rotavirus infection. Majority 8 (57%) of the detected rotavirus RNA profiles were long electropherotypes. G3, G9 and P4 were the predominant genotypes identified. CONCLUSION Rotavirus is an important aetiology of acute gastroenteritis among children under five years in this region. Risk factors common in other regions and rotavirus vaccine preventable genotypes are responsible for infection. We recommend the introduction of rotavirus vaccines, coupled with good infant nutrition, safe water supply and maternal hygienic practices during infant feeding.
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Affiliation(s)
- Ahmed Mohamed Fidhow
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
- Jomo Kenyatta University of Agriculture and
Technology, Kenya
| | - Amwayi Samwel
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
| | | | | | | | - Arvelo Wences
- Field Epidemiology and Laboratory Training Program,
Ministry of Public Health and Sanitation, Kenya
- Centers of Disease Control and Prevention, Kenya
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Mchaile DN, Philemon RN, Kabika S, Albogast E, Morijo KJ, Kifaro E, Mmbaga BT. Prevalence and genotypes of Rotavirus among children under 5 years presenting with diarrhoea in Moshi, Tanzania: a hospital based cross sectional study. BMC Res Notes 2017; 10:542. [PMID: 29084598 PMCID: PMC5661935 DOI: 10.1186/s13104-017-2883-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 10/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background Diarrhoea is a main cause of morbidity and mortality in children under 5 responsible for approximately four billion cases and 1.1 million deaths annually. In developing countries, it causes two million deaths each year. The major causative organism responsible is Rotavirus which is responsible for one-third of hospitalizations with approximately 40% mortality. Results The prevalence of Rotavirus infection was 26.4% (73/277). The predominant strain of Rotavirus found was G1 21/73 (53.8%), followed by G8 9/73 (23.1%), G12 5/73 (12.8%), G9 3/73(7.7%) and G4 1/73 (2.6%). All serotypes identified were in children who had completed Rotavirus vaccination except for one who had G8 in whom the vaccine was introduced after they had completed immunizations. Conclusion The overall prevalence of rotavirus has reduced from 33.2% in 2009 to 26.4% in 2016. We have found G1 to be the predominant serotype as well as other circulating serotypes namely G4, G8, G9 and G12. Despite a reduction in prevalence, there is a need for further rotavirus surveillance in the region. Electronic supplementary material The online version of this article (10.1186/s13104-017-2883-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deborah N Mchaile
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania. .,Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Rune N Philemon
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sonia Kabika
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Evelyn Albogast
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kikoti J Morijo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emmanuel Kifaro
- Department of Veterinary Microbiology and Parasitology, Sokoine University of Agriculture (SUA), Morogoro, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Wandera EA, Mohammad S, Bundi M, Komoto S, Nyangao J, Kathiiko C, Odoyo E, Miring'u G, Taniguchi K, Ichinose Y. Impact of rotavirus vaccination on rotavirus and all-cause gastroenteritis in peri-urban Kenyan children. Vaccine 2017; 35:5217-5223. [PMID: 28780116 DOI: 10.1016/j.vaccine.2017.07.096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 12/25/2022]
Abstract
A monovalent rotavirus vaccine (RV1) was introduced into the National Immunization Program in Kenya in July 2014. We examined the impact of the vaccine on hospitalization for all-cause acute gastroenteritis (AGE) and rotavirus-specific AGE and strain distribution at a large referral hospital which serves a predominantly peri-urban population in Central Kenya. Data on rotavirus AGE and strain distribution were derived from ongoing hospital-based AGE surveillance. Hospital administrative data were used to compare trends in all-cause AGE. Pre-vaccine (July 2009-June 2014) and post-vaccine (July 2014-June 2016) periods were compared for changes in hospitalization for all-cause AGE and rotavirus AGE and strain distribution. Following the vaccine introduction, the proportion of children aged <5years hospitalized for rotavirus declined by 30% (95% CI: 19-45%) in the first year and 64% (95% CI: 49-77%) in the second year. Reductions in rotavirus positivity were most pronounced among the vaccine-eligible group (<12months) in the first year post-vaccination at 42% (95% CI: 28-56%). Greater reductions of 67% (95% CI: 51-79%) were seen in the second year in the 12-23months age group. Similarly, hospitalizations for all-cause AGE among children <5years of age decreased by 31% (95% CI: 24-40%) in the first year and 58% (95% CI: 49-67%) in the second year of vaccine introduction. Seasonal peaks of rotavirus and all-cause AGE were reduced substantially. There was an increased detection of G2P[4], G3P[6] and G3P[8], which coincided temporally with the timing of the vaccine introduction. Thus, introducing the rotavirus vaccine into the routine immunization program in Kenya has resulted in a notable decline in rotavirus and all-cause AGE hospitalizations in Central Kenya. This provides early evidence for public health policy makers in Kenya to support the sustained use of the rotavirus vaccine in routine immunizations.
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Affiliation(s)
- Ernest Apondi Wandera
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya; Graduate School of Biomedical Sciences, Nagasaki University, Japan.
| | - Shah Mohammad
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya
| | - Martin Bundi
- Graduate School of Biomedical Sciences, Nagasaki University, Japan; National Biosafety Authority, Nairobi, Kenya
| | - Satoshi Komoto
- Department of Virology and Parasitology, School of Medicine, Fujita Health University, Japan
| | | | - Cyrus Kathiiko
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya
| | - Erick Odoyo
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya
| | - Gabriel Miring'u
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya
| | - Koki Taniguchi
- Department of Virology and Parasitology, School of Medicine, Fujita Health University, Japan
| | - Yoshio Ichinose
- KEMRI/Nagasaki University, Institute of Tropical Medicine, Kenya Research Station, Nairobi, Kenya; Graduate School of Biomedical Sciences, Nagasaki University, Japan
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12
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Agutu MT, Ongus J, Kombich J, Kamenwa R, Nyangao J, Kagira J, Ogutu AA, Bitek A. Prevalence and genetic diversity of rotavirus infection in children with acute gastroenteritis in a hospital setting, Nairobi Kenya in post vaccination era: a cross-sectional study. Pan Afr Med J 2017; 26:38. [PMID: 28451016 PMCID: PMC5398238 DOI: 10.11604/pamj.2017.26.38.10312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 12/19/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Rotavirus is the leading cause of severe diarrhoea among infants and young children. Each year more than 611 000 children die from rotavirus gastroenteritis, and two million are hospitalized, worldwide. In Kenya, the impact of recent rotavirus vaccinations on morbidities has not been estimated. The study aimed at determining the prevalence and identity of rotavirus strains isolated from rotavirus-associated diarrhoea in vaccinated children presenting with acute gastroenteritis. Methods Two hundred and ninety eight specimen from children presented at Gertrude Childrens’ Hospital from January to June 2012 were tested by EIA (Enzyme-linked Immunosorbent Assay) for rotavirus antigens. Molecular characterization was conducted on rotavirus-positive specimens. Extracted viral RNA was separated by polyacrylamide gel electrophoresis (PAGE) and the specific rotavirus VP4 (P-types) and VP7 (G-types) determined. Results The prevalence rate of rotavirus was 31.5% (94/298). Of the rotavirus dsRNA, 57 (60.1%) gave visible RNA profiles, 38 (40.4%) assigned long electropherotypes while 19 (20.2%) were short electropherotypes. The strains among the vaccinated were G3P [4], G12P [6], G3P [6], G9P [4], G mixed G9/3P [4] and G1/3P [4]. Specifically, the G genotypes were G9/3 (5.3%), G9 (4.3%), G3 (4.3%), G12 (2.1%) and mixed G1/3 (1.1%). The P genotypes detected were P [4] (5.3%) and P [6] (5.3%). Conclusion The present study demonstrates diversity in circulating genotypes with emergence of genotypes G3, G9, G12 and mixed genotypes G9/3 and recommends that vaccines should be formulated with a broad range of strains to include G9 and G12.
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Affiliation(s)
- Mary-Theresa Agutu
- Institute of Tropical Medicine and Infectious Diseases, Kenya.,Jomo Kenyatta University of Agriculture and Technology, Kenya
| | - Julliette Ongus
- Jomo Kenyatta University of Agriculture and Technology, Kenya
| | | | | | | | - John Kagira
- Jomo Kenyatta University of Agriculture and Technology, Kenya
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13
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Wandera EA, Mohammad S, Komoto S, Maeno Y, Nyangao J, Ide T, Kathiiko C, Odoyo E, Tsuji T, Taniguchi K, Ichinose Y. Molecular epidemiology of rotavirus gastroenteritis in Central Kenya before vaccine introduction, 2009-2014. J Med Virol 2016; 89:809-817. [DOI: 10.1002/jmv.24691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Ernest A. Wandera
- Institute of Tropical Medicine, Center for Microbiology Research, KEMRI; KEMRI-Nagasaki University; Nairobi Kenya
| | - Shah Mohammad
- Institute of Tropical Medicine, Center for Microbiology Research, KEMRI; KEMRI-Nagasaki University; Nairobi Kenya
| | - Satoshi Komoto
- Department of Virology and Parasitology, School of Medicine; Fujita Health University; Toyoake Japan
| | - Yoshimasa Maeno
- Department of Virology and Parasitology, School of Medicine; Fujita Health University; Toyoake Japan
| | | | - Tomihiko Ide
- Department of Virology and Parasitology, School of Medicine; Fujita Health University; Toyoake Japan
| | - Cyrus Kathiiko
- Institute of Tropical Medicine, Center for Microbiology Research, KEMRI; KEMRI-Nagasaki University; Nairobi Kenya
| | - Erick Odoyo
- Institute of Tropical Medicine, Center for Microbiology Research, KEMRI; KEMRI-Nagasaki University; Nairobi Kenya
| | - Takao Tsuji
- Department of Microbiology, School of Medicine; Fujita Health University; Toyoake Japan
| | - Koki Taniguchi
- Department of Virology and Parasitology, School of Medicine; Fujita Health University; Toyoake Japan
| | - Yoshio Ichinose
- Institute of Tropical Medicine, Center for Microbiology Research, KEMRI; KEMRI-Nagasaki University; Nairobi Kenya
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Nyaga MM, Stucker KM, Esona MD, Jere KC, Mwinyi B, Shonhai A, Tsolenyanu E, Mulindwa A, Chibumbya JN, Adolfine H, Halpin RA, Roy S, Stockwell TB, Berejena C, Seheri ML, Mwenda JM, Steele AD, Wentworth DE, Mphahlele MJ. Whole-genome analyses of DS-1-like human G2P[4] and G8P[4] rotavirus strains from Eastern, Western and Southern Africa. Virus Genes 2014; 49:196-207. [PMID: 24952422 DOI: 10.1007/s11262-014-1091-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/27/2014] [Indexed: 01/02/2023]
Abstract
Group A rotaviruses (RVAs) with distinct G and P genotype combinations have been reported globally. We report the genome composition and possible origin of seven G8P[4] and five G2P[4] human RVA strains based on the genetic evolution of all 11 genome segments at the nucleotide level. Twelve RVA ELISA positive stool samples collected in the representative countries of Eastern, Southern and West Africa during the 2007-2012 surveillance seasons were subjected to sequencing using the Ion Torrent PGM and Illumina MiSeq platforms. A reference-based assembly was performed using CLC Bio's clc_ref_assemble_long program, and full-genome consensus sequences were obtained. With the exception of the neutralising antigen, VP7, all study strains exhibited the DS-1-like genome constellation (P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2) and clustered phylogenetically with reference strains having a DS-1-like genetic backbone. Comparison of the nucleotide and amino acid sequences with selected global cognate genome segments revealed nucleotide and amino acid sequence identities of 81.7-100 % and 90.6-100 %, respectively, with NSP4 gene segment showing the most diversity among the strains. Bayesian analyses of all gene sequences to estimate the time of divergence of the lineage indicated that divergence times ranged from 16 to 44 years, except for the NSP4 gene where the lineage seemed to arise in the more distant past at an estimated 203 years ago. However, the long-term effects of changes found within the NSP4 genome segment should be further explored, and thus we recommend continued whole-genome analyses from larger sample sets to determine the evolutionary mechanisms of the DS-1-like strains collected in Africa.
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Affiliation(s)
- Martin M Nyaga
- South African Medical Research Council/UL Diarrhoeal Pathogens Research Unit (MRC/DPRU), Department of Virology, University of Limpopo (Medunsa Campus) and National Health Laboratory Service, PO Box 173, Medunsa, Pretoria, 0204, South Africa
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15
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Moyo SJ, Blomberg B, Hanevik K, Kommedal O, Vainio K, Maselle SY, Langeland N. Genetic diversity of circulating rotavirus strains in Tanzania prior to the introduction of vaccination. PLoS One 2014; 9:e97562. [PMID: 24844631 PMCID: PMC4028215 DOI: 10.1371/journal.pone.0097562] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/21/2014] [Indexed: 12/25/2022] Open
Abstract
Background Tanzania currently rolls out vaccination against rotavirus-diarrhea, a major cause of child illness and death. As the vaccine covers a limited number of rotavirus variants, this study describes the molecular epidemiology of rotavirus among children under two years in Dar es Salaam, Tanzania, prior to implementation of vaccination. Methods Stool specimens, demographic and clinical information, were collected from 690 children admitted to hospital due to diarrhea (cases) and 545 children without diarrhea (controls) during one year. Controls were inpatient or children attending child health clinics. Rotavirus antigen was detected using ELISA and positive samples were typed by multiplex semi-nested PCR and sequencing. Results The prevalence of rotavirus was higher in cases (32.5%) than in controls (7.7%, P<0.001). The most common G genotypes were G1 followed by G8, G12, and G4 in cases and G1, G12 and G8 in controls. The Tanzanian G1 variants displayed 94% similarity with the Rotarix vaccine G1 variant. The commonest P genotypes were P[8], P[4] and P[6], and the commonest G/P combination G1 P[8] (n = 123), G8 P[4] and G12 P[6]. Overall, rotavirus prevalence was higher in cool (23.9%) than hot months (17.1%) of the year (P = 0.012). We also observed significant seasonal variation of G genotypes. Rotavirus was most frequently found in the age group of four to six months. The prevalence of rotavirus in cases was lower in stunted children (28.9%) than in non-stunted children (40.1%, P = 0.003) and lower in HIV-infected (15.4%, 4/26) than in HIV-uninfected children (55.3%, 42/76, P<0.001). Conclusion This pre-vaccination study shows predominance of genotype G1 in Tanzania, which is phylogenetically distantly related to the vaccine strains. We confirm the emergence of genotype G8 and G12. Rotavirus infection and circulating genotypes showed seasonal variation. This study also suggests that rotavirus may not be an opportunistic pathogen in children infected with HIV.
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Affiliation(s)
- Sabrina J. Moyo
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Kurt Hanevik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Centre for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway
| | - Oyvind Kommedal
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | - Kirsti Vainio
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Samuel Y. Maselle
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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High burden of rotavirus gastroenteritis in young children in rural western Kenya, 2010-2011. Pediatr Infect Dis J 2014; 33 Suppl 1:S34-40. [PMID: 24343611 DOI: 10.1097/inf.0000000000000049] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Diarrhea is a leading cause of hospitalization and death in children <5 years of age. OBJECTIVES To facilitate evaluation of the impact of rotavirus vaccine introduction in western Kenya, we estimated baseline rates of rotavirus-associated hospitalization and mortality among children <5 years of age. METHODS From January 2010 to December 2011, we collected demographic, clinical and laboratory data for children <5 years of age seeking care at the district hospital and 2 outpatient facilities within a Health and Demographic Surveillance System (HDSS). Children with acute gastroenteritis (AGE), defined as ≥3 loose stools and/or ≥1 episode of unexplained vomiting followed by loose stool within a 24-hour period, were asked to provide a stool sample for rotavirus ELISA testing. Rates of rotavirus-associated hospitalization and mortality were estimated using time of residence in the HDSS to calculate person-years of observation. To estimate the rotavirus-associated mortality rate, we applied the percentage positive for rotavirus among AGE hospitalizations to verbal autopsy estimates of diarrhea deaths in the HDSS. RESULTS There were 4991 hospitalizations of children <5 years of age; 1134 (23%) were for AGE and stool specimens were obtained from 790 (70%). Rotavirus was detected in 211 (27%) specimens. Among 4951 <5 outpatient sick visits, 608 (12%) were for AGE; 320 (51%) provided specimens and 62 (20%) were positive for rotavirus. Rotavirus AGE accounted for 501 <5 hospitalizations per 100,000 person-years of observation. Rotavirus-associated <5 mortality was 136 deaths per 100,000 person-years of observation. CONCLUSIONS Continued surveillance of rotavirus AGE will provide timely data on the population-level impact of rotavirus vaccine following its likely introduction in 2014.
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Hospital-based surveillance for rotavirus gastroenteritis in children younger than 5 years of age in Ethiopia: 2007-2012. Pediatr Infect Dis J 2014; 33 Suppl 1:S28-33. [PMID: 24343610 DOI: 10.1097/inf.0000000000000048] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rotavirus surveillance was initiated in Ethiopia to estimate the burden of rotavirus gastroenteritis in children <5 years of age, to generate data to assist the policy-making process for new vaccine introduction and to monitor impact of vaccination on disease burden after introduction. METHODS Sentinel surveillance was conducted at 3 hospitals in Addis Ababa, Ethiopia using a standardized WHO surveillance protocol from August 2007 to March 2012. Children <5 years of age, hospitalized for the primary reason of treatment for acute gastroenteritis, were enrolled, stool samples were collected and tested for group A rotavirus using an enzyme immunoassay. Confirmed positive specimens were further characterized by rotavirus genotyping. RESULTS A total of 1841 children were enrolled and 21% were rotavirus positive. Children 6-12 months of age had the highest proportion of rotavirus (36%) followed by children <6 months of age (23%). There was no significant difference between sexes. Significant differences in clinical characteristics, such as vomiting, vomiting episodes, cases with vomiting and diarrhea among rotavirus positive cases, were observed. Rotavirus circulated year round with peak prevalence from October through January. The most prevalent detected genotypes were G1P[8] (20%), G12P[8] (17%) and G3P[6] (15%), respectively. CONCLUSIONS Rotavirus infection is common in Ethiopian children. A safe and effective intervention against the infection is needed to prevent severity of the disease. Rotavirus vaccine introduction is planned before the end of 2013. The established surveillance system and the data generated can be used to monitor the impact of rotavirus vaccination program on severe disease.
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Abstract
BACKGROUND Rotavirus is the leading cause of diarrhea in children <5 years of age. In light of the implementation of rotavirus vaccines of limited valency, it is important to characterize the genotypic diversity of circulating rotavirus in sub-Saharan Africa. METHODS We collected stool samples from children 0-59 months of age who presented at the health centres as cases with moderate-to-severe diarrhea in the Upper River Region of The Gambia. Stool samples were also collected from age, sex and area-matched healthy controls. All stool samples were assayed for rotavirus antigens by enzyme-linked immunosorbent assay and genotyping was done using reverse transcriptase polymerase chain reaction. RESULTS We enrolled 1029 cases and 1569 controls during the 3-year study period (2008-2010). The detection rate of rotavirus among the cases was 20% (204/1029) and 3% (42/1569) among controls. At least 18 genotypes were found and the predominant genotypes were G2P[6] (28%), G1P[8] (26%) and G1P[10] (10%). The rare identified genotypes (<1%) were G2P[14], G8P[6], G9P[6] and G4P[10]. There was also a strong positive association between rotavirus infection and the dry season (odds ratio: 9.83, 95% confidence interval: 6.18-15.63, P < 0.001). A significant increase in the odds of rotavirus and G1P[8] detection with the use of untreated water and the presence of cats, rodents and cows in the child's residence was also found. CONCLUSION This study provides important baseline data for the genotypes circulating before vaccine implementation. The wide diversity of genotypes circulating in The Gambia implies the need for vigilant effectiveness surveillance following the implementation of RotaTeq in August 2013.
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Rotavirus G and P types circulating in the eastern region of Kenya: predominance of G9 and emergence of G12 genotypes. Pediatr Infect Dis J 2014; 33 Suppl 1:S85-8. [PMID: 24343620 PMCID: PMC5813690 DOI: 10.1097/inf.0000000000000059] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The World Health Organization has recommended that rotavirus (RV) vaccines be included in all national immunization programs as part of a strategy to control RV-associated diarrheal diseases. Hospital-based surveillance of RV infection is therefore crucial in monitoring the impact pre- and post-vaccine introduction and also to document changes in genotype distribution. This study sought to determine the RV genotypes circulating in the eastern region of Kenya before introduction of the RV vaccine. METHODS During September 2009 to August 2011, 500 stool samples were collected from children <5 years of age admitted for acute diarrhea in hospitals in the eastern region of Kenya and analyzed for the presence of group A RV using an enzyme immunoassay. G and P genotypes were determined using hemi-nested reverse transcriptase polymerase chain reaction. RESULTS One hundred and eighty nine out of 500 (38%) samples analyzed were positive for rotavirus. The following G types were detected: G9 (50.9%), G1 (26.8%), G8 (12.1%), G12 (3.1%), G2 (0.6%), mixed G (1.3%) and 5.1% were G nontypeable. P types detected included: P[8] (63.7%), P[4] (12.1%), P[6] (4.5%), mixed P (7.6%) and 12.1% were P nontypeable. The most dominant strain was G9P[8] (35%), followed by G1P[8] (26.8%), G8P[4] (9.6%), G12P[6] (2.5%), G9P[6] (1.9%), G9P[4] (1.3%), G8P[8] (1.3%), and G2P[4] (0.6%). CONCLUSIONS The present study demonstrates the recurring changing genotypes of RV circulating in Kenya, with genotypes G9, G1 and G8 being the dominant strains circulating in the eastern region of Kenya between 2009 and 2011. Additionally, G12 genotype was detected for the first time in Kenya.
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Agustina R, Sari TP, Satroamidjojo S, Bovee-Oudenhoven IMJ, Feskens EJM, Kok FJ. Association of food-hygiene practices and diarrhea prevalence among Indonesian young children from low socioeconomic urban areas. BMC Public Health 2013; 13:977. [PMID: 24138899 PMCID: PMC3813984 DOI: 10.1186/1471-2458-13-977] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 10/04/2013] [Indexed: 02/03/2023] Open
Abstract
Background Information on the part that poor food-hygiene practices play a role in the development of diarrhea in low socioeconomic urban communities is lacking. This study was therefore aimed at assessing the contribution of food-hygiene practice to the prevalence of diarrhea among Indonesian children. Methods A cross-sectional study was conducted among 274 randomly selected children aged 12–59 months in selected low socioeconomic urban areas of East Jakarta. The prevalence of diarrhea was assessed from 7-day records on frequency and consistency of the child’s defecation pattern. Food-hygiene practices including mother’s and child’s hand washing, food preparation, cleanliness of utensils, water source and safe drinking water, habits of buying cooked food, child’s bottle feeding hygiene, and housing and environmental condition were collected through home visit interviews and observations by fieldworkers. Thirty-six practices were scored and classified into poor (median and below) and better (above median) food-hygiene practices. Nutritional status of children, defined anthropometrically, was measured through height and weight. Results Among the individual food-hygiene practices, children living in a house with less dirty sewage had a significantly lower diarrhea prevalence compared to those who did not [adjusted odds ratio (OR) 0.16, 95% confidence interval (CI) = 0.03-0.73]. The overall food-hygiene practice score was not significantly associated with diarrhea in the total group, but it was in children aged < 2 years (adjusted OR 4.55, 95% CI = 1.08-19.1). Conclusions Overall poor mother’s food-hygiene practices did not contribute to the occurrence of diarrhea in Indonesian children. However, among children < 2 years from low socioeconomic urban areas they were associated with more diarrhea.
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Affiliation(s)
- Rina Agustina
- SEAMEO RECFON (Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition), P,O, Box 3852, Jakarta 10038, Indonesia.
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Enweronu-Laryea CC, Sagoe KW, Damanka S, Lartey B, Armah GE. Rotavirus genotypes associated with childhood severe acute diarrhoea in southern Ghana: a cross-sectional study. Virol J 2013; 10:287. [PMID: 24034588 PMCID: PMC3848793 DOI: 10.1186/1743-422x-10-287] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/21/2013] [Indexed: 12/05/2022] Open
Abstract
Background Rotavirus immunization has been effective in developed countries where genotype G1P[8] is the predominant rotavirus strain. Knowledge of circulating strains in a population before introduction of rotavirus immunization program will be useful in evaluating the effect of the intervention. Methods Rotavirus was identified by enzyme immuno-assay (EIA) on stool specimens of children (age 0 – 59 months) hospitalized with acute gastroenteritis from August 2007 to February 2011 in Accra, Ghana. Rotavirus positive specimens were further characterized by polyacrylamide gel electrophoresis (PAGE) and reverse-transcriptase polymerase chain reaction (RT-PCR). Results Of the 2277 acute gastroenteritis hospitalizations 1099 (48.2%) were rotavirus-positive by EIA. Of the 1099 cases 977 (89%) were PAGE positive. All EIA positive specimens were further subjected to RT-PCR and 876 (79.7%) had sufficient material for characterization. Of these 876 cases, 741 (84.6%) were assigned G genotype, 709 (80.9%) P genotype, and 624 (71.2%) both G and P genotypes. We identified 8 G genotypes (G1, G2, G3, G4, G8, G9, G10, G12) and 3 P genotypes (P[4], P[6], P[8]). G1 (50.9%), G2 (18.8%), G3 (12.8%), P[8] (36.1%) and P[6] (30.7%) were the most prevalent. The most prevalent genotype combination was G1P[8] (28%). Mixed G (7.3%) and P (24.2%) genotypes were not uncommon. There was year-by-year and seasonal variations for most genotypes. Conclusion There is great diversity of rotavirus strains in children with severe gastroenteritis in southern Ghana. Even though cross-protection with vaccine-induced immunity occurs, continued strain surveillance is recommended after the introduction of rotavirus vaccine in the national immunization program.
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Affiliation(s)
- Christabel C Enweronu-Laryea
- Department of Child Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana.
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Sarkar R, Kang G, Naumova EN. Rotavirus seasonality and age effects in a birth cohort study of southern India. PLoS One 2013; 8:e71616. [PMID: 23977089 PMCID: PMC3745434 DOI: 10.1371/journal.pone.0071616] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/30/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Understanding the temporal patterns in disease occurrence is valuable for formulating effective disease preventive programs. Cohort studies present a unique opportunity to explore complex interactions associated with emergence of seasonal patterns of infectious diseases. METHODS We used data from 452 children participating in a birth cohort study to assess the seasonal patterns of rotavirus diarrhea by creating a weekly time series of rotavirus incidence and fitting a Poisson harmonic regression with biannual peaks. Age and cohort effects were adjusted for by including the weekly counts of number of children in the study and the median age of cohort in a given week. Weekly average temperature, humidity and an interaction term to reflect the joint effect of temperature and humidity were included to consider the effects of meteorological variables. RESULTS In the overall rotavirus time series, two significant peaks within a single year were observed--one in winter and the other in summer. The effect of age was found to be the most significant contributor for rotavirus incidence, showing a strong negative association. Seasonality remained a significant factor, even after adjusting for meteorological parameters, and the age and cohort effects. CONCLUSIONS The methodology for assessing seasonality in cohort studies is not yet developed. This is the first attempt to explore seasonal patterns in a cohort study with a dynamic denominator and rapidly changing immune response on individual and group levels, and provides a highly promising approach for a better understanding of the seasonal patterns of infectious diseases, tracking emergence of pathogenic strains and evaluating the efficacy of intervention programs.
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Affiliation(s)
- Rajiv Sarkar
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Gagandeep Kang
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
| | - Elena N. Naumova
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, TN, India
- Department of Civil and Environmental Engineering Tufts University School of Engineering, Boston, Massachusetts, United States of America
- * E-mail:
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Swierczewski BE, Odundo EA, Koech MC, Ndonye JN, Kirera RK, Odhiambo CP, Cheruiyot EK, Wu MT, Lee JE, Zhang C, Oaks EV. Surveillance for enteric pathogens in a case-control study of acute diarrhea in Western Kenya. Trans R Soc Trop Med Hyg 2012; 107:83-90. [PMID: 23222955 DOI: 10.1093/trstmh/trs022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Acute diarrhea remains a major public health problem in East African nations such as Kenya. Surveillance for a broad range of enteric pathogens is necessary to accurately predict the frequency of pathogens and potential changes in antibiotic resistance patterns. METHOD Stool samples were collected from September 2009 to September 2011; 193 and 239 samples, from age-matched cases and asymptomatic controls, were collected, respectively, from Kericho and Kisumu District Hospitals in western Kenya. Bacterial pathogens were identified by conventional microbiological methods; antibiotic susceptibility of bacterial isolates was ascertained using the MicroScan WalkAway 40 Plus. An enzyme immunoassay kit was used to detect rotavirus, and ova and parasite examination was conducted by microscopy and an enzyme immunoassay. RESULTS Rotavirus (10.2% and 10.5%) and Shigella (11% and 8%) were isolated significantly more often in the cases than the controls from Kericho and Kisumu District Hospitals respectively. The diarrheagenic Escherichia coli, Campylobacter jejuni and Salmonella were found most often in the cases while Giardia lamblia and Entamoeba histolytica/E. dispar were found more often in the controls. Most pathogens were isolated from children under 5 years old. More than 50% of the Shigella, Salmonella and diarrheagenic E. coli isolates were multidrug resistant to ampicillin, tetracycline and trimethoprim/sulfamethoxazole with several enteroaggregative and enterotoxigenic E. coli isolates producing extended-spectrum beta-lactamases. CONCLUSION Accurate epidemiologic information on acute diarrheal illness in Kenya will be critical for augmenting existing diarrhea management policies in terms of treatment and to strengthen future community awareness and health promotion programs.
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Affiliation(s)
- Brett E Swierczewski
- United States Army Medical Research Unit - Kenya, Kericho Field Station, PO Box 1357, Hospital Road, Kericho, Kenya 20220
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van Hoek AJ, Ngama M, Ismail A, Chuma J, Cheburet S, Mutonga D, Kamau T, Nokes DJ. A cost effectiveness and capacity analysis for the introduction of universal rotavirus vaccination in Kenya: comparison between Rotarix and RotaTeq vaccines. PLoS One 2012; 7:e47511. [PMID: 23115650 PMCID: PMC3480384 DOI: 10.1371/journal.pone.0047511] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/12/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Diarrhoea is an important cause of death in the developing world, and rotavirus is the single most important cause of diarrhoea associated mortality. Two vaccines (Rotarix and RotaTeq) are available to prevent rotavirus disease. This analysis was undertaken to aid the decision in Kenya as to which vaccine to choose when introducing rotavirus vaccination. METHODS Cost-effectiveness modelling, using national and sentinel surveillance data, and an impact assessment on the cold chain. RESULTS The median estimated incidence of rotavirus disease in Kenya was 3015 outpatient visits, 279 hospitalisations and 65 deaths per 100,000 children under five years of age per year. Cumulated over the first five years of life vaccination was predicted to prevent 34% of the outpatient visits, 31% of the hospitalizations and 42% of the deaths. The estimated prevented costs accumulated over five years totalled US$1,782,761 (direct and indirect costs) with an associated 48,585 DALYs. From a societal perspective Rotarix had a cost-effectiveness ratio of US$142 per DALY (US$5 for the full course of two doses) and RotaTeq US$288 per DALY ($10.5 for the full course of three doses). RotaTeq will have a bigger impact on the cold chain compared to Rotarix. CONCLUSION Vaccination against rotavirus disease is cost-effective for Kenya irrespective of the vaccine. Of the two vaccines Rotarix was the preferred choice due to a better cost-effectiveness ratio, the presence of a vaccine vial monitor, the requirement of fewer doses and less storage space, and proven thermo-stability.
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Affiliation(s)
- Albert Jan van Hoek
- Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, London, United Kingdom
| | - Mwanajuma Ngama
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- * E-mail:
| | - Amina Ismail
- Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Jane Chuma
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
| | - Samuel Cheburet
- Health Information System, Ministry of Health, Nairobi, Kenya
| | - David Mutonga
- Division of Disease Surveillance and Response, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Tatu Kamau
- Division of Vaccines & Immunization, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - D. James Nokes
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
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Plosker GL. Rotavirus vaccine RIX4414 (Rotarix™): a pharmacoeconomic review of its use in the prevention of rotavirus gastroenteritis in developing countries. PHARMACOECONOMICS 2011; 29:989-1009. [PMID: 21988293 DOI: 10.2165/11207210-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article provides an overview of the clinical profile of rotavirus vaccine RIX4414 (Rotarix™) in the prevention of rotavirus gastroenteritis (RVGE) in developing countries, followed by a comprehensive review of pharmacoeconomic analyses with the vaccine in low- and middle-income countries. RVGE is associated with significant morbidity and mortality among children <5 years of age in developing countries. The protective efficacy of a two-dose oral series of rotavirus vaccine RIX4414 has been demonstrated in several well designed clinical trials conducted in developing countries, and the 'real-world' effectiveness of the vaccine has also been shown in naturalistic and case-control trials after the introduction of universal vaccination programmes with RIX4414 in Latin American countries. The WHO recommends universal rotavirus vaccination programmes for all countries. Numerous modelled cost-effectiveness analyses have been conducted with rotavirus vaccine RIX4414 across a wide range of low- and middle-income countries. Although data sources and assumptions varied across studies, results of the analyses consistently showed that the introduction of the vaccine as part of a national vaccination programme would be very (or highly) cost effective compared with no rotavirus vaccination programme, according to widely used cost-effectiveness thresholds for developing countries. Vaccine price was not known at the time the analyses were conducted and had to be estimated. In sensitivity analyses, rotavirus vaccine RIX4414 generally remained cost effective at the highest of a range of possible vaccine prices considered. Despite these favourable results, decisions regarding the implementation of universal vaccination programmes with RIX4414 may also be contingent on budgetary and other factors, underscoring the importance of subsidized vaccination programmes for poor countries through the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization).
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Fletcher SM, Stark D, Ellis J. Prevalence of gastrointestinal pathogens in Sub-Saharan Africa: systematic review and meta-analysis. J Public Health Afr 2011; 2:e30. [PMID: 28299071 PMCID: PMC5345503 DOI: 10.4081/jphia.2011.e30] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/21/2011] [Indexed: 02/07/2023] Open
Abstract
A significant proportion of vulnerable people in sub-Saharan Africa (SSA) remain at risk for contracting diarrhoeal diseases due to the presence of many risk factors facilitating their transmission. A systematic review of published articles from the SSA region was done to determine the prevalence and types of diarrhoeal pathogens in circulation, based on a search of databases, including EBSCO host, PubMed, Scopus, Science Direct, Google scholar and Web of Science was done between September 2009 and December 2010. Data were summarized from 27 studies, with pooled data analysed and reported. Pathogens were isolated from between 26.8–65.6% of cases, with an overall isolation rate of 55.7% (95% CI, 48.2–62.9%). Isolation rates were highest amongst adult cases followed by children, and the odds of isolating a pathogen was greater in diarrhoeal cases (Odds Ratio 4.93 (95% CI, 1.99 to 12.23), than in asymptomatic controls. Overall isolation ranged from 8% to 99%; and heterogeneity testing suggests differences between age groups (Q=5.806; df=2, P=0. 055). Mixed E. coli spp., (29.95%), Cryptosporidium (21.52%), Cyclospora (18%), Entamoeba. (13.8%), Shigella spp. (10.49%), Salmonella spp. (8.36%), and Campylobacter spp. (8.33%), were most commonly reported, and rotavirus was the most common virus isolated. This is the first review to look at the range of enteric pathogens circulating in SSA, and has confirmed high rates of isolation of pathogens from diarrhoeal cases. Public health practitioners can use this information to understanding the challenges related to diarrhoeal illness and set priorities for their prevention and control.
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Affiliation(s)
- Stephanie M Fletcher
- iThree Institute and Department of Medical and Molecular Biosciences, University of Technology, Sydney
| | - Damien Stark
- iThree Institute and Department of Medical and Molecular Biosciences, University of Technology, Sydney;; Division of Microbiology, St. Vincent's Hospital, Sydney, Australia
| | - John Ellis
- iThree Institute and Department of Medical and Molecular Biosciences, University of Technology, Sydney
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Kiulia NM, Netshikweta R, Page NA, Van Zyl WB, Kiraithe MM, Nyachieo A, Mwenda JM, Taylor MB. The detection of enteric viruses in selected urban and rural river water and sewage in Kenya, with special reference to rotaviruses. J Appl Microbiol 2011; 109:818-28. [PMID: 20337763 DOI: 10.1111/j.1365-2672.2010.04710.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM To determine the occurrence of eight human enteric viruses in surface water and sewage samples from different geographical areas in Kenya. METHODS AND RESULTS Enteric viruses were recovered from the water and sewage sources by glass-wool adsorption elution and/or polyethylene glycol/NaCl precipitation and detected by singleplex real-time and conventional PCR and reverse transcriptase-PCR assays. One or more enteric viruses were detected in nearly all sewage and river water samples except the urban Mbagathi River. The VP7 (G types) and the VP4 (P types) of the rotaviruses (RV) were characterized by multiplex nested PCR methods. The G and P types could be determined in 95·5% of the RV strains, respectively. Mixed G types were detected with G12 and G1 predominating, and unusual G types, G5 and G10, were present. P[4] predominated in the urban Karen sewage samples, while P[8] predominated in the urban and rural streams. CONCLUSIONS The high prevalence of RVs in surface water highlights the importance of assessing the water sources used for domestic purposes for viral contamination. SIGNIFICANCE AND IMPACT OF THE STUDY This study demonstrates the benefit of environmental surveillance as an additional tool to determine the epidemiology of RVs and other enteric viruses circulating in a given community.
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Affiliation(s)
- N M Kiulia
- Enteric Viruses Research Group, Institute of Primate Research, Karen, Nairobi, Kenya
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Ghosh S, Gatheru Z, Nyangao J, Adachi N, Urushibara N, Kobayashi N. Full genomic analysis of a G8P[1] rotavirus strain isolated from an asymptomatic infant in Kenya provides evidence for an artiodactyl-to-human interspecies transmission event. J Med Virol 2011; 83:367-76. [PMID: 21181935 DOI: 10.1002/jmv.21974] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Group A rotavirus (GAR) G8P[1] strains, found sometimes in cattle, have been reported rarely from humans. Therefore, analysis of the full genomes of human G8P[1] strains are of significance in the context of studies on interspecies transmission of rotaviruses. However, to date, only partial-length nucleotide sequences are available for the 11 genes of a single human G8P[1] strain, while the partial sequences of two other strains have been reported. The present study reports the first complete genome sequence of a human G8P[1] strain, B12, detected from an asymptomatic infant in Kenya in 1987. By nucleotide sequence identities and phylogenetic analyses, the full-length nucleotide sequences of VP7-VP4-VP6-VP1-VP2-VP3-NSP1-NSP2-NSP3-NSP4-NSP5 genes of strain B12 were assigned to G8-P[1]-I2-R2-C2-M2-A3-N2-T6-E2-H3 genotypes, respectively. Each of the 11 genes of strain B12 appeared to be more related to cognate genes of artiodactyl (ruminant and/or camelid) and/or artiodactyl-derived human GAR strains than those of most other rotaviruses. Strain B12 exhibited low levels of genetic relatedness to canonical human GAR strains, such as Wa and DS-1, ruling out the possibility of its origin from reassortment events between artiodactyl-like human and true human strains. These observations suggest that strain B12 might have been directly transmitted from artiodactyls to humans. Unhygienic conditions and close proximity of humans to livestock at the sampling site might have facilitated this rare event. This is the first report on a full genomic analysis of a rotavirus strain from Kenya. To our knowledge, strain B12 might be the oldest G8 strain characterized molecularly from the Africa continent.
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Affiliation(s)
- Souvik Ghosh
- Department of Hygiene, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Nakawesi JS, Wobudeya E, Ndeezi G, Mworozi EA, Tumwine JK. Prevalence and factors associated with rotavirus infection among children admitted with acute diarrhea in Uganda. BMC Pediatr 2010; 10:69. [PMID: 20868488 PMCID: PMC2955671 DOI: 10.1186/1471-2431-10-69] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/24/2010] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Rotavirus remains the commonest cause of severe dehydrating diarrhea among children worldwide. Children in developing countries die more because of several factors including poorer access to hydration therapy and greater prevalence of malnutrition. Hitherto, the magnitude of rotavirus disease in Uganda has remained unknown. This study was therefore done to determine the prevalence and factors associated with rotavirus infection among children aged 3-59 months admitted with acute diarrhea to paediatric emergency ward of Mulago Hospital, Uganda METHODS Three hundred and ninety children, aged between 3-59 months with acute diarrhoea were recruited. The clinical history, socio-demographic characteristics, physical examination findings and laboratory investigations were recorded. Stool samples were tested for rotavirus antigens using the DAKO IDEIA rotavirus EIA detection kit. RESULTS The prevalence of rotavirus infection was 45.4%. On multivariate analysis rotavirus was significantly associated with a higher education (above secondary) level of the mother [OR 1.8; 95% CI 1.1-2.7]; dehydration [OR 1.8; 95% CI 1.1-3.0] and breastfeeding [OR 2.6; 95% CI 1.4-4.0]. Although age was significantly associated with rotavirus on bivariate analysis; this association disappeared on multivariate analysis. No significant association was found between rotavirus infection and nutritional status, HIV status and attendance of day care or school. CONCLUSIONS Rotavirus infection is highly prevalent among children with acute diarrhoea admitted to Mulago Hospital in Uganda.
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Affiliation(s)
- Jane S Nakawesi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, P O Box 7072 Kampala, Uganda.
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Nokes DJ, Peenze I, Netshifhefhe L, Abwao J, De Beer MC, Seheri M, Williams TN, Page N, Steele D. Rotavirus genetic diversity, disease association, and temporal change in hospitalized rural Kenyan children. J Infect Dis 2010; 202 Suppl:S180-6. [PMID: 20684700 DOI: 10.1086/653566] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The effectiveness of rotavirus vaccines will be dependent on the immunity conferred against prevalent and emergent variants causing severe diarrheal disease. Longitudinal surveillance of disease-causing strains is a prerequisite to intervention. METHODS Molecular characterization was conducted on rotavirus-positive stool samples from children admitted with diarrhea to a rural district hospital during 2002-2004. Extracted viral RNA was separated by polyacrylamide gel electrophoresis, and rotavirus VP4 (P types) and VP7 (G types) specificities were determined. RESULTS Among 558 investigated cases, the predominant genotype was P[8]G1 (42%), followed by P[8]G9 (15%), P[4]G8 (7%), P[6]G8 (6%), and P[8]G8 (4%), with 10% mixed strains. Overall, there were 6 different P types and 7 G types. No association was identified between genotype and child age, sex, or severity of diarrhea. The P and G genotypes and polyacrylamide gel electropherotypes showed significant temporal variation in frequency: P[8]G1 decreased from 51% (95% confidence interval [CI], 43%-58%) in 2002 to 30% (95% CI, 24%-37%) in 2004, and P[4]G8 increased from 2% (95% CI, 0%-5%) in 2002 to 13% (95% CI, 9%-19%). Quarterly data revealed seasonally endemic and emergence and/or decay patterns. CONCLUSIONS Our study of rotavirus strains causing severe diarrhea in rural Kenyan children showed a predominance of P[8]G1 and confirms the importance of G8 and G9 strains in sub-Saharan Africa. Considerable genetic diversity of rotavirus strains was observed, including substantial mixed and unusual types, coupled with significant temporal strain variation and emergence. These results warn of variable vaccine efficacy and the need for long-term surveillance of circulating rotavirus genotypes.
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Affiliation(s)
- D James Nokes
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya
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