1
|
Sobi RA, Sultana AA, Khan SH, Haque MA, Nuzhat S, Hossain MN, Bardhan PK, Chisti MJ, Chakraborty S, Ahmed T, Das R, Faruque ASG. Impact of Rotaviral Diarrhea on Child Growth in Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study. Am J Trop Med Hyg 2024; 110:749-758. [PMID: 38377601 PMCID: PMC10993829 DOI: 10.4269/ajtmh.23-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/12/2023] [Indexed: 02/22/2024] Open
Abstract
Rotavirus is the leading cause of dehydrating diarrhea among children in developing countries. The impact of rotaviral diarrhea on nutritional status is not well understood. We aimed to determine the association between rotavirus-positive moderate-to-severe diarrhea and nutrition in children under 5 years of age. We analyzed data from the Global Enteric Multicenter Study on children 0-59 months old from South Asia and sub-Saharan Africa. The relationships between explanatory variables and outcome variables were assessed using multiple linear regression; the explanatory variable was the presence of rotavirus in the stool sample, and the outcome variables were z scores [length/height-for-age (LAZ/HAZ), weight-for-age (WAZ), and weight-for-length/height (WLZ/WHZ)] at follow-up (∼60 days). The prevalence of rotaviral diarrhea was 17.3% (905/5,219) in South Asia and 19.95% (842/4,220) in sub-Saharan Africa. Rotavirus was associated with higher LAZ/HAZ (β: 0.19; 95% CI: 0.12, 0.26; P <0.001) and WAZ (β: 0.15; 95% CI: 0.79, 0.22; P <0.001) in sub-Saharan Africa and with lower WLZ/WHZ (β coefficient: -0.08; 95% CI: -0.15, -0.009; P = 0.027) in South Asia. Our study indicates that rotaviral diarrhea is positively associated with nutritional status in sub-Saharan Africa and is negatively associated with nutritional status in South Asia. An expedited implementation policy of ongoing preventive and control strategies, including vaccination against rotavirus, is necessary to reduce the burden of rotaviral diarrhea, which may further help to reduce the potential nutritional ramifications.
Collapse
Affiliation(s)
- Rukaeya Amin Sobi
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Al-Afroza Sultana
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Soroar Hossain Khan
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Ahshanul Haque
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharika Nuzhat
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Md. Nasif Hossain
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Pradip K. Bardhan
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Subhra Chakraborty
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Tahmeed Ahmed
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Department of Global Health, University of Washington, Seattle, Washington
| | - Rina Das
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Abu S. G. Faruque
- Nutrition Research Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
2
|
Razanajatovo IM, Andrianomiadana L, Habib A, Randrianarisoa MM, Razafimanjato H, Rakotondrainipiana M, Andriantsalama P, Randriamparany R, Andriamandimby SF, Vonaesch P, Sansonetti PJ, Lacoste V, Randremanana RV, Collard JM, Heraud JM. Factors Associated with Carriage of Enteropathogenic and Non-Enteropathogenic Viruses: A Reanalysis of Matched Case-Control Data from the AFRIBIOTA Site in Antananarivo, Madagascar. Pathogens 2023; 12:1009. [PMID: 37623969 PMCID: PMC10459613 DOI: 10.3390/pathogens12081009] [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: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023] Open
Abstract
Environmental Enteric Dysfunction (EED) is an associate driver of stunting in poor settings, and intestinal infections indirectly contribute to the pathophysiology underlying EED. Our work aimed at assessing whether enteric viral carriage is determinant to stunting. A total of 464 healthy and asymptomatic children, aged 2 to 5 years, were recruited, and classified as non-stunted, moderately stunted, or severely stunted. Among the recruited children, 329 stool samples were obtained and screened for enteric and non-enteric viruses by real-time polymerase chain reaction. We statistically tested for the associations between enteric viral and potential risk factors. Approximately 51.7% of the stool samples were positive for at least one virus and 40.7% were positive for non-enteric adenoviruses. No statistical difference was observed between virus prevalence and the growth status of the children. We did not find any statistically significant association between viral infection and most of the socio-demographic risk factors studied, except for having an inadequate food quality score or an over-nourished mother. In addition, being positive for Ascaris lumbricoides was identified as a protective factor against viral infection. In conclusion, we did not find evidence of a direct link between stunting and enteropathogenic viral carriage in our population.
Collapse
Affiliation(s)
- Iony Manitra Razanajatovo
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (I.M.R.); (H.R.); (S.F.A.); (V.L.)
| | - Lova Andrianomiadana
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar (A.H.); (J.-M.C.)
| | - Azimdine Habib
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar (A.H.); (J.-M.C.)
| | - Mirella Malala Randrianarisoa
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (M.M.R.); (M.R.); (P.A.); (R.R.); (R.V.R.)
| | - Helisoa Razafimanjato
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (I.M.R.); (H.R.); (S.F.A.); (V.L.)
| | - Maheninasy Rakotondrainipiana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (M.M.R.); (M.R.); (P.A.); (R.R.); (R.V.R.)
| | - Prisca Andriantsalama
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (M.M.R.); (M.R.); (P.A.); (R.R.); (R.V.R.)
| | - Ravaka Randriamparany
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (M.M.R.); (M.R.); (P.A.); (R.R.); (R.V.R.)
| | - Soa Fy Andriamandimby
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (I.M.R.); (H.R.); (S.F.A.); (V.L.)
| | - Pascale Vonaesch
- Department of Fundamental Microbiology, University of Lausanne, 1002 Lausanne, Switzerland;
- Unité de Pathogénie Microbienne Moléculaire, Institut Pasteur, 75015 Paris, France
| | | | - Vincent Lacoste
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (I.M.R.); (H.R.); (S.F.A.); (V.L.)
| | - Rindra Vatosoa Randremanana
- Epidemiology and Clinical Research Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (M.M.R.); (M.R.); (P.A.); (R.R.); (R.V.R.)
| | - Jean-Marc Collard
- Experimental Bacteriology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar (A.H.); (J.-M.C.)
| | - Jean-Michel Heraud
- Virology Unit, Institut Pasteur de Madagascar, Antananarivo 101, Madagascar; (I.M.R.); (H.R.); (S.F.A.); (V.L.)
| | | |
Collapse
|
3
|
St Jean DT, Edwards JK, Rogawski McQuade ET, Thompson P, Thomas JC, Becker-Dreps S. Transporting monovalent rotavirus vaccine efficacy estimates to an external target population: a secondary analysis of data from a randomised controlled trial in Malawi. Epidemiol Infect 2023; 151:e49. [PMID: 36843494 PMCID: PMC10052556 DOI: 10.1017/s0950268823000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023] Open
Abstract
Oral rotavirus vaccine efficacy estimates from randomised controlled trials are highly variable across settings. Although the randomised study design increases the likelihood of internal validity of findings, results from trials may not always apply outside the context of the study due to differences between trial participants and the target population. Here, we used a weight-based method to transport results from a monovalent rotavirus vaccine clinical trial conducted in Malawi between 2005 and 2008 to a target population of all trial-eligible children in Malawi, represented by data from the 2015-2016 Malawi Demographic and Health Survey (DHS). We reweighted trial participants to reflect the population characteristics described by the Malawi DHS. Vaccine efficacy was estimated for 1008 trial participants after applying these weights such that they represented trial-eligible children in Malawi. We also conducted subgroup analyses to examine the heterogeneous treatment effects by stunting and tuberculosis vaccination status at enrolment. In the original trial, the estimates of one-year vaccine efficacy against severe rotavirus gastroenteritis and any-severity rotavirus gastroenteritis in Malawi were 49.2% (95% CI 15.6%-70.3%) and 32.1% (95% CI 2.5%-53.1%), respectively. After weighting trial participants to represent all trial-eligible children in Malawi, vaccine efficacy increased to 62.2% (95% CI 35.5%-79.0%) against severe rotavirus gastroenteritis and 38.9% (95% CI 11.4%-58.5%) against any-severity rotavirus gastroenteritis. Rotavirus vaccine efficacy may differ between trial participants and target populations when these two populations differ. Differences in tuberculosis vaccination status between the trial sample and DHS population contributed to varying trial and target population vaccine efficacy estimates.
Collapse
Affiliation(s)
- Denise T. St Jean
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessie K. Edwards
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - James C. Thomas
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Diversity of Rotavirus Strains among Children with Acute Diarrhea in Karachi, Pakistan. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5231910. [PMID: 35502336 PMCID: PMC9056210 DOI: 10.1155/2022/5231910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
One of the common viral pathogens in infectious diarrhea is Rotavirus; in developing countries, it is a primary cause of deaths in children less than five years of age. This study was planned to find out the etiologic agents of acute watery diarrhea. In this study, 1465 stool samples were analyzed with the symptoms of acute diarrhea. Demographic data analysis showed no. of episodes of diarrhea, vomiting, and fever. All samples were checked by ELISA technique for the presence of Rotavirus circulating strains. More than 6% patients were found to be positive with Rotavirus. Common Rotavirus genotypes, including G2P4, G2P6, G3P4, G8P4, G8P6, G9P4, and G10P4, were detected in patients through RT-PCR. This study concluded that detection of rotavirus strain diversity and management of diarrheal patients may identify assortment of emerging strains and reduce emergence of antimicrobial resistance and repeated episodes of diarrhea, which may also help to avoid and manage the essential nutrients lost leading to malnutrition and stunted growth, as well as to reduce high mortality rate in young children less than five years.
Collapse
|
6
|
Tadesse T, Turi E, Wirtu D, Bikila H, Assefa L. Determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, Gambella Region, South-Western Ethiopia: Unmatched case–control study. SAGE Open Med 2022; 10:20503121211070727. [PMID: 35070312 PMCID: PMC8771739 DOI: 10.1177/20503121211070727] [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: 03/08/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Wasting among refugee children continues to be a serious public health problem particularly in conflict and in situations when people are displaced. Evidence of risk factors in the refugee context is crucial to successfully prevent malnutrition and its consequences. However, little information is known about the determinants of wasting in a refugee setting. Hence, this study was aimed to identify determinants of wasting among South Sudanese 6- to 59-month-old children in Okugo refugee camp, South-Western Ethiopia. Methods: Institutional-based unmatched case–control study was conducted on 99 acute malnutrition children (cases) and 297 children who are not malnourished (control) from 6 April to 2 May 2019. The study participant was selected by systematic random sampling and data on exposure variables were collected by face-to-face interview using a structured questionnaire. Data were entered into Epi data version 3.1 and was exported to SPSS version 25 for further analysis. Descriptive, bivariable, and multivariable analyses were done to compute summary statistics and to identify determinants of wasting. Result: The mean age of the cases and controls with standard deviation (SD) was 13.8 (±6.9) and 19.2 (±8.7) months, respectively. Multi-variable analysis revealed that mothers who were unable to read and write (adjusted odds ratio = 3.26, 95% confidence interval (1.07–7.93)), fathers only decision-maker to use donations items in the household (adjusted odds ratio = 3.75, 95% confidence interval (1.28–10.85)), not used all donated refugee food and non-food items (adjusted odds ratio = 2.57; 95% confidence interval (1.17–5.66)), the incidence of diarrhea 2 weeks preceding the survey (adjusted odds ratio = 5.28, 95% confidence interval (2.31–12.04)), and mother’s smoking habit (adjusted odds ratio = 2.98, 95% confidence interval (1.19–7.44)) were significant determinants of wasting. Conclusion: The finding shows that mothers who are unable to read and write, father only decision-maker, parents’ smoking habit, not using all donated refugee food items, and diarrheal disease were found to be independent determinants of wasting. Hence, interventions on acute malnutrition which are focused on empowering women through training and strengthening their control over the household assets, proper utilization of donated food, and non-food items will play a paramount role.
Collapse
Affiliation(s)
| | - Ebisa Turi
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | | | | | | |
Collapse
|
7
|
Burnett E, Parashar UD, Tate JE. Rotavirus Infection, Illness, and Vaccine Performance in Malnourished Children: A Review of the Literature. Pediatr Infect Dis J 2021; 40:930-936. [PMID: 34117200 PMCID: PMC8489158 DOI: 10.1097/inf.0000000000003206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Live, oral rotavirus vaccines are more effective at preventing rotavirus disease in countries with low child mortality compared with high child mortality. Among several hypotheses, poorer protection in malnourished children, who are more prevalent in countries with high child mortality, may partially explain this difference. We conducted a literature search to identify articles with a laboratory-confirmed rotavirus endpoint that evaluated differences by malnutrition status in rotavirus vaccine effectiveness and vaccine efficacy (VE) or the prevalence of rotavirus infection or illness among children <5 years old. We identified 7 analyses from 11 countries published from 2007 to 2019 that stratified rotavirus VE by malnutrition status. Among well-nourished children, VE point estimates ranged from 71% to 84% in observational studies and 26% to 61% in clinical trials. Among malnourished children, they ranged from -28% to 45% in observational studies and -3% to 61% in clinical trials. The relative difference between VE in well-nourished and malnourished children by length-for-age ranged from 37% to 64%, by weight-for-age ranged from 0% to 107%, and by weight-for-height ranged from -65% to 137%. We identified 3 cohort and 6 cross-sectional studies of natural rotavirus infection and illness and none reported that malnourished children were more susceptible to rotavirus infection or illness than well-nourished children. Overall, rotavirus vaccines may offer less protection to children with malnutrition than well-nourished children. As malnourished children often have worse outcomes from diarrhea, high rotavirus vaccine coverage and a better understanding of the performance of oral rotavirus vaccines in this population is important, though our finding that malnourished children may be less susceptible to rotavirus provides important context and information for vaccine evaluation design.
Collapse
Affiliation(s)
- Eleanor Burnett
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D. Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E. Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
8
|
Palit P, Nuzhat S, Khan SS, Gazi MA, Islam MR, Islam MO, Mahfuz M, Liu J, Houpt ER, Haque R, Ahmed T. Use of TaqMan Array Cards to investigate the aetiological agents of diarrhoea among young infants with severe acute malnutrition. Trop Med Int Health 2021; 26:1659-1667. [PMID: 34498343 DOI: 10.1111/tmi.13677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Studies involving less sensitive conventional microscopy and culture-based approaches have identified distinct differences in diarrhoeal aetiology in childhood malnutrition. Our study involved the use of an advanced molecular biology technique, the TaqMan Array Cards (TAC), to elucidate the diarrhoeal aetiology among young infants with severe acute malnutrition (SAM). METHOD A total of 113 faecal samples was collected from SAM infants, aged 2-6 months, upon admission to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) with complications of diarrhoea and related comorbidities. We used TAC for the detection of 29 different diarrhoeal enteropathogens from a single faecal sample. For comparison, we also analysed 25 diarrhoeal samples from well-nourished infants of similar age. RESULTS Higher odds of detection of all bacterial enteropathogens were associated with diarrhoea among SAM infants. In particular, the detection of Aeromonas sp (aOR: 25.7, p = 0.011), Campylobacter sp (aOR: 9.6, p < 0.01) and ETEC (aOR: 5.2, p = 0.022) was significantly associated with diarrhoea among SAM infants in comparison to well-nourished infants. 80% higher odds of detection of rotavirus and norovirus GII were associated with diarrhoea among well-nourished infants in comparison to SAM infants (aOR: 0.2, p < 0.05). CONCLUSION Our study findings demonstrate a difference in diarrhoeal aetiology among SAM and well-nourished young infants, which may be useful in providing an evidence-based logic for possible revision of treatment guidelines for treatment of young diarrhoeal infants with SAM in the early management of the menace of antimicrobial resistance.
Collapse
Affiliation(s)
- Parag Palit
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shaila Sharmeen Khan
- Emerging Infections and Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Amran Gazi
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ridwan Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Md Ohedul Islam
- Emerging Infections and Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Rashidul Haque
- Emerging Infections and Parasitology Laboratory, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
9
|
Chawla S, Goel AK, Thiyagarajan V, Nair NP. Nutritional Assessment and its Association with Rotavirus Positivity Among Under Five Children Admitted with Diarrhea in a Tertiary Care Hospital of Southern Haryana, India. Indian J Pediatr 2021; 88:138-143. [PMID: 33409955 DOI: 10.1007/s12098-020-03611-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To estimate the burden of undernutrition and its association with rotavirus positivity among under-five children admitted with diarrhea. METHODS This prospective observational study was carried out in hospital-setting from February 2016 to January 2020. For all cases who met the eligibility criteria, an informed written consent was obtained from parents/caregivers. A case report form was used to collect sociodemographic, anthropometric and clinical data. The anthropometric measurements of children were performed according to World Health Organization (WHO) guidelines. RESULTS Nutritional assessment revealed that 74.1% study subjects were underweight [Weight-for-Age (WAZ) < -2], 59% were stunted [Height-for-Age (HAZ), < -2] and 52.3% were wasted Body Mass Index (BMIZ) < -2]. Stunting was found to be significantly higher among boys as compared to girls and rotavirus positive diarrhea was significantly less prevalent among stunted children. CONCLUSION There exists a very high prevalence of underweight, stunting, and wasting among hospitalized children with diarrhea. As the better nutrition has not been shown to guard against rotavirus diarrhea, coverage scale-up of rotavirus vaccination, improved hygiene and sanitation, and focussed nutrition programmes are the need of the hour in India.
Collapse
Affiliation(s)
- Suraj Chawla
- Department of Community Medicine, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Haryana, 122107, India.
| | - Anil Kumar Goel
- Department of Pediatrics, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Varunkumar Thiyagarajan
- Department of GI Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| | - Nayana P Nair
- Department of GI Sciences, Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India
| |
Collapse
|
10
|
Chissaque A, Cassocera M, Gasparinho C, Langa JS, Bauhofer AFL, Chilaúle JJ, João ED, Munlela BA, Sambo JAM, Boene SS, Djedje MB, Anapakala EM, Guimarães EL, Bero DM, Manhique-Coutinho LV, Cossa-Moiane I, Kellogg TA, Gonçalves LAP, de Deus N. Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea - a cross-sectional study in four provinces of Mozambique. BMC Infect Dis 2021; 21:18. [PMID: 33407207 PMCID: PMC7788695 DOI: 10.1186/s12879-020-05718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique. METHODS The analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR). RESULTS Of the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3-30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0-47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4-15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24-59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed. CONCLUSIONS The frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children's development.
Collapse
Affiliation(s)
- Assucênio Chissaque
- Instituto Nacional de Saúde (INS), Maputo, Moçambique.
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Marta Cassocera
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carolina Gasparinho
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | | | - Eva Dora João
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Benilde António Munlela
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Centro de Biotecnologia - Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Júlia Assiat Monteiro Sambo
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Simone Salvador Boene
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Centro de Biotecnologia - Universidade Eduardo Mondlane, Maputo, Moçambique
| | | | | | - Esperança Lourenço Guimarães
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | - Idalécia Cossa-Moiane
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Institute of Tropical Medicine (ITM), Antwerp, Belgium Institute for Global Health Sciences, Antwerp, Belgium
| | - Timothy A Kellogg
- University of California San Francisco, San Francisco, California, USA
| | - Luzia Augusta Pires Gonçalves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Centro de Estatística e Aplicações da Universidade de Lisboa, Lisboa, Portugal
| | - Nilsa de Deus
- Instituto Nacional de Saúde (INS), Maputo, Moçambique
- Departamento de Ciências Biológicas, Universidade Eduardo Mondlane, Maputo, Moçambique
| |
Collapse
|
11
|
Itaka MB, Omole OB. Prevalence and factors associated with malnutrition among under 5-year-old children hospitalised in three public hospitals in South Africa. Afr J Prim Health Care Fam Med 2020; 12:e1-e7. [PMID: 33354983 PMCID: PMC7736651 DOI: 10.4102/phcfm.v12i1.2444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
Background Malnutrition is a significant risk factor for ill health among children under 5 years of age and the consequences are significant. Aim The aim of this study was to determine the prevalence and factors associated with malnutrition among under-5-year-old hospitalised children. Setting This study was set at Sebokeng, Kopanong and Heidelberg hospitals, Sedibeng district, South Africa. Methods This was a cross-sectional study comprising 306 hospitalised under-5-year-old children. Information on socio-demography, feeding practices, immunisation and clinical problems was obtained from caregivers and medical records. Anthropometric measurements were also performed. Results Most participants were male (59.8%), had normal birth weights (80.0%), come from a household with a monthly income R2000 (about 150 US dollars) (50.3%), up-to-date immunisation (97.4%), breastfed for 6 months (57.4%) and were fed 3–4 meals/day (66.7%) and, at most, one snack/day (63.4%). Acute malnutrition accounted for 9.5% (n = 29) of admissions. Among these, 82.8% (n = 24) had severe acute malnutrition. On test of association, monthly household income (p = 0.01), mother’s and father’s employment status (p = 0.01; p = 0.01), breastfeeding history (p = 0.01) and having diarrhoea in index admission (p = 0.01) were significantly associated with malnutrition admission. In multivariate regression analyses, not being breastfed (odds ratio [OR] = 3.9; 95% confidence interval [CI]: 1.23–12.29; p = 0.02) and diarrhoea at index admission were independently associated with malnutrition (OR = 23.3; 95% CI: 6.85–79.43; p = 0.01). Conclusion A significant proportion of participants had malnutrition and were subjected to suboptimal feeding practices. Healthcare providers in primary care need to entrench dietary education and anthropometric screening in all clinic visits for children 5 years old, particularly when they present with diarrhoea or are not being breastfed.
Collapse
Affiliation(s)
- Makanda B Itaka
- Division of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
| | | |
Collapse
|
12
|
Koyuncu A, Simuyandi M, Bosomprah S, Chilengi R. Nutritional status, environmental enteric dysfunction, and prevalence of rotavirus diarrhoea among children in Zambia. PLoS One 2020; 15:e0240258. [PMID: 33007035 PMCID: PMC7531814 DOI: 10.1371/journal.pone.0240258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Rotavirus is the most common cause of fatal diarrhoeal disease among children under the age of five globally and is responsible for millions of hospitalizations each year. Although nutritional status and environmental enteric dysfunction (EED) are recognized as important predictors of susceptibility to diarrhoeal disease, no research to date has examined the mechanisms by which undernutrition and EED may protect against prevalence of rotavirus infection. METHODS We utilized data collected from a study evaluating the effectiveness of Rotarix™ vaccine against severe gastroenteritis among children under the age of 5 in Zambia. The prevalence of malnutrition, wasting, and stunting at the time of study enrollment was calculated using WHO child growth standards. Commercial ELISA kits were used to assess levels of faecal biomarkers for EED: alpha-1-antitrypsin and myeloperoxidase, and calprotectin. Separate multivariate logistic regression models were used to examine each measure of nutritional status and rotavirus diarrhoea including and excluding adjustment for EED. RESULTS In models that did not include adjustment for EED, malnourished children had 0.66 times the odds of having rotavirus diarrhoea compared to children with normal nutritional status (95% CI: 0.42, 1.0; p = 0.07). EED severity score was significantly higher among controls asymptomatic for diarrhoeal disease compared to cases with rotavirus diarrhoea (p = 0.02). CONCLUSION The morphological changes associated with EED may confer protection against rotavirus infection and subsequent diarrhoeal disease among children. Further research is critically needed to better understand the complex mechanisms by which nutritional status and EED may impact susceptibility to rotavirus in early life.
Collapse
Affiliation(s)
- Aybüke Koyuncu
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | | | - Samuel Bosomprah
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Roma Chilengi
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| |
Collapse
|
13
|
Sokefun EE, Atulomah NO. Predictors of infant-survival practices among mothers attending paediatric clinics in Ijebu-Ode, Ogun State, Nigeria. BMC Public Health 2020; 20:1245. [PMID: 32807128 PMCID: PMC7430007 DOI: 10.1186/s12889-020-09310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background Despite concerted global efforts towards achieving infant-survival, infant mortality lingers as a problem in developing countries. Environmental and personal-level factors are assumed to account for this situation. This study was undertaken to provide better understanding of the dynamics of predictors of infant-survival practices among mothers with infants attending paediatric clinics. Methods A cross-sectional survey design was adopted. Data was collected from 386 nursing mothers selected by convenience sampling. Interviewer-administered questionnaires were used for data collection. The questionnaire consisted of 38-items including demographic information of respondents, health-literacy counsels received during antenatal care, social-support from significant others, and self-efficacy to carry-out infant-survival instructions. Responses were transformed into rating scales for each variable and data analysis was conducted by linear regression analysis with test of hypotheses at 5% level of significance. Results The mean age of respondents was 29.8 ± 5.8 years. Majority (81.6%) were married. Yorubas (83.90%) were predominant. Participants had mean scores of 10.50 ± 3.83, 10.56 ± 3.70 and 16.61 ± 4.56 respectively computed for levels of health-literacy, social-support, and self-efficacy. The dependent variable measured level of infant-survival practices and respondents scored 16.53 ± 4.71. The study found a significant association among variables. Self-efficacy was the major predictor variable of self-reported infant-survival practices (R = 0.466; R2 = 0.217; P<0.05). Conclusion We conclude that participants had average levels of health-literacy, social-support, self-efficacy, and infant-survival practices. Healthcare providers should make efforts to empower pregnant women on activities essential for infant-survival. Family members of nursing mothers should as well be knowledgeable about the advantages of supporting them.
Collapse
|
14
|
Aetiology and outcome of acute diarrhoea in children with severe acute malnutrition: a comparative study. Public Health Nutr 2020; 23:1563-1568. [PMID: 31699164 DOI: 10.1017/s1368980019003069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status. DESIGN Cross-sectional comparative study. SETTING Tertiary-care hospital catering mainly to the urban poor of East Delhi, India. PARTICIPANTS Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months. RESULTS Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups. CONCLUSIONS Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.
Collapse
|
15
|
Pankov RC, Gondim RNDG, Prata MMG, Medeiros PHQS, Veras HN, Santos AKS, Havt A, da Silva MFM, Fumian TM, Miagostovich MP, Leite JPG, Lima AAM. Rotavirus A Infections in Community Childhood Diarrhea in the Brazilian Semiarid Region During Postvaccination Era. J Pediatr Gastroenterol Nutr 2019; 69:e91-e98. [PMID: 31568040 DOI: 10.1097/mpg.0000000000002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Rotavirus A (RVA) is one of the leading causes of acute gastroenteritis worldwide; however, few studies assessed RVA genetics with community surveillance. OBJECTIVES This study aimed to investigate clinical data, genetic diversity, and coinfection patterns of RVA infections in children from 2 to 36 months old with or without community childhood diarrhea in the Brazilian semiarid region during postvaccination era. METHODS We enrolled and collected socioeconomic/clinical information using a standardized questionnaire and fecal samples from 291 children. Viral RNA samples were extracted and analyzed using quantitative reverse transcription polymerase chain reaction to establish the diagnosis of RVA. Sequencing of VP7 and VP4 (VP8*) regions and phylogenetic analysis were performed. RESULTS RVA-negative diagnosis was associated with children 24 to 36 months old with complete vaccination schedule. Genotype G1P[8] was the most prevalent (57%), whereas unusual genotypes including G1P[4], G2P[8], and G3P[9] were also detected. G1- and P[8]-positive samples showed high degrees of similarity with the vaccine strain. RVA coinfections were frequently observed, and enteroaggregative Escherichia coli was the most prevalent copathogen. CONCLUSIONS These results demonstrate that genotype G1P[8] is the most prevalent strain. VP7 and/or VP8* gene segments arising from RV1 vaccine strain were documented in these children, suggesting shedding or herd vaccination. Moreover, our study indicates full vaccination is important for protection against RVA infections.
Collapse
Affiliation(s)
- Rafaela C Pankov
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Rafhaella N D G Gondim
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Mara M G Prata
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Pedro H Q S Medeiros
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Herlice N Veras
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Ana K S Santos
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | - Alexandre Havt
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| | | | | | | | | | - Aldo A M Lima
- Institute of Biomedicine and Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE
| |
Collapse
|
16
|
Lee B, Dickson DM, deCamp AC, Ross Colgate E, Diehl SA, Uddin MI, Sharmin S, Islam S, Bhuiyan TR, Alam M, Nayak U, Mychaleckyj JC, Taniuchi M, Petri WA, Haque R, Qadri F, Kirkpatrick BD. Histo-Blood Group Antigen Phenotype Determines Susceptibility to Genotype-Specific Rotavirus Infections and Impacts Measures of Rotavirus Vaccine Efficacy. J Infect Dis 2019; 217:1399-1407. [PMID: 29390150 PMCID: PMC5894073 DOI: 10.1093/infdis/jiy054] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Lewis and secretor histo–blood group antigens (HBGAs) have been associated with decreased susceptibility to P[8] genotype rotavirus (RV) infections. Efficacy of vaccines containing attenuated P[8] strains is decreased in low-income countries. Host phenotype might impact vaccine efficacy (VE) by altering susceptibility to vaccination or RV diarrhea (RVD). We performed a substudy in a monovalent RV vaccine (RV1) efficacy trial in Bangladesh to determine the impact of Lewis and secretor status on risk of RVD and VE. Methods In infants randomized to receive RV1 or no RV1 at 10 and 17 weeks with 1 year of complete active diarrheal surveillance, we performed Lewis and secretor phenotyping and genotyped the infecting strain of each episode of RVD. Results A vaccine containing P[8] RV protected secretors and nonsecretors similarly. However, unvaccinated nonsecretors had a reduced risk of RVD (relative risk, 0.53 [95% confidence interval, .36–.79]) mediated by complete protection from P[4] but not P[8] RVs. This effect reduced VE in nonsecretors to 31.7%, compared to 56.2% among secretors, and decreased VE for the overall cohort. Conclusions Host HBGA status may impact VE estimates by altering susceptibility to RV in unvaccinated children; future trials should therefore account for HBGA status. Clinical Trials Registration NCT01375647.
Collapse
Affiliation(s)
- Benjamin Lee
- Vaccine Testing Center, 1Department of Pediatrics
| | - Dorothy M Dickson
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Allan C deCamp
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - E Ross Colgate
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| | - Sean A Diehl
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| | | | - Salma Sharmin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Shahidul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | | | - Masud Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Uma Nayak
- Center for Public Health Genomics and Department of Public Health Sciences
| | | | - Mami Taniuchi
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Firdausi Qadri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka
| | - Beth D Kirkpatrick
- Department of Medicine, University of Vermont Larner College of Medicine, Burlington
| |
Collapse
|
17
|
Bartelt LA, Bolick DT, Guerrant RL. Disentangling Microbial Mediators of Malnutrition: Modeling Environmental Enteric Dysfunction. Cell Mol Gastroenterol Hepatol 2019; 7:692-707. [PMID: 30630118 PMCID: PMC6477186 DOI: 10.1016/j.jcmgh.2018.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022]
Abstract
Environmental enteric dysfunction (EED) (also referred to as environmental enteropathy) is a subclinical chronic intestinal disorder that is an emerging contributor to early childhood malnutrition. EED is common in resource-limited settings, and is postulated to consist of small intestinal injury, dysfunctional nutrient absorption, and chronic inflammation that results in impaired early child growth attainment. Although there is emerging interest in the hypothetical potential for chemical toxins in the environmental exposome to contribute to EED, the propensity of published data, and hence the focus of this review, implicates a critical role of environmental microbes. Early childhood malnutrition and EED are most prevalent in resource-limited settings where food is limited, and inadequate access to clean water and sanitation results in frequent gastrointestinal pathogen exposures. Even as overt diarrhea rates in these settings decline, silent enteric infections and faltering growth persist. Furthermore, beyond restricted physical growth, EED and/or enteric pathogens also associate with impaired oral vaccine responses, impaired cognitive development, and may even accelerate metabolic syndrome and its cardiovascular consequences. As these potentially costly long-term consequences of early childhood enteric infections increasingly are appreciated, novel therapeutic strategies that reverse damage resulting from nutritional deficiencies and microbial insults in the developing small intestine are needed. Given the inherent limitations in investigating how specific intestinal pathogens directly injure the small intestine in children, animal models provide an affordable and controlled opportunity to elucidate causal sequelae of specific enteric infections, to differentiate consequences of defined nutrient deprivation alone from co-incident enteropathogen insults, and to correlate the resulting gut pathologies with their functional impact during vulnerable early life windows.
Collapse
Affiliation(s)
- Luther A Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - David T Bolick
- Center for Global Health, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
18
|
Genetic Diversity of Norovirus Infections, Coinfections, and Undernutrition in Children From Brazilian Semiarid Region. J Pediatr Gastroenterol Nutr 2018; 67:e117-e122. [PMID: 29985875 DOI: 10.1097/mpg.0000000000002085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Norovirus (NoV) infections are known to have high-morbidity and mortality rates and are a major health problem globally. The impact of NoV on child development is, however, poorly understood. We evaluated the distribution of NoV genotypes in children from a low-income Brazilian semiarid region, in relation with their clinical symptoms, nutritional status, and co-pathogens. METHODS The test population included children aged 2 to 36 months from 6 cities of the Brazilian semiarid region. Fecal samples were collected from each child, along with the information regarding their socioeconomic/clinical conditions using a standardized questionnaire. Detection and quantification of NoV were performed by reverse-transcription quantitative polymerase chain reaction, followed by molecular and phylogenetic analyses. RESULTS The NoV detection rate was 45.2%. Presence of NoV was associated with lower z scores for weight-for-age (P = 0.03), weight-for-height (P = 0.03), and body mass index-for-age (P = 0.03). NoV infection was associated with more frequent respiratory illnesses (P < 0.01). GII.P7 (polymerase) and GII.3 (capsid) were the most frequent NoV genotypes. Analysis of the open reading frame (ORF)1-2 junction identified recombinant NoV strains in 80% of the sequenced samples. Enteroaggregative Escherichia coli coinfection was the major predictor for diarrhea in NoV-positive samples (P < 0.02). Moreover, Shigella spp was also associated with NoV-positive diagnosis (P = 0.02). CONCLUSIONS This study highlights the genetic variability of NoV and, associated co-infections and undernutrition in infants from low-income Brazilian semiarid region.
Collapse
|
19
|
Muendo C, Laving A, Kumar R, Osano B, Egondi T, Njuguna P. Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus vaccine introduction in Kenya, a hospital cross-sectional study. BMC Pediatr 2018; 18:323. [PMID: 30309343 PMCID: PMC6180366 DOI: 10.1186/s12887-018-1291-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rotavirus infection is the most common cause of acute gastroenteritis globally in children under 5 years of age and is responsible for approximately 5% of all child deaths yearly. Rotavirus vaccination is considered an effective public health strategy to prevent infection and reduce the severity of disease. Multi-centre country trials on rotavirus vaccines demonstrated efficacy rates of more than 85% in developed countries but only about 65% in developing nations. Rotavirus vaccination was introduced into the Kenya Expanded Programme on Immunization (KEPI) in 2014. The objective of our study was to determine the prevalence of rotavirus infection, severity of acute diarrhoea and to determine the rotavirus vaccination status among children aged 3-24 months presenting with acute diarrhoea at Kenyatta National Hospital after introduction of rotavirus vaccine in Kenya. METHODS A total of 365 children aged 3-24 months presenting with acute diarrhoea at KNH were recruited from August 2016 to April 2017. Data on rotavirus vaccination status, nutritional status, feeding practices and sociodemographic characteristics were obtained and a full clinical evaluation of the patients was done. Severity of the gastroenteritis was assessed using the 20 point Vesikari Clinical Severity Scoring System. The children who were admitted were followed up for 7 days using hospital ward registers. Comorbid conditions were established from patient's clinical records and physical examination. Stool specimens from study participants were tested for rotavirus using a commercially available enzyme linked immunosorbent immunoassay kit- ProSpecT Rotavirus Microplate Assay. RESULTS Majority of the children (96.7%) had received rotavirus vaccinations. The overall rotavirus prevalence was 14.5% and was higher among 17-24 months at 19.5%. The prevalence somewhat differed by gender, nutritional status, exclusive breastfeeding status, age and education level of mother/caregiver. Overall, a half of the children had severe acute diarrhoea and there were some differences in severity by child/mother characteristics. CONCLUSION There is still burden of rotavirus diarrhoea after introduction of rotavirus vaccine and the prevalence varies by child characteristics.
Collapse
Affiliation(s)
| | - Ahmed Laving
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Rashmi Kumar
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Boniface Osano
- Department of Paediatrics and Child Health, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya
| | - Thaddaeus Egondi
- Drugs for Neglected Diseases initiative, P.O. Box 21936–00505, Nairobi, Kenya
| | - Pamela Njuguna
- Public Health Specialist, Afya Resource Associates, P. O. Box 238–00202, Nairobi, Kenya
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW Rotavirus vaccines are playing a pivotal role in improving lives of infants and young children in low and middle-income countries (LMICs). Many of these countries have adopted the vaccine into their routine immunization, whereas others are considering introduction. This article provides an update on the impact of rotavirus vaccines in LMICs on morbidity and mortality in children aged less than 5 years, and their cost-effectiveness. RECENT FINDINGS The WHO, in 2013, updated its recommendation to prioritize introduction of rotavirus vaccines in the routine immunization schedule, without age restrictions. Despite the decreased efficacy of the vaccines in LMICs, data from Sub-Saharan Africa have demonstrated a decrease in rotavirus-related morbidity, with some sites reporting an indirect protective effect on children age ineligible to receive the vaccine. Even with improvements in sanitation, nutritional status in children, and other health-related indices in LMICs, the use of rotavirus vaccines will play an important role in preventing rotavirus-related gastroenteritis. Economic models predict a reduction in economic burden because of rotavirus-related health costs, making vaccine introduction cost-effective in resource-constrained settings. SUMMARY Increasing evidence from impact studies shows the significant impact of rotavirus vaccination on hospitalizations and economic burden because of rotavirus gastroenteritis in LMICs. Universal rotavirus vaccination is recommended, and introductions should be monitored by robust surveillance systems to measure effectiveness and impact.
Collapse
|
21
|
Kieser S, Sarker SA, Berger B, Sultana S, Chisti MJ, Islam SB, Foata F, Porta N, Betrisey B, Fournier C, Descombes P, Mercenier A, Sakwinska O, Brüssow H. Antibiotic Treatment Leads to Fecal Escherichia coli and Coliphage Expansion in Severely Malnourished Diarrhea Patients. Cell Mol Gastroenterol Hepatol 2017; 5:458-460.e6. [PMID: 29675461 PMCID: PMC5904031 DOI: 10.1016/j.jcmgh.2017.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 11/29/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Silas Kieser
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| | - Shafiqul A. Sarker
- International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Bernard Berger
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| | - Shamima Sultana
- International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammod J. Chisti
- International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Shoeb B. Islam
- International Centre for Diarrheal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Francis Foata
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| | - Nadine Porta
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| | | | | | | | - Annick Mercenier
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| | - Olga Sakwinska
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland,Corresponding author: Olga Sakwinska, PhD, PO Box 44, CH-1000 Lausanne 26, Switzerland. fax: + 41 21 785 8444.
| | - Harald Brüssow
- Nestlé Research Centre, Nutrition and Health Research, Lausanne, Switzerland
| |
Collapse
|
22
|
Hiramatsu H, Suzuki R, Nagatani A, Boda H, Miyata M, Hattori F, Miura H, Sugata K, Yamada S, Komoto S, Taniguchi K, Ihira M, Nishimura N, Ozaki T, Yoshikawa T. Rotavirus Vaccination Can Be Performed Without Viral Dissemination in the Neonatal Intensive Care Unit. J Infect Dis 2017; 217:589-596. [DOI: 10.1093/infdis/jix590] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 11/10/2017] [Indexed: 11/13/2022] Open
|
23
|
Gasparinho C, Piedade J, Mirante MC, Mendes C, Mayer C, Vaz Nery S, Brito M, Istrate C. Characterization of rotavirus infection in children with acute gastroenteritis in Bengo province, Northwestern Angola, prior to vaccine introduction. PLoS One 2017; 12:e0176046. [PMID: 28422995 PMCID: PMC5397047 DOI: 10.1371/journal.pone.0176046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Rotavirus group A (RVA) is considered the leading cause of pediatric diarrhea, responsible for the high burden of diarrheal diseases in sub-Saharan Africa. Despite recent studies, the existent data are scarce for some African countries like Angola, a country with one of the highest RVA-related death estimates. The aim of this study was to determine the RVA detection rate and circulating genotypes in children less than five years of age with acute gastroenteritis attended at the Bengo General Hospital in Caxito, Bengo province, Angola, before vaccine introduction. METHODS Between September 2012 and December 2013, 342 fecal specimens were collected from children enrolled. Positive samples for RVA by immunochromatographic rapid test were G and P-typed by hemi-nested type-specific multiplex PCR, and subgrouped for the VP6 gene. VP4 and VP7 genes from a subset of samples were sequenced for phylogenetic analysis. RESULTS During the study period, a high RVA detection rate was registered (25.1%, 86/342). The age group most affected by RVA infection includes children under 6 months of age (p<0.01). Vomiting was highly associated with RVA infection (72.1%; p<0.001). From the 86 RVA-positive samples, 72 (83.7%) were genotyped. The most prevalent genotype was G1P[8] (34/72; 47.2%), followed by the uncommon G1P[6] (21/72; 29.2%), and G2P[4] (9/72; 12.5%). Only two G-types were found: G1 (60/72; 83.3%) and G2 (11/72; 15.3%). Among the P-genotypes, P[8] was the most prevalent (34/72; 47.2%), followed by P[6] (22/72; 30.6%) and P[4] (9/72; 12.5%). In the phylogenetic trees, the identified G and P-types clustered tightly together and with reference sequences in specific monophyletic groups, with highly significant bootstrap values (≥92%). CONCLUSION This pre-vaccination study revealed, for the first time for Bengo province (Angola), the RVA genotype profile, including phylogenetic relationships, and a high RVA detection rate, supporting the immediate introduction of a RVA vaccine in the national immunization programme.
Collapse
Affiliation(s)
- Carolina Gasparinho
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Província do Bengo, Angola
| | - João Piedade
- Global Health and Tropical Medicine (GHTM), Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Maria Clara Mirante
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Província do Bengo, Angola
| | - Cristina Mendes
- Global Health and Tropical Medicine (GHTM), Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| | - Carlos Mayer
- Hospital Geral do Bengo, Caxito, Província do Bengo, Angola
| | - Susana Vaz Nery
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Província do Bengo, Angola
- Research School of Population Health, The Australian National University, Canberra, Australia
| | - Miguel Brito
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Província do Bengo, Angola
- Escola Superior de Tecnologia da Saúde de Lisboa, Lisbon, Portugal
| | - Claudia Istrate
- Global Health and Tropical Medicine (GHTM), Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical (IHMT), Universidade NOVA de Lisboa (UNL), Lisbon, Portugal
| |
Collapse
|
24
|
Protein Malnutrition Modifies Innate Immunity and Gene Expression by Intestinal Epithelial Cells and Human Rotavirus Infection in Neonatal Gnotobiotic Pigs. mSphere 2017; 2:mSphere00046-17. [PMID: 28261667 PMCID: PMC5332602 DOI: 10.1128/msphere.00046-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 12/11/2022] Open
Abstract
Malnutrition and rotavirus infection, prevalent in developing countries, individually and in combination, affect the health of millions of children, compromising their immunity and increasing the rates of death from infectious diseases. However, the interactions between the two and their combined effects on immune and intestinal functions are poorly understood. We have established the first human infant microbiota-transplanted neonatal pig model of childhood malnutrition that reproduced the impaired immune, intestinal, and other physiological functions seen in malnourished children. This model can be used to evaluate relevant dietary and other health-promoting interventions. Our findings provide an explanation of why adequate nutrition alone may lack efficacy in malnourished children. Malnutrition affects millions of children in developing countries, compromising immunity and contributing to increased rates of death from infectious diseases. Rotavirus is a major etiological agent of childhood diarrhea in developing countries, where malnutrition is prevalent. However, the interactions between the two and their combined effects on immune and intestinal functions are poorly understood. In this study, we used neonatal gnotobiotic (Gn) pigs transplanted with the fecal microbiota of a healthy 2-month-old infant (HIFM) and fed protein-deficient or -sufficient bovine milk diets. Protein deficiency induced hypoproteinemia, hypoalbuminemia, hypoglycemia, stunting, and generalized edema in Gn pigs, as observed in protein-malnourished children. Irrespective of the diet, human rotavirus (HRV) infection early, at HIFM posttransplantation day 3 (PTD3), resulted in adverse health effects and higher mortality rates (45 to 75%) than later HRV infection (PTD10). Protein malnutrition exacerbated HRV infection and affected the morphology and function of the small intestinal epithelial barrier. In pigs infected with HRV at PTD10, there was a uniform decrease in the function and/or frequencies of natural killer cells, plasmacytoid dendritic cells, and CD103+ and apoptotic mononuclear cells and altered gene expression profiles of intestinal epithelial cells (chromogranin A, mucin 2, proliferating cell nuclear antigen, SRY-Box 9, and villin). Thus, we have established the first HIFM-transplanted neonatal pig model that recapitulates major aspects of protein malnutrition in children and can be used to evaluate physiologically relevant interventions. Our findings provide an explanation of why nutrient-rich diets alone may lack efficacy in malnourished children. IMPORTANCE Malnutrition and rotavirus infection, prevalent in developing countries, individually and in combination, affect the health of millions of children, compromising their immunity and increasing the rates of death from infectious diseases. However, the interactions between the two and their combined effects on immune and intestinal functions are poorly understood. We have established the first human infant microbiota-transplanted neonatal pig model of childhood malnutrition that reproduced the impaired immune, intestinal, and other physiological functions seen in malnourished children. This model can be used to evaluate relevant dietary and other health-promoting interventions. Our findings provide an explanation of why adequate nutrition alone may lack efficacy in malnourished children.
Collapse
|