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Mohy A, Lagoubi Y, Gomez JA, Amadou B, Bouskraoui M. Health economic evaluation of 2-dose and 3-dose rotavirus vaccines in children below 5 years of age in Morocco. Hum Vaccin Immunother 2024; 20:2353480. [PMID: 38757507 PMCID: PMC11110695 DOI: 10.1080/21645515.2024.2353480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
Following the introduction of rotavirus vaccination into the Moroccan National Immunization Program, the prevalence of the disease has decreased by nearly 50%. However, evidence on the economic value of rotavirus vaccinations in Morocco is limited. This health economic analysis evaluated, from both country payer and societal perspectives, the costs and the cost-effectiveness of three rotavirus vaccines using a static, deterministic, population model in children aged < 5 years in Morocco. Included vaccines were HRV (2-dose schedule), HBRV (3-dose schedule) and BRV-PV 1-dose vial (3-dose schedule). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainty in model inputs. The model predicted that vaccination with HRV was estimated to result in fewer rotavirus gastroenteritis events (-194 homecare events, -57 medical visits, -8 hospitalizations) versus the 3-dose vaccines, translating into 7 discounted quality-adjusted life years gained over the model time horizon. HRV was associated with lower costs versus HBRV from both the country payer (-$1.8 M) and societal (-$4.1 M) perspectives, and versus BRV-PV 1-dose vial from the societal perspective (-$187,000), dominating those options in the cost-effectiveness analysis. However, costs of BRV-PV 1-dose vial were lower than HRV from the payer perspective, resulting in an ICER of approximately $328,376 per QALY, above the assumed cost effectiveness threshold of $3,500. Vaccination with a 2-dose schedule of HRV may be a cost-saving option and could lead to better health outcomes for children in Morocco versus 3-dose schedule rotavirus vaccines.
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Affiliation(s)
- Ahmed Mohy
- Value Evidence & Outcomes Emerging Markets, GSK, Wavre, Belgium
| | | | - Jorge A. Gomez
- Vaccines, Emerging Markets, GSK, Buenos Aires, Argentina
| | - Barry Amadou
- Vaccines Emerging Markets, GSK, Casablanca, Morocco
| | - Mohammed Bouskraoui
- Faculté de Médecine et de Pharmacie, Cadi Ayyad University, Marrakech, Morocco
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Sharma AD, Grewal RK, Gorle S, Cuspoca AF, Kaushik V, Rajjak Shaikh A, Cavallo L, Chawla M. T cell epitope based vaccine design while targeting outer capsid proteins of rotavirus strains infecting neonates: an immunoinformatics approach. J Biomol Struct Dyn 2024; 42:4937-4955. [PMID: 37382214 DOI: 10.1080/07391102.2023.2226721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023]
Abstract
Gastrointestinal diarrhea is majorly caused by the rotavirus (RV) in the children who generally are under the age group of 5 years. WHO estimates that ∼95% of the children contract RV infection, by this age. The disease is highly contagious; notably in many cases, it is proven fatal with high mortality rates especially in the developing countries. In India alone, an estimated 145,000 yearly deaths occurs due to RV related gastrointestinal diarrhea. WHO pre-qualified vaccines that are available for RV are all live attenuated vaccines with modest efficacy range between 40 and 60%. Further, the risk of intussusceptions has been reported in some children on RV vaccination. Thus, in a quest to develop alternative candidate to overcome challenges associated with these oral vaccines, we chose immunoinformatics approach to design a multi-epitope vaccine (MEV) while targeting the outer capsid viral proteinsVP4 and VP7 of the neonatal strains of rotavirus. Interestingly, ten epitopes, that is, six CD8+T-cells and four CD4+T-cell epitopes were identified which were predicted to be antigenic, non-allergic, non-toxic and stable. These epitopes were then linked to adjuvants, linkers, and PADRE sequences to create a multi-epitope vaccine for RV. The in silico designed RV-MEV and human TLR5 complex displayed stable interactions during molecular dynamics simulations. Further, the immune simulation studies of RV-MEV corroborated that the vaccine candidate emerges as a promising immunogen. Future investigations while performing in vitro and in vivo analyses with designed RV-MEV construct are highly desirable to warrant the potential of this vaccine candidate in protective immunity against different strains of RVs infecting neonates.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Arijit Das Sharma
- School of Bio-Engineering and Bio-Sciences, Lovely Professional University, Punjab, India
| | - Ravneet Kaur Grewal
- Department of Research and Innovation, STEMskills Research and Education Lab Private Limited, Faridabad, Haryana, India
| | - Suresh Gorle
- Department of Research and Innovation, STEMskills Research and Education Lab Private Limited, Faridabad, Haryana, India
| | - Andrés Felipe Cuspoca
- Grupo de Investigación Epidemiología Clínica de Colombia (GRECO), Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
- Centro de Atención e Investigación Médica - CAIMED, Chía, Colombia
| | - Vikas Kaushik
- School of Bio-Engineering and Bio-Sciences, Lovely Professional University, Punjab, India
| | - Abdul Rajjak Shaikh
- Department of Research and Innovation, STEMskills Research and Education Lab Private Limited, Faridabad, Haryana, India
| | - Luigi Cavallo
- Physical Sciences and Engineering Division, Kaust Catalysis Center, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Mohit Chawla
- Physical Sciences and Engineering Division, Kaust Catalysis Center, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
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Vaccine evaluation and genotype characterization in children infected with rotavirus in Qatar. Pediatr Res 2023:10.1038/s41390-023-02468-7. [PMID: 36658331 PMCID: PMC10382313 DOI: 10.1038/s41390-023-02468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND We characterized and identified the genetic and antigenic variations of circulating rotavirus strains in comparison to used rotavirus vaccines. METHODS Rotavirus-positive samples (n = 231) were collected and analyzed. The VP7 and VP4 genes were sequenced and analyzed against the rotavirus vaccine strains. Antigenic variations were illustrated on the three-dimensional models of surface proteins. RESULTS In all, 59.7% of the hospitalized children were vaccinated, of which only 57.2% received two doses. There were no significant differences between the vaccinated and non-vaccinated groups in terms of clinical outcome. The G3 was the dominant genotype (40%) regardless of vaccination status. Several amino acid changes were identified in the VP7 and VP4 antigenic epitopes compared to the licensed vaccines. The highest variability was seen in the G3 (6 substitutions) and P[4] (11 substitutions) genotypes in comparison to RotaTeq®. In comparison to Rotarix®, G1 strains possessed three amino acid changes in 7-1a and 7-2 epitopes while P[8] strains possessed five amino acid changes in 8-1 and 8-3 epitopes. CONCLUSIONS The current use of Rotarix® vaccine might not be effective in preventing the infection due to the higher numbers of G3-associated cases. The wide range of mutations in the antigenic epitopes compared to vaccine strains may compromise the vaccine's effectiveness. IMPACT The reduced rotavirus vaccine effectiveness necessitate regular evaluation of the vaccine content to ensure optimal protection. We characterized and identified the genetic and antigenic variations of circulating rotavirus strains in comparison to the Rotarix vaccine strain that is used in Qatar. The study highlight the importance for regular monitoring of emerging rotavirus variants and their impact on vaccine effectiveness in young children.
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Carias C, Hu T, Chen YT. Burden of rotavirus gastroenteritis on caregivers: Findings from a systematic literature review. Hum Vaccin Immunother 2022; 18:2047545. [PMID: 35377826 PMCID: PMC9196848 DOI: 10.1080/21645515.2022.2047545] [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] [Indexed: 11/04/2022] Open
Abstract
Rotavirus gastroenteritis (RVGE) poses a substantial clinical, economic, and humanistic burden globally. While predominantly affecting children, the burden of RVGE extends to caregivers and families but is often overlooked. In this systematic literature review, we aim to identify and summarize methods and estimates of RVGE associated caregiver burden. Of the 190 publications identified, 10 were included. Four studies used the EuroQoL-5 Dimension instrument and its associated Visual Analog Scale and reported a decrease in caregiver health related quality of life when a child contracted RVGE, with the greatest reduction observed in caregivers of hospitalized children. Other studies utilized surveys to assess impacts on caregivers’ quality of life. Caregivers of RVGE patients experienced multiple impacts beyond financial costs related to productivity and absenteeism, with disruptions to daily routines and anxiety/stress frequently reported. This review highlights the importance of including RVGE caregiver burden when evaluating interventions, such as vaccination, to decrease RVGE burden.
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Affiliation(s)
- Cristina Carias
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tianyan Hu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Ya-Ting Chen
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Cho JY, Liu R, Macbeth JC, Hsiao A. The Interface of Vibrio cholerae and the Gut Microbiome. Gut Microbes 2021; 13:1937015. [PMID: 34180341 PMCID: PMC8244777 DOI: 10.1080/19490976.2021.1937015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/04/2023] Open
Abstract
The bacterium Vibrio cholerae is the etiologic agent of the severe human diarrheal disease cholera. The gut microbiome, or the native community of microorganisms found in the human gastrointestinal tract, is increasingly being recognized as a factor in driving susceptibility to infection, in vivo fitness, and host interactions of this pathogen. Here, we review a subset of the emerging studies in how gut microbiome structure and microbial function are able to drive V. cholerae virulence gene regulation, metabolism, and modulate host immune responses to cholera infection and vaccination. Improved mechanistic understanding of commensal-pathogen interactions offers new perspectives in the design of prophylactic and therapeutic approaches for cholera control.
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Affiliation(s)
- Jennifer Y. Cho
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA, USA
- Department of Biochemistry, University of California, Riverside, California, USA
| | - Rui Liu
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA, USA
- Graduate Program in Genetics, Genomics, and Bioinformatics, University of California, Riverside, California, USA
| | - John C. Macbeth
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA, USA
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, California, USA
| | - Ansel Hsiao
- Department of Microbiology and Plant Pathology, University of California, Riverside, CA, USA
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Prevalence of Rotavirus-Associated Acute Gastroenteritis Cases in Early Childhood in Turkey: Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2020; 7:children7100159. [PMID: 33023241 PMCID: PMC7599778 DOI: 10.3390/children7100159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rotavirus is globally the most common viral pathogen in childhood gastroenteritis. This study aimed to estimate the number of Turkish children suffering from early-childhood gastroenteritis by rotavirus by performing a meta-analysis. METHODS Meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Following the guidelines, primary studies were found reporting the prevalence of rotavirus gastroenteritis in Turkey. We performed a computerized search of published studies in national and international databases from 1990 to 2018. We selected 38 out of 721 studies for our study. Meta-analysis was carried out using R statistical software. The Cochrane Q statistic was calculated to assess the heterogeneity of the study results. Heterogeneity among studies was evaluated using the I2 statistic. Effect-size estimate was reported with 95% confidence interval. RESULTS On the basis of 38 selected articles, 80,113 children up to five years of age were diagnosed with symptoms of acute gastroenteritis, of whom the stool samples of 13,651 children were positive for rotavirus. The pooled prevalence of rotavirus was 19% in children younger than five years of age with acute gastroenteritis. In terms of seasonal prevalence, the highest prevalence rate was found in winter. CONCLUSION This study supports the major prevalence of early-childhood gastroenteritis by rotavirus among Turkish children. Therefore, the decision to adopt immunization programs to prevent rotavirus infection might be helpful in Turkey.
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Dynamics of G2P[4] strain evolution and rotavirus vaccination: A review of evidence for Rotarix. Vaccine 2020; 38:5591-5600. [PMID: 32651115 DOI: 10.1016/j.vaccine.2020.06.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/27/2022]
Abstract
Rotavirus (RV) gastroenteritis is a vaccine-preventable disease that creates high medical and economic burden in both developed and developing countries. Worldwide, more than 100 countries have introduced RV vaccines in their national immunization programs, and the remarkable impact of reducing the burden of severe childhood gastroenteritis has been unequivocally demonstrated. Currently, 2 oral vaccines (Rotarix, GSK and RotaTeq, Merck) are widely utilized. Recent temporary increases in the relative prevalence of G2P[4] RV strains have been observed in countries implementing RV vaccination. This comprehensive literature review aims to provide an insight on RV genotype evolution in the context of mass vaccination with Rotarix, particularly in the case of G2P[4]. In the post-vaccine era, strain surveillance data indicated temporal and spatial changes in countries both with and without RV vaccination programs. Annual fluctuations in G2P[4] prevalence seem to occur naturally, with no substantial differences between countries using Rotarix, RotaTeq or mixed vaccination programs. Moreover, Rotarix has been shown to be efficacious and effective against gastroenteritis caused by non-vaccine strains, including G2P[4]. These data indicate that shifts in RV genotype distribution are likely to constitute an inherent process of virus evolution to infect the human gut. Following RV vaccine introduction, incidences of RV gastroenteritis declined dramatically and mass vaccination will likely maintain this status, despite possible fluctuations in the relative distribution of genotypes. There is no conclusive evidence of unusual burst of new or vaccine-escape strains since global RV vaccines use. The emergence of strains with a potential to increase the current burden of RV disease should be continuously monitored and can only be established by exhaustive characterization of strains, including whole genomic sequencing. Given the natural fluctuations in RV strains over time, caution is advised when interpreting temporal changes in RV strain dynamics, as they could mistakenly be attributed to vaccination.
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Genotyping of Rotaviruses in River Nile in Giza, Egypt. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:173-180. [PMID: 32309236 PMCID: PMC7152643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In 2013, WHO estimated the annual diarrheal mortality rate among children less than five years in Egypt was 24 deaths per 100.000, 2% was due to rotavirus infection. METHODS Eight water samples were collected monthly from the Nile water stream passing through Giza over 12 months during June 2016 to May 2017. Totally, ninety-six water samples were collected and concentrated for the detection of rotavirus group A (RV-A) using RT-PCR. Multiplex semi-nested RT-PCR was performed to identify the genotypes P and G of RV-A. RESULTS The detection rate of RV-A was 18.75% (18/96), whereas the rate of rotavirus genotypes G and P were 61% (11/18) and 50% (9/18), respectively. Rotaviruses G1P[8] and G1P[4] were the most common genotypes identified in our survey. In addition, the seasonal distribution findings demonstrated that the highest detection rate was 37.5% in the winter season, followed by 20.8%, 12.5% and 4% in spring, autumn and summer, respectively. CONCLUSION Multiplex semi-nested RT-PCR is a useful method for rapid detection and genotyping of RV-A in surface water samples.
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Badur S, Öztürk S, Pereira P, AbdelGhany M, Khalaf M, Lagoubi Y, Ozudogru O, Hanif K, Saha D. Systematic review of the rotavirus infection burden in the WHO-EMRO region. Hum Vaccin Immunother 2019; 15:2754-2768. [PMID: 30964372 PMCID: PMC6930073 DOI: 10.1080/21645515.2019.1603984] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Rotavirus gastroenteritis imposes a heavy burden on low- and middle-income countries. The World Health Organization defines the Eastern Mediterranean region (WHO-EMRO) as a diverse area in terms of socioeconomic status and health indicators. Rotavirus vaccination has been introduced, at least partially, in 19 out of the 22 EM countries; however, vaccine coverage remains low, and data on rotavirus disease burden is scarce.Available data on rotavirus prevalence, seasonality, vaccination status, and genotype evolution was systematically compiled following a literature review that identified 165 relevant WHO-EMRO epidemiology studies published between 1990 and 2017.Although the infectious agents responsible for acute gastroenteritis vary over time, rotavirus remained the leading cause of acute gastroenteritis in children, as seen in 76.3% of reviewed publications. Younger children (<2 years old) were at higher risk and thus increased vaccination coverage and surveillance systems are required to reduce the rotavirus gastroenteritis burden in WHO-EMRO countries.
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Affiliation(s)
- Selim Badur
- MENA, Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Serdar Öztürk
- MENA, Medical & Clinical Emerging Markets, GSK, Istanbul, Turkey
| | - Priya Pereira
- Global Medical Affairs Rota/MMRV, GSK, Wavre, Belgium
| | | | - Mansour Khalaf
- EM Central Vaccines Medical/Clinical, GSK, Jeddah, Saudi Arabia
| | - Youness Lagoubi
- EM Central Vaccines Medical/Clinical, GSK, Casablanca, Morocco
| | - Onur Ozudogru
- EM Central Vaccines Medical/Clinical, GSK, Dubai, United Arab Emirates
| | - Kashif Hanif
- EM Central Vaccines Medical/Clinical, GSK, Karachi, Pakistan
| | - Debasish Saha
- Epidemiology/Health Economics EM, GSK, Wavre, Belgium
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Harb A, O'Dea M, Abraham S, Habib I. Childhood Diarrhoea in the Eastern Mediterranean Region with Special Emphasis on Non-Typhoidal Salmonella at the Human⁻Food Interface. Pathogens 2019; 8:E60. [PMID: 31064086 PMCID: PMC6631750 DOI: 10.3390/pathogens8020060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Diarrhoeal disease is still one of the most challenging issues for health in many countries across the Eastern Mediterranean region (EMR), with infectious diarrhoea being an important cause of morbidity and mortality, especially in children under five years of age. However, the understanding of the aetiological spectrum and the burden of enteric pathogens involved in diarrhoeal disease in the EMR is incomplete. Non-typhoidal Salmonella (NTS), the focus of this review, is one of the most frequently reported bacterial aetiologies in diarrhoeal disease in the EMR. Strains of NTS with resistance to antimicrobial drugs are increasingly reported in both developed and developing countries. In the EMR, it is now widely accepted that many such resistant strains are zoonotic in origin and acquire their resistance in the food-animal host before onward transmission to humans through the food chain. Here, we review epidemiological and microbiological aspects of diarrhoeal diseases among children in the EMR, with emphasis on the implication and burden of NTS. We collate evidence from studies across the EMR on the zoonotic exposure and antimicrobial resistance in NTS at the interface between human and foods of animal origin. This review adds to our understanding of the global epidemiology of Salmonella with emphasis on the current situation in the EMR.
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Affiliation(s)
- Ali Harb
- College of Science, Health, Education and Engineering, Murdoch University, Perth 6150, Australia.
- Thi-Qar Public Health Division, Ministry of Health, Thi-Qar 64007, Iraq.
| | - Mark O'Dea
- College of Science, Health, Education and Engineering, Murdoch University, Perth 6150, Australia. m.o'
| | - Sam Abraham
- College of Science, Health, Education and Engineering, Murdoch University, Perth 6150, Australia.
| | - Ihab Habib
- College of Science, Health, Education and Engineering, Murdoch University, Perth 6150, Australia.
- High Institute of Public Health, Alexandria University, Alexandria 21516, Egypt.
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Harb A, Abraham S, Rusdi B, Laird T, O'Dea M, Habib I. Molecular Detection and Epidemiological Features of Selected Bacterial, Viral, and Parasitic Enteropathogens in Stool Specimens from Children with Acute Diarrhea in Thi-Qar Governorate, Iraq. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091573. [PMID: 31064051 PMCID: PMC6539995 DOI: 10.3390/ijerph16091573] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/30/2019] [Accepted: 05/01/2019] [Indexed: 01/02/2023]
Abstract
Knowledge of etiology causes of diarrheal illness is essential for development and implementation of public health measures to prevent and control this disease syndrome. There are few published studies examining diarrhea in children aged <5 years in Iraq. This study aims to investigate the occurrences and epidemiology of selected bacterial (Salmonella spp. and Campylobacter spp.), viral (adenovirus, norovirus GI and GII, and astrovirus), and parasitic (Entamoeba spp. and Giardia spp.) agents in stool samples from 155 child diarrheal cases enrolled between March and August 2017, in a hospital-based cross-sectional study in Thi-Qar, southeastern Iraq. Using molecular techniques and sequence-based characterization, adenovirus was the most frequently detected enteropathogen (53/155 (34.2%)), followed by Salmonella spp. (23/155 (14.8%)), Entamoeba spp. (21/155 (13.5%)), and Campylobacter spp. (17/155 (10.9%)). Mixed infection with Salmonella spp. and Campylobacter spp. was evident, and the same was revealed between various enteric viruses, particularly adenovirus and norovirus. The most frequent co-infection pattern was between adenovirus and Campylobacter spp., in seven cases (7/155 (4.5%)). Whole-genome sequencing-derived typing data for Salmonella isolates (n = 23) revealed that sequence type 49 was the most prevalent in this sample set (15/23 (65.2%)). To the best of our knowledge, this study provides the first report on detection and identification of floR, blaCARB-2, and mphA antimicrobial resistance genes in Salmonella isolated from children in the Middle East region. Logistic regression analysis pointed to few enteropathogen-specific correlations between child age, household water source, and breastfeeding patterns in relation to the outcome of detection of individual enteropathogens. This study presents the first published molecular investigation of multiple enteropathogens among children <5 years of age in Iraq. Our data provide supporting evidence for planning of childhood diarrhea management programs. It is important to build on this study and develop future longitudinal case-control research in order to elaborate the epidemiology of enteropathogens in childhood diarrhea in Iraq.
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Affiliation(s)
- Ali Harb
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia.
- Thi-Qar Public Health Division, Ministry of Health, Nassriya 64001, Iraq.
| | - Sam Abraham
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia.
| | - Bertha Rusdi
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia.
| | - Tanya Laird
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia.
| | - Mark O'Dea
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia. m.o'
| | - Ihab Habib
- School of Veterinary Medicine, College of Science, Health, Engineering and Education, Murdoch University, Perth 6150, Australia.
- High Institute of Public Health, Alexandria University, Alexandria 0203, Egypt.
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Tavakoli Nick S, Mohebbi SR, Ghaemi A, Hosseini SM. Human rotavirus in Iran; molecular epidemiology, genetic diversity and recent updates on vaccine advances. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2019; 12:98-109. [PMID: 31191833 PMCID: PMC6536013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/18/2018] [Indexed: 10/28/2022]
Abstract
Human rotavirus is the predominant pathogen causing gastroenteritis in infants and children younger than 5 years of age globally. Before introduction and implementation of rotavirus vaccine, more than frothy percent of all caused acute gastroenteritis hospitalization and nearly half a million deaths per year was occurred due to Rotavirus infection mostly in the low-income countries. Rotaviruses are divided in G and P genotypes, based on two genomic segments' nucleotide sequences VP7 and VP4, respectively. Currently, 27 G and 37 P types have been described; among them G1 to G4 and G9 and P[8], P[4], and P[6] genotypes are the most prevalent circulating rotavirus strains globally. Molecular epidemiological surveys revealed that G1P[8] is the predominant genotype in Iran, although other genotypes have also been reported. Rotavirus vaccine was recommended by the World Health Organization as a necessary part of national childhood immunization programs in 2009. Rotarix (monovalent) and RotaTeq (pantavalent) are two oral vaccines that have been available in more than one hundred countries around the world to control the viral infection and reduce the cases of diarrheal diseases. This article provides a review of frequency, molecular epidemiology and current situation of Rotavirus genetic diversity Iran. In addition, recent advances in rotavirus vaccine research are discussed.
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Affiliation(s)
- Shadi Tavakoli Nick
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Microbiology and microbial biotechnology, Faculty of life Sciences and biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Seyed Reza Mohebbi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ghaemi
- Department of Virology, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed Masoud Hosseini
- Department of Microbiology and microbial biotechnology, Faculty of life Sciences and biotechnology, Shahid Beheshti University, Tehran, Iran
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Mohamed MS, Sayed AI, Khedr MA, Nofal S, Soror SH. Evaluation of novel pyrrolopyrimidine derivatives as antiviral against gastroenteric viral infections. Eur J Pharm Sci 2018; 127:102-114. [PMID: 30366078 DOI: 10.1016/j.ejps.2018.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 11/19/2022]
Abstract
Viral gastroenteritis is a major global public-health threat. All age groups are susceptible for this infection, but its most serious consequences affect children. Rotavirus, Coxsackievirus and Adenovirus are the most common viruses that cause gastroenteritis. Herein, we synthesized novel pyrrole, pyrrolo[2,3‑d]pyrimidine and pyrrolo[3,2‑e][1,2,4]triazolo[4,3‑c]pyrimidine derivatives. The non-toxic doses of these compounds were determined using BGM cell lines. We examined all the new compounds for their anti-viral activities against Rotavirus Wa strain and Coxsackievirus B4. Compounds 2a, 2d, 5a, 5c, 5d, 7b, 7j, 7n, 14b, 14c, 14e and 14f exhibited significant antiviral activity. We interpreted the action of these compounds using molecular docking against the homology models of viral polymerase enzymes of these viruses. RMSD value of 5d/Coxsackievirus was higher than the RMSD value for 5d/rotavirus and hence better as a stability parameter, which can be correlated to the biological activity.
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Affiliation(s)
- Mosaad S Mohamed
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ain Helwan, Cairo, Egypt
| | - Amira I Sayed
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ain Helwan, Cairo, Egypt
| | - Mohammed A Khedr
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Helwan University, Ain Helwan, Cairo, Egypt
| | - Shahira Nofal
- Department of Pharmacology and Toxicology, faculty of Pharmacy, Helwan University, Ain Helwan, Cairo, Egypt
| | - Sameh H Soror
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy, Helwan University, Ain Helwan, Cairo, Egypt; Center for scientific excellence "Helwan Structural Biology Research (HSBR)", Cairo, Egypt..
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Ahmed MLCB, Weddih A, Benhafid M, Bollahi MA, Sidatt M, Makhalla K, Mokdad AH, Heukelbach J, Filali-Maltouf A. Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0⁻5 Years in a Referral Hospital of Mauritania. Trop Med Infect Dis 2018; 3:tropicalmed3030103. [PMID: 30274499 PMCID: PMC6161072 DOI: 10.3390/tropicalmed3030103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022] Open
Abstract
Diarrhea and respiratory diseases are the leading causes of morbidity and mortality among <5-year-olds worldwide, but systematic data are not available from Mauritania. We conducted a hospital-based retrospective study. Data on admissions to Mauritania's National Referral Hospital (the main pediatric referral center in the country), due to diarrhea and respiratory diseases, during 2011⁻2014, were analyzed. A total of 3695 children <5 years were hospitalized during this period; 665 (18.0%) due to respiratory diseases, and 829 (22.4%) due to diarrhea. Case fatality rates in the respiratory diseases and diarrhea groups were 18.0% (120/665) and 14.1% (117/829), respectively. The highest frequency of deaths due to diarrhea occurred in the age group 2⁻5 years (16/76; 21.0%), and due to respiratory diseases in the age group 6⁻12 months (32/141; 22.6%). We conclude that case fatality rates caused by respiratory diseases and diarrhea are extremely high in children hospitalized at the National Referral Hospital. These data call for intensified efforts to reduce deaths among hospitalized Mauritanian children, and also for integrated control measures to prevent and reduce the burden of both diseases. Additional studies are needed to show the effectiveness of the introduction of vaccination programs for pneumococcal diseases and rotavirus infection in the child population, which were launched in November 2013 and December 2014, respectively.
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Affiliation(s)
- Mohamed Lemine Cheikh Brahim Ahmed
- Department of Biology, University Mohammed V, Rabat 10010, Morocco.
- Department of Virology, National Institute of Hygiene, Rabat 10010, Morocco.
- Institut National de Recherche en Santé Publique (INRSP), Nouakchott 2373, Mauritania.
| | - Abdellahi Weddih
- Ministry of Health and University of Nouakchott, Department of Pediatrics, Nouakchott 2373, Mauritania.
| | - Mohammed Benhafid
- Department of Virology, National Institute of Hygiene, Rabat 10010, Morocco.
| | - Mohamed Abdellahi Bollahi
- Institut National de Recherche en Santé Publique (INRSP), Nouakchott 2373, Mauritania.
- Ministry of Health and University of Nouakchott, Department of Pediatrics, Nouakchott 2373, Mauritania.
| | - Mariem Sidatt
- Ministry of Health and University of Nouakchott, Department of Pediatrics, Nouakchott 2373, Mauritania.
| | - Khattry Makhalla
- Ministry of Health and University of Nouakchott, Department of Pediatrics, Nouakchott 2373, Mauritania.
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WD 98195, USA.
| | - Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza CE60430-140, Brazil.
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townville, QLD 4810, Australia.
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Eljilany I, El-Dahiyat F, Curley LE, Babar ZUD. Evaluating quantity and quality of literature focusing on health economics and pharmacoeconomics in Gulf Cooperation Council countries. Expert Rev Pharmacoecon Outcomes Res 2018; 18:403-414. [PMID: 29779401 DOI: 10.1080/14737167.2018.1479254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The importance of pharmacoeconomics and health economics has been augmented. It has the potential to provide evidence to aid in optimal decision-making in the funding of cost-effective medicines and services in Gulf Cooperation Council countries (G.C.C). OBJECTIVE To evaluate the quality and quantity of health economic researches published until the end of 2017 in G.C.C. and to identify the factors that affect the quality of studies. METHOD Studies were included according to predefined inclusion and exclusion criteria. The quantity was recorded, and the quality was assessed using the Quality of Health Economic Studies (QHES) instrument. RESULTS Forty-nine studies were included. The mean (SD) quality score of all studies was 57.83 (25.05), and a high number of reviewed studies (47%) were evaluated as either poor or extremely poor quality. The factors that affect the quality of studies with statistical significance were, the type and method of economic evaluation, the economic outcome was the objective of the research, author`s background, the perspective of the study, health intervention and source of funding. CONCLUSION The use of economic evaluation studies in G.C.C was limited. Different factors that affect the quality of articles such as performing a full economic evaluation and choosing societal perspective were identified. Strategies to improve the quality of future studies were recommended.
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Affiliation(s)
- Islam Eljilany
- a Independent Researcher , Pharmacoeconomics Expert , Qatar
| | - Faris El-Dahiyat
- b College of Pharmacy , Al Ain University of Science and Technology , Al Ain , United Arab Emirates
| | - Louise Elizabeth Curley
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Zaheer-Ud-Din Babar
- c School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand.,d Department of Pharmacy , University of Huddersfield , Huddersfield , United Kingdom
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16
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Zaraket H, Charide R, Kreidieh K, Dbaibo G, Melhem NM. Update on the epidemiology of rotavirus in the Middle East and North Africa. Vaccine 2017; 35:6047-6058. [PMID: 28986034 DOI: 10.1016/j.vaccine.2017.09.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/07/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Rotavirus (RV) is the leading cause of severe acute gastroenteritis (AGE) worldwide. Consequently, we conducted a systematic literature review on articles studying RV in the 25 countries of the MENA region during the past 15years (2000-2015). The methods and reporting were set according to the 2015 preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and based on the elements from the international prospective register of systematic reviews (PROSPERO). Our literature search identified 169 studies meeting our predefined inclusion criteria. Studies reporting on RV were conducted in 19 out of the 24 countries of the MENA region. The largest number of studies was reported in Turkey (n=32), Iran (n=31), Saudi Arabia (n=19) and Egypt (n=17). The majority of studies reporting on RV gastroenteritis rates were clinical observational studies. In 115 studies out of 169, RV was reported among in-patients whereas 35 studies reported RV among outpatients. The predominantly reported RV genotype in the region was G1[P8] followed by G2[P4] and G9[P8]. The majority of studies (n=108) were conducted among children less than 5years of age whereas the remaining studies reported on AGE among other age groups and rarely adults. In MENA countries, RV infection was reported all year round with peaks described in cold as well as hot months. This systematic review provides a current update on the epidemiology of RV-associated gastroenteritis in countries of the MENA region and draws attention to the major gaps existing in the continuous monitoring of RV.
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Affiliation(s)
- Hassan Zaraket
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rana Charide
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Kreidieh
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon; Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nada M Melhem
- Center for Infectious Diseases Research, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Medical Laboratory Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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17
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Zaki A, Abousekkien M, Alkholy UM, Eid A. Effectiveness and impact of rotavirus vaccines in Saudi Arabia: A single hospital-based study. Arab J Gastroenterol 2017; 18:140-143. [DOI: 10.1016/j.ajg.2017.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 05/26/2017] [Accepted: 09/10/2017] [Indexed: 10/18/2022]
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Ahmed MO, Almshawt NF, Elnageh HR. Diarrheagenic Escherichia Coli O157 from Libya: Recent Perspectives and Challenges. J Public Health Afr 2017; 8:685. [PMID: 28890774 PMCID: PMC5585584 DOI: 10.4081/jphia.2017.685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mohamed O Ahmed
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Libya
| | - Nariman F Almshawt
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Libya
| | - Hiam R Elnageh
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Libya
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19
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Monavari SHR, Hadifar S, Mostafaei S, Miri A, Keshavarz M, Babaei F, Moghoofei M. Epidemiology of Rotavirus in the Iranian Children: A Systematic Review and Meta-analysis. J Glob Infect Dis 2017; 9:66-72. [PMID: 28584458 PMCID: PMC5452554 DOI: 10.4103/0974-777x.205173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rotavirus is associated with increased risk for severe diarrhea in infants and young children worldwide. This systematic review and meta-analysis was performed to determine the prevalence rate of rotavirus from different parts of Iran and provide an overall relative frequency (RF) for Iran. We performed a systematic literature review from several databases including PubMed, ISI Web of Science, Scopus, OVID, MAG IRAN, IranMedex, and Iranian Scientific Information Database. We searched the following keywords: "rotavirus," "rotavirus infection," "acute gastroenteritis," "diarrhea," "children," "infant," and "Iran." The purpose of this study was to report the prevalence of rotavirus with the application of meta-analysis. We selected 43 researches out of 1147 for our study. From all the samples, the pooled estimate of prevalence (95% confidence interval) =39.9% (0.396%-0.409%) were rotavirus positive. It should be noted that rotavirus infection's RF varied from 6.4% to 79.3% in Birjand and Tehran Provinces, respectively. Thereupon, it is divergent in different studies. According to our study result, rotavirus RF has a wide range in Iran and is associated with diarrhea in children. Thus, further researches should be taken to minimize the emergence and transmission of rotavirus.
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Affiliation(s)
| | - Shima Hadifar
- Department of Mycobacteriology and Pulmonary Research, Pasteur Institute, Tehran, Iran
| | - Shayan Mostafaei
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Miri
- Department of Nutrition, School of Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohsen Keshavarz
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Babaei
- Department of Microbiology, School of Medicine, Kermanshah University of Medical Science, Kermanshah, Iran
| | - Mohsen Moghoofei
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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20
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Hegazi MA, Sayed MH, Sindi HH, Bekhit OE, El-Deek BS, Alshoudri FMY, Noorelahi AK. Is rotavirus still a major cause for diarrheal illness in hospitalized pediatric patients after rotavirus vaccine introduction in the Saudi national immunization program? Medicine (Baltimore) 2017; 96:e6574. [PMID: 28403085 PMCID: PMC5403082 DOI: 10.1097/md.0000000000006574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous studies in Jeddah, western Saudi Arabia, showed rotavirus (RV) prevalence around 40% in pediatric inpatients with gastroenteritis (GE) with a maximum level during cooler months. Currently, there are no data on impact of rotavirus vaccine (RVV) on RV-GE in Saudi Arabia. Therefore, this study was conducted to assess impact of RVV on incidence and severity of RV-GE in hospitalized pediatric patients; 3 years after introduction of RVV in Saudi immunization program (SIP) in January, 2013.This cross-sectional observational study included GE cases under 5 years of age admitted to 2 tertiary hospitals, in Jeddah, from October to December, 2015. All included GE-cases had RV antigen detection in stool by immunochromatographic assay, complete data collection including RVV status and severity assessment (Vesikari score) in initial admission.During study period, a total of 359 GE cases in children under 5 years of age were hospitalized with 14 (3.9%) RV-GE confirmed cases. Mean age of RV-GE patients was 13.10 ± 5.70 months. All RV cases had severe GE and 1 case received RVV. Among other 345 GE cases, 35.7% did not receive RVV and 46.1% had severe GE. Severe GE (Vesikari score > 11) was more significantly identified among RV-GE cases than in other all-cause GE (P < .001). During same period of this study in 2012, 369 RV-GE out of 1193 total GE cases (31%) were hospitalized at 2 hospitals, so, number of hospitalized pediatric patients for all-cause and RV-GE in children under 5 years of age decreased significantly in 2015 RV season (compared to 2015 RV season, odds ratio for RV-GE in 2012: 11.04, 95% CI: 6.38-19.09).Logistic regression analysis of variables of this cross-sectional, hospital-based study in Jeddah, Saudi Arabia, 3 years after introduction of RVV in SIP, showed that among the studied variables, RVV was associated with remarkable reduction of hazard of all-cause and RV-GE in vaccinated and even in unvaccinated children under 5 years of age possibly by RVV herd effect. However, RV was still associated with severe GE-related hospitalizations in unvaccinated children against RV who were younger than 2 years and particularly in the 1st year of life, indicating need for more optimum rate of RVV coverage. Hopefully, further improvement in RVV coverage rate may make RV-GE a disease of the past in Saudi children.
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Affiliation(s)
- Moustafa Abdelaal Hegazi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
| | - Mohamed Hesham Sayed
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Haifa Hasan Sindi
- Department of Pediatrics, Maternity and Children Hospital (Al-Mossadia), Jeddah, Saudi Arabia
| | - Osama Elsayed Bekhit
- Department of Pediatrics, Faculty of Medicine, Fayoum University, Egypt
- Department of Pediatrics, Hai Al-Jameah Hospital, Jeddah, Saudi Arabia
| | - Basem Salama El-Deek
- Department of Community Medicine and Public Health, Mansoura Faculty of Medicine, Mansoura, Egypt
- Department of Community Medicine and Public Health, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Amroo Khaled Noorelahi
- Department of Pediatrics, Maternity and Children Hospital (Al-Mossadia), Jeddah, Saudi Arabia
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21
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Ali Z, Harastani H, Hammadi M, Reslan L, Ghanem S, Hajar F, Sabra A, Haidar A, Inati A, Rajab M, Fakhouri H, Ghanem B, Baasiri G, Gerbaka B, Zaraket H, Matar GM, Dbaibo G. Rotavirus Genotypes and Vaccine Effectiveness from a Sentinel, Hospital-Based, Surveillance Study for Three Consecutive Rotavirus Seasons in Lebanon. PLoS One 2016; 11:e0161345. [PMID: 27571515 PMCID: PMC5003350 DOI: 10.1371/journal.pone.0161345] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/03/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Globally, rotavirus (RV) is the leading cause of gastroenteritis (GE) in children. Longitudinal data about changes in RV genotype distribution and vaccine effectiveness (VE) are scarce. This study was conducted in Lebanon over 3 consecutive RV seasons to estimate the rate of RVGE hospitalization, identify RV genotypes, determine the seasonal and geographical variations, and calculate RV VE. Materials and Methods This prospective, multicenter, hospital-based surveillance study was conducted between 2011 and 2013 and enrolled children (<5 years) admitted for GE. Socio-demographic and clinical data about the current episode of GE at admission were collected. Genotypes were determined from stool samples testing positive for RV by PCR. Results Of 1,414 cases included in the final analysis, 83% were <2 years old and 55.6% were boys. Median duration of hospitalization was 4 days and 91.6% of GE cases were severe (Vesikari score ≥11). PCR testing showed that 30.3% of subjects were RV-positive of which 62.1% had fever versus 71.1% of RV-negative subjects (P = 0.001). RV was predominantly detected in the cold season from November till March (69.9%). G and P genotype pairs for all RV-positive stool specimens showed a predominance of G1P[8] in 36% (n = 154) of specimens, G9P[8] in 26.4% (n = 113), and G2P[4] in 17.8% (n = 76). RV-negative subjects were more likely to be RV-vaccinated (21%) compared to the RV-positive subjects (11.3%) (P<0.001), with a vaccine breakthrough rate of 18.8%. The ratio of RV1-vaccinated for each RV5-vaccinated subject was 7.8 and VE against RV disease was 68.4% (95%CI, 49.6%-80.2%). Conclusion RV is a major cause of GE requiring hospitalization of children under 5 years of age in Lebanon. A few genotypes predominated over the three RV seasons studied. Mass RV vaccination will likely decrease the burden of hospitalization due to RV. VE is similar to what has been observed for other middle-income countries.
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Affiliation(s)
- Zainab Ali
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Houda Harastani
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Moza Hammadi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Lina Reslan
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Soha Ghanem
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Farah Hajar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Ahmad Sabra
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Amjad Haidar
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | - Adlette Inati
- Department of Pediatrics, Nini Hospital, Tripoli, Lebanon
| | - Mariam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Hassan Fakhouri
- Department of Pediatrics, Rafic Hariri University Hospital, Beirut, Lebanon
| | - Bassam Ghanem
- Department of Pediatrics, Nabatieh Governmental Hospital, Nabatieh, Lebanon
| | | | - Bernard Gerbaka
- Department of Pediatrics, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Hassan Zaraket
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghassan M. Matar
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Center for Infectious Diseases Research, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Faculty of Medicine, Beirut, Lebanon
- * E-mail: ;
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22
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Direct effect of infliximab on intestinal mucosa sustains mucosal healing: exploring new mechanisms of action. Dig Liver Dis 2016; 48:391-8. [PMID: 26804809 DOI: 10.1016/j.dld.2015.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infliximab is effective in inflammatory bowel disease through several mechanisms, possibly acting at the mucosal level. AIM To assess the role of infliximab on intestinal mucosa and whether it contributes to mucosal healing. METHODS Human colonic mucosal biopsies were incubated with or without infliximab. Cultured biopsies were evaluated for histological staining, CD68, CD3, E-cadherin and phospho-extracellular signal-regulated kinases (ERK) expression, and apoptosis. A scratch assay and MTT assay were performed with Caco2 cells in the presence of infliximab and/or tumour necrosis factor (TNF)-α or treated with supernatants obtained from human peripheral blood mononuclear cells or human intestinal fibroblasts treated with TNF-α and infliximab alone or in association. RESULTS Infliximab-treated biopsies displayed a better histological appearance, reduced inflammation with an increase of E-cadherin, phospho-ERK and apoptosis. Supernatants showed lower TNF-α, IL-17, IL-6 and IL-8 concentration, with an increase in fibroblast-growth-factor. Motility at scratch assay and proliferation at MTT assay of Caco2 cells displayed differential modulation by TNF-α and infliximab, directly or through supernatants of human intestinal fibroblasts and human peripheral blood mononuclear cells exposed to them. CONCLUSION Infliximab contributes to the mucosal healing process by acting directly at an intestinal mucosal level; infliximab indirectly affects epithelial cell migration and proliferation by acting on both fibroblasts and leukocytes.
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Mousavi Jarrahi Y, Zahraei SM, Sadigh N, Esmaeelpoor Langeroudy K, Khodadost M, Ranjbaran M, Sanjari Moghaddam A, Besharat M, Mosavi Jarrahi A. The cost effectiveness of rotavirus vaccination in Iran. Hum Vaccin Immunother 2016; 12:794-800. [PMID: 26360331 PMCID: PMC4964645 DOI: 10.1080/21645515.2015.1087626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/07/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022] Open
Abstract
Rotavirus is the most common cause of severe diarrhea leading to hospitalization or disease-specific death among young children. Effective vaccines have recently been approved and successful vaccination program implemented. The aim of this study was to evaluate the cost effectiveness of mass rotavirus vaccination program in Iran. We developed a Markov model that reflects key features of rotavirus natural history. Parameters of the model were assessed by field study or developed through literature search and published data. We applied the model to the 2009 Iranian birth cohort and evaluated the cost-effectiveness of including the rotavirus vaccine (Rotarix®) into Iranian expanded immunization program (EPI). With an estimated hospitalization rate of 0.05 and outpatient rate of 0.23 cases per person-year, vaccinating cohort of 1231735 infants in Iran with 2 doses of (Rotarix®), would prevent 32092 hospitalizations, 158750 outpatient visits, and 1591 deaths during 5 y of follow-up. Under base-case assumption of $10 cost per course of vaccine, the vaccination would incur an extra cost of $1,019,192 from health care perspective and would avert 54680 DALYs. From societal perspective, there would be $15,192,568 saving for the society with the same averted DALYs. The incremental cost effectiveness ratio showed a cost of $19 US dollars per averted DALY from health care perspective and a saving of $278 US dollars for each averted DALY from societal perspective. Introducing rotavirus vaccine into EPI program would be highly cost-effective public health intervention in Iran.
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Affiliation(s)
| | - Seyed Mohsen Zahraei
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Nader Sadigh
- Kermanshah University of Medical Sciences, Kemanshah, Iran
| | | | - Mahmoud Khodadost
- Department of Epidemiology, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mehdi Ranjbaran
- Department of Epidemiology, Faculty of Health, Arak University of Medical Sciences, Arak, Iran
| | - Ali Sanjari Moghaddam
- Medical School, Shahid Beheshti Univesrsity of Medical Sciences and Health Services, Tehran, Iran
| | - Mehdi Besharat
- Medical School, Shahid Beheshti Univesrsity of Medical Sciences and Health Services, Tehran, Iran
| | - Alireza Mosavi Jarrahi
- Medical School, Shahid Beheshti Univesrsity of Medical Sciences and Health Services, Tehran, Iran
- Faculty of Health Sciences, Simon Fraser University, BC, Canada
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Mayindou G, Ngokana B, Sidibé A, Moundélé V, Koukouikila-Koussounda F, Christevy Vouvoungui J, Kwedi Nolna S, Velavan TP, Ntoumi F. Molecular epidemiology and surveillance of circulating rotavirus and adenovirus in Congolese children with gastroenteritis. J Med Virol 2015; 88:596-605. [DOI: 10.1002/jmv.24382] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 01/21/2023]
Affiliation(s)
- Gontran Mayindou
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Berge Ngokana
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Anissa Sidibé
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Victoire Moundélé
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Felix Koukouikila-Koussounda
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Jeannhey Christevy Vouvoungui
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
| | - Sylvie Kwedi Nolna
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Capacity for Leadership Excellence and Research; Yaoundé Cameroon
| | - Thirumalaisamy P. Velavan
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Institute for Tropical Medicine; University of Tübingen; Tübingen Germany
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale; Brazzaville Republic of Congo
- Faculty of Health Sciences; Marien Ngouabi University; Brazzaville Republic of Congo
- Institute for Tropical Medicine; University of Tübingen; Tübingen Germany
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Shoeib ARS, Hull JJ, Jiang B. Rotavirus G and P types in children with acute diarrhea in Cairo, Egypt, 2011-2012. J Egypt Public Health Assoc 2015; 90:121-124. [PMID: 26544841 DOI: 10.1097/01.epx.0000470849.84604.13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The WHO estimated the annual rotavirus-related mortality among children below 5 years old in Egypt in 2004 to be 30 deaths per 100 000, or out of an estimated 2616 deaths, 3.9% were because of rotavirus infection. The aim of this article was to study the epidemiology and circulating genotypes of rotaviruses in Cairo from 2011 to 2012. MATERIALS AND METHODS A total of 197 stool samples were collected from 130 inpatient children at the Cairo University Children Hospital and 67 outpatient children at the Al-Saff Children Clinic. The collected stool samples were then screened for rotavirus using enzyme immunoassay, followed by a screening for G-type and P-type using RT-PCR, and confirmation by sequence analysis. RESULTS Rotavirus was detected in 39.1% (77/197) of the children, with a higher rate in inpatients (43.9%, 57/130) than in outpatients (29.9%, 20/67). There was an increase of rotavirus infection in the winter season. The majority of rotavirus cases (85.7%) occurred during the first year of life. The predominant genotypes identified during this study were G3P[8] (37.7%) and G1P[8] (19.5%), but uncommon genotypes G1P[6] (3.9%), G9P[6] (1.3%), G8P[14] (1.3%), and G12P[6] (2.6%) were also detected. CONCLUSION AND RECOMMENDATIONS The change in genotype distribution, compared with previous studies, along with the high burden of rotavirus-associated diarrhea among Egyptian children below 2 years old, emphasizes the importance of continuing strain surveillance and the need of developing and introducing rotavirus vaccine in Egypt.
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Affiliation(s)
- Ashraf R S Shoeib
- aEnvironmental Virology Laboratory, Department of Water Pollution Research, National Research Centre, Giza, Egypt bGastroenteritis and Respiratory Viruses Laboratory Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention 'CDC', Atlanta, Georgia, USA
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Howidi M, Balhaj G, Yaseen H, Gopala K, Van Doorn LJ, DeAntonio R. Burden and genotyping of rotavirus disease in the United Arab Emirates: a multicenter hospital-based surveillance. Hum Vaccin Immunother 2015; 10:2284-9. [PMID: 25424933 DOI: 10.4161/hv.29386] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rotavirus (RV) is the most common etiological agent causing acute gastroenteritis (GE) in children aged <5 years. This cross-sectional, hospital-based surveillance study (NCT01201252) was designed to investigate RVGE disease burden. It was conducted from July 2009-July 2010 at 3 referral hospitals in the United Arab Emirates (UAE). Children who had been hospitalized for acute GE were enrolled with informed consent. Stool samples were tested for RV using enzyme immunoassay and RV-positive samples were further typed using reverse transcriptase-polymerase chain reaction and reverse hybridization to determine the G and P types. GE data were collected from medical charts and GE severity was assessed through clinical examination. Treatment and outcome were prospectively recorded. Among 6323 children hospitalized due to any reason, 771 (12.2%) presented acute GE and were enrolled, of whom 758 (98.3%) were included in the final analysis. Acute GE and RVGE accounted for 12.0% (758/6323) and 6.0% (381/6323) of all hospitalizations, respectively. RVGE accounted for 50.3% (381/758) of GE hospitalizations and predominantly affected, children younger than 2 years (66.1%; 252/381). The severity of GE before hospitalization was significantly associated with RV-positive status (P = 0.0031). The majority (>95%) of children received intravenous hydration during hospitalization. RVGE occurred throughout the year, with a subtle winter peak in February 2010 (63.6%; 56/88). G1WTP[8]WT was the most commonly detected RV strain (56.3%) in 268 analyzed samples. RV was a major cause of GE-hospitalizations in children under 5 years in the UAE; the highest number of RVGE cases was observed in children younger than 2 years.
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Aly M, Al Khairy A, Al Johani S, Balkhy H. Unusual rotavirus genotypes among children with acute diarrhea in Saudi Arabia. BMC Infect Dis 2015; 15:192. [PMID: 25884670 PMCID: PMC4407833 DOI: 10.1186/s12879-015-0923-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 04/01/2015] [Indexed: 02/08/2023] Open
Abstract
Background Human rotavirus A (human RV-A) is the most common cause of viral gastroenteritis in infants. The objective of the study was to characterize the G and P genotypes among clinical rotavirus isolates from children with acute diarrhea admitted to a tertiary care hospital in Riyadh, Saudi Arabia. Methods From 2011 to 2012, 541 pediatric patients with acute diarrhea were tested for rotavirus infection. RNA extractions from the fecal specimens were done by commercial kit. RT-PCR and sequencing techniques were used to detect the prevalent genotypes. Phylogenetic analysis by Maximum Likelihood method was used to study the clustering of the circulating genotypes. Results The data showed that 171/541 (31.6%) faecal samples were positive for human RVA and majority were children aged below 2 years. From the G and P [types] detected it was seen that (a) 171 minus 43 ie. 128 rotavirus positives were G typed successfully (b) 171 minus 20 ie. 151 rotavirus positives were P typed successfully; (c) overall G [P] nature was determined for 113 rotavirus positives out of 171. VP4 genotyping showed that majority of the positives 146/151 (96.7%) were P [8]; 4/151 (2.6%) were P [4]; 1/151 (0.66%) was P [6]. The dominant strains included G1P [8] 70/113 (61.9%); G9P [8] 19/113 (16.8%); G12P [8] 7/113 (6.2%) and G3P [8] 5/113 (4.4%) while the uncommon strains detected from Saudi Arabia during the study were G1P [4] 1/113 (0.88%) and G12P [6] 1/113 (0.88%). Phylogenetic tree, based on VP4/VP7 sequence analysis, revealed that G1P [8] was distinctly related to homologous strains included in human RV-A vaccine strains. Nevertheless, the uncommon genotypes G1P [4] and G12P [6] were clustered with isolates from other countries such as Bangladesh, China, Japan, Thailand and Philippines. Conclusions More studies will be required to further focus on newly emerging genotypes in our region together with the seasonality of rotavirus infection in the region, especially after January 2013 when the rotavirus vaccination has become part of routine childhood immunizations.
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Affiliation(s)
- Mahmoud Aly
- King Abdullah International Medical Research Centre, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Aisha Al Khairy
- King Abdullah International Medical Research Centre, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia.
| | - Sameera Al Johani
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Microbiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
| | - Hanan Balkhy
- King Abdullah International Medical Research Centre, P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
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Mohamed MS, Abd El-Hameed RH, Sayed AI, Soror SH. Novel antiviral compounds against gastroenteric viral infections. Arch Pharm (Weinheim) 2015; 348:194-205. [PMID: 25704120 DOI: 10.1002/ardp.201400387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 12/24/2014] [Accepted: 01/09/2015] [Indexed: 11/07/2022]
Abstract
Viral gastroenteritis is a serious viral infection which affects a large number of individuals around the world, most of them being children. The infection may occur due to different viruses, for example, coxsackievirus, adenovirus, and rotavirus. There is no available cure for such infections, and the treatment mainly depends on hospitalization and administration of nutritional supports. A new antiviral agent against gastroenteritis viral infection will be a breakthrough in healthcare. Pyrrole and pyrrolopyrimidine derivatives are well known for their biological activity as antibacterial, antifungal, and anticancer agents. These compounds also proved to possess antiviral activity. Here, we synthesized novel pyrrole and pyrrolopyrimidine compounds and examined their antiviral activity. We synthesized several new pyrrole, pyrrolo[2,3-d]pyrimidine, and pyrrolo[3,2-e][1,2,4]triazolo[1,5-c]pyrimidine derivatives. The characterization of all synthesized compounds was based on microanalysis and spectral data. Moreover, we determined the non-toxic doses of these compounds on BGM, Hep-2, and MA-104 cells. We tested all the synthesized compounds for their antiviral activities against coxsackievirus B4, adenovirus type 7, and rotavirus Wa strain. Several compounds exhibited significant activities as antiviral agents.
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Affiliation(s)
- Mosaad S Mohamed
- Pharmaceutical Organic Chemistry Department, Faculty of Pharmacy, Helwan University, Ain Helwan, Helwan, Egypt
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Khalil M, Azhar E, Kao M, Al-Kaiedi N, Alhani H, Al Olayan I, Pawinski R, Gopala K, Kandeil W, Anis S, Van Doorn LJ, DeAntonio R. Gastroenteritis attributable to rotavirus in hospitalized Saudi Arabian children in the period 2007-2008. Clin Epidemiol 2015; 7:129-37. [PMID: 25709500 PMCID: PMC4334312 DOI: 10.2147/clep.s69502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Rotavirus (RV) is a leading cause of severe gastroenteritis (GE) in children across the world. As there is a lack of epidemiological data for RV gastroenteritis (RVGE) in Saudi Arabia, this hospital-based study was designed to estimate the disease burden of RVGE and assess the prevalent RV types in Saudi children younger than 5 years of age. Patients and methods Children hospitalized for acute GE were enrolled at four pediatric referral hospitals in Saudi Arabia. The study was conducted from February 2007 to March 2008 and used the World Health Organization’s generic protocol for RVGE surveillance. The Vesikari severity scale was used to assess the severity of RVGE. Stool samples were tested for RV using an enzyme-linked immunosorbent assay. Samples were further typed by reverse transcriptase–polymerase chain reaction and hybridization assay for determining the G and P types. Results A total of 1,007 children were enrolled; the final analysis included 970 children, of whom 395 were RV positive, 568 were RV negative, and seven had unknown RV status. The proportion of RVGE among GE hospitalizations was 40.7% (95% confidence interval: 37.6–43.9). The highest percentage of RVGE hospitalizations (83.1%) was seen in children younger than 2 years of age. The highest proportion of RV among GE hospitalizations was in June 2007 with 57.1%. The most common RV types detected were G1P[8] (49.3%), G1G9P[8] (13.2%), and G9P[8] (9.6%). Before hospitalization, severe GE episodes occurred in 88.1% RV-positive and 79.6% RV-negative children. Overall, 94% children had recovered by the time they were discharged. Two children (one RV positive and one RV negative) died due to GE complications. Conclusion RVGE is responsible for a high proportion of hospitalizations in Saudi children younger than 5 years of age. Routine RV vaccination has therefore been introduced into the national immunization program and may help reduce the morbidity, mortality, and disease burden associated with RVGE in Saudi Arabia.
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Affiliation(s)
- Mohamed Khalil
- Public Health and Research Development, Ministry of Health, Riyadh, Saudi Arabia
| | - Esam Azhar
- Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia ; Special Infectious Agents Unit, Bio-Safety Level 3, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Moujahed Kao
- Special Infectious Agents Unit, Bio-Safety Level 3, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Noura Al-Kaiedi
- Special Infectious Agents Unit, Bio-Safety Level 3, King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatim Alhani
- Maternity and Children's Hospital, Dammam, Saudi Arabia
| | | | - Robert Pawinski
- Reckitt Benckiser Pharmaceuticals, Slough, UK ; GlaxoSmithKline Vaccines, Wavre, Belgium
| | - Kusuma Gopala
- GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, Karnataka, India
| | | | - Sameh Anis
- GlaxoSmithKline Vaccines, Wavre, Belgium ; AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
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Alkoshi S, Maimaiti N, Dahlui M. Cost-effectiveness analysis of rotavirus vaccination among Libyan children using a simple economic model. Libyan J Med 2014; 9:26236. [PMID: 25499622 PMCID: PMC4262756 DOI: 10.3402/ljm.v9.26236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rotavirus infection is a major cause of childhood diarrhea in Libya. The objective of this study is to evaluate the cost-effectiveness of rotavirus vaccination in that country. METHODS We used a published decision tree model that has been adapted to the Libyan situation to analyze a birth cohort of 160,000 children. The evaluation of diarrhea events in three public hospitals helped to estimate the rotavirus burden. The economic analysis was done from two perspectives: health care provider and societal. Univariate sensitivity analyses were conducted to assess uncertainty in some values of the variables selected. RESULTS The three hospitals received 545 diarrhea patients aged≤5 with 311 (57%) rotavirus positive test results during a 9-month period. The societal cost for treatment of a case of rotavirus diarrhea was estimated at US$ 661/event. The incremental cost-effectiveness ratio with a vaccine price of US$ 27 per course was US$ 8,972 per quality-adjusted life year gained from the health care perspective. From a societal perspective, the analysis shows cost savings of around US$ 16 per child. CONCLUSION The model shows that rotavirus vaccination could be economically a very attractive intervention in Libya.
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Affiliation(s)
- Salem Alkoshi
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
| | - Namaitijiang Maimaiti
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Wangchuk S, Dorji T, Tsheten, Tshering K, Zangmo S, Pem Tshering K, Dorji T, Nishizono A, Ahmed K. A Prospective Hospital-based Surveillance to Estimate Rotavirus Disease Burden in Bhutanese Children under 5 Years of Age. Trop Med Health 2014; 43:63-8. [PMID: 25859154 PMCID: PMC4361340 DOI: 10.2149/tmh.2014-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/06/2014] [Indexed: 11/18/2022] Open
Abstract
As part of efforts to develop an informed policy for rotavirus vaccination, this prospective study was conducted to estimate the burden of rotavirus diarrhea among children less than 5 years old attended to the Department of Pediatrics, Jigme Dorji Wangchuk National Referral Hospital (JDWNRH), Thimphu, Bhutan. The duration of the study was three years, extending from February 2010 through December 2012. We estimated the frequency of hospitalization in the pediatric ward and dehydration treatment unit (DTU) for diarrhea and the number of events attributable to rotavirus infection among children under 5 years of age. During the study period, a total of 284 children (1 in 45) were hospitalized in the pediatric ward, and 2,220 (1 in 6) in the DTU with diarrhea among children residing in the Thimphu district. Group A rotavirus was detected in 32.5% and 18.8% of the stool samples from children hospitalized in the pediatric ward, respectively. Overall, 22.3% of the stool samples were rotavirus-positive, and the majority (90.8%) of them was detected in children under 2 years of age. From this study, we estimated that the annual incidence of hospitalization in the pediatric ward and DTU due to rotavirus diarrhea was 2.4/1000 (95% CI 1.7–3.4) and 10.8/1000 (95% CI 9.1–12.7) children, respectively. This study revealed that rotavirus is a major cause of diarrhea in Bhutanese children in Thimphu district and since no study has been performed previously, represents an important finding for policy discussions regarding the adoption of a rotavirus vaccine in Bhutan.
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Affiliation(s)
- Sonam Wangchuk
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Tshering Dorji
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Tsheten
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Karchung Tshering
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Sangay Zangmo
- Public Health Laboratory, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Kunzang Pem Tshering
- Department of Pediatrics, Jigme Dorji Wangchuk National Referral Hospital , Thimphu, Bhutan
| | - Tandin Dorji
- Communicable Disease Division, Department of Public Health, Ministry of Health, Royal Government of Bhutan , Thimphu, Bhutan
| | - Akira Nishizono
- Department of Microbiology, Faculty of Medicine, Oita University , Yufu, Oita, Japan
| | - Kamruddin Ahmed
- Department of Microbiology, Faculty of Medicine, Oita University , Yufu, Oita, Japan ; Research Promotion Institute, Oita University , Yufu, Oita, Japan
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Moradi-Lakeh M, Shakerian S, Yaghoubi M, Esteghamati A, Shokraneh F, Baradaran HR, Ghanaee RM. Rotavirus Infection in Children with Acute Gastroenteritis in Iran: A Systematic Review and Meta-analysis. Int J Prev Med 2014; 5:1213-23. [PMID: 25400878 PMCID: PMC4223939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/06/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data. METHODS We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests. RESULTS A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively. CONCLUSIONS This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran.
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Affiliation(s)
- Maziar Moradi-Lakeh
- Department of Community Medicine, Gastro-Intestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran,Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sareh Shakerian
- Department of Educational Management, Economics and policy, School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran,Correspondence to: Dr. Sareh Shakerian, School of Medical Education, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran.
| | - Mohsen Yaghoubi
- Department of Community Medicine, Clinical Knowledge Management Unit, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdoulreza Esteghamati
- Department of Pediatrics, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Frahad Shokraneh
- Cochrane Schizophrenia Group, Institute of Mental Health, A Partnership Between The University of Nottingham and Nottinghamshire Healthcare NHS Trust, UK
| | - Hamid-Reza Baradaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Science, Iran University of Medical Sciences, Tehran, Iran
| | - Roxana Mansour Ghanaee
- Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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ALKOSHI S, ERNST K, MAIMAITI N, DAHLUI M. Rota Viral Infection: A Significant Disease Burden to Libya. IRANIAN JOURNAL OF PUBLIC HEALTH 2014; 43:1356-63. [PMID: 26060697 PMCID: PMC4441888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/10/2014] [Indexed: 11/01/2022]
Abstract
BACKGROUND Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children. METHODS A cross-sectional study was carried out prospectively among children 5 years old and below between August 2012 and April 2013. Stool samples of children with diarrhea attending the outpatient department or admitted to the pediatric wards, at three public hospitals within the northwestern region of Libya were tested for rotavirus. The seasonality, symptomology demographics and outcomes of rotavirus cases were determined and compared to other diarrhea illnesses. An estimated incidence rate per 100,000 children aged 5 years and below was determined. RESULTS A total of 545 children with diarrhea were identified for participation. Results of rotavirus immunoassays determined 57% of cases were caused by rotavirus. Inpatients were more likely to be rotavirus positive than outpatients (58% vs. 53%, P<0.05), Most rotavirus positive cases (86%) were found among children below 2 years of age. Rotaviral cases peaked in the winter, constituting 76% of diarrheal illness in February and very few rotavirus cases in the summer months. The incidence rate of rotavirus diarrhea was estimated at 640/100,000 children aged 5 years and below. CONCLUSION Rotavirus infection poses a significant disease burden in Libya. Preventive measures such as proper hygiene should be emphasized. Introduction of vaccination against rotavirus into the national immunization program should be examined, as it would likely be a cost-effective investment.
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Affiliation(s)
- Salem ALKOSHI
- 1. Dept. of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,* Corresponding Author:
| | - Kacey ERNST
- 2. Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, the University of Arizona, Tucson, Arizona State, USA
| | - Namaitijiang MAIMAITI
- 3. International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Maznah DAHLUI
- 1. Dept. of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Review of global rotavirus strain prevalence data from six years post vaccine licensure surveillance: is there evidence of strain selection from vaccine pressure? INFECTION GENETICS AND EVOLUTION 2014; 28:446-61. [PMID: 25224179 DOI: 10.1016/j.meegid.2014.08.017] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/13/2014] [Accepted: 08/14/2014] [Indexed: 11/23/2022]
Abstract
Comprehensive reviews of pre licensure rotavirus strain prevalence data indicated the global importance of six rotavirus genotypes, G1P[8], G2P[4], G3P[8], G4P[8], G9P[8] and G12P[8]. Since 2006, two vaccines, the monovalent Rotarix (RV1) and the pentavalent RotaTeq (RV5) have been available in over 100 countries worldwide. Of these, 60 countries have already introduced either RV1 or RV5 in their national immunization programs. Post licensure vaccine effectiveness is closely monitored worldwide. This review aimed at describing the global changes in rotavirus strain prevalence over time. The genotype distribution of the nearly 47,000 strains that were characterized during 2007-2012 showed similar picture to that seen in the preceding period. An intriguing finding was the transient predominance of heterotypic strains, mainly in countries using RV1. Unusual and novel antigen combinations continue to emerge, including some causing local outbreaks, even in vaccinated populations. In addition, vaccine strains have been found in both vaccinated infants and their contacts and there is evidence for genetic interaction between vaccine and wild-type strains. In conclusion, the post-vaccine introduction strain prevalence data do not show any consistent pattern indicative of selection pressure resulting from vaccine use, although the increased detection rate of heterotypic G2P[4] strains in some countries following RV1 vaccination is unusual and this issue requires further monitoring.
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Association between norovirus and rotavirus infection and histo-blood group antigen types in Vietnamese children. J Clin Microbiol 2014; 52:1366-74. [PMID: 24523471 DOI: 10.1128/jcm.02927-13] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Norovirus and rotavirus are the two most important causes of acute gastroenteritis in children worldwide. Both norovirus and rotavirus recognize human histo-blood group antigens (HBGAs), and multiple binding patterns for HBGAs have been reported. To explore the role of HBGAs in host susceptibility to norovirus and rotavirus, we conducted a cross-sectional study in children hospitalized with diarrhea in northern Vietnam from September 2010 through September 2012. Of 260 children with paired stool and saliva samples, 158 (61%) were classified as HBGA secretors (Lea-b+), 31 (12%) were nonsecretors (Lea+b-), and 71 (27%) were partial secretors (Lea+b+). Norovirus was detected in 50 patients (19%), with viral genotypes GII.3 (n=28) and GII.4 (n=22) being the most common. All children infected with norovirus strains of genotype GII.4 were either HBGA secretors or partial secretors. Of the 28 GII.3 cases, 12 involved HBGA secretors, 11 partial secretors, and 5 nonsecretors. A total of 85 children tested positive for rotavirus, 74 of whom were infected with genotype P[8], 5 with P[4], and 6 with P[6]; all were HBGA secretors or partial secretors. This is the first epidemiological study demonstrating in a population that HBGA phenotype is a key susceptibility factor for both norovirus and rotavirus infections in children.
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Akoua-Koffi C, Asse Kouadio V, Yao Atteby JJ. Hospital-based surveillance of rotavirus gastroenteritis among children under 5 years of age in the Republic of Ivory Coast: a cross-sectional study. BMJ Open 2014; 4:e003269. [PMID: 24486676 PMCID: PMC3913025 DOI: 10.1136/bmjopen-2013-003269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the proportion of rotavirus gastroenteritis (RVGE) among children aged less than 5 years who had been diagnosed with acute gastroenteritis (AGE) and admitted to hospitals and emergency rooms (ERs). The seasonal distribution of RVGE and most prevalent rotavirus (RV) strains was also assessed. DESIGN A cross-sectional hospital-based surveillance study. SETTING 5 reference paediatric hospitals across Abidjan. PARTICIPANTS Children aged less than 5 years, who were hospitalised/visiting ERs for WHO-defined AGE, were enrolled. Written informed consent was obtained from parents/guardians before enrolment. Children who acquired nosocomial infection were excluded from the study. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of RVGE among AGE hospitalisations and ER visits was expressed with 95% exact CI. Stool samples were collected from all enrolled children and were tested for the presence of RV using an enzyme immunoassay. RV-positive samples were serotyped using reverse transcriptase-PCR. RESULTS Of 357 enrolled children (mean age 13.6±11.14 months), 332 were included in the final analyses; 56.3% (187/332) were hospitalised and 43.7% (145/332) were admitted to ERs. The proportion of RVGE hospitalisations and ER visits among all AGE cases was 30.1% (95% CI 23.6% to 37.3%) and 26.9% (95% CI 19.9% to 34.9%), respectively. Ninety-five children (28.6%) were RV positive; the highest number of RVGE cases was observed in children aged 6-11 months. The number of GE cases peaked in July and August 2008; the highest percentage of RV-positive cases was observed in January 2008. G1P[8] wild-type and G8P[6] were the most commonly detected strains. CONCLUSIONS RVGE causes substantial morbidity among children under 5 years of age and remains a health concern in the Republic of Ivory Coast, where implementation of prevention strategies such as vaccination might help to reduce disease burden.
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Affiliation(s)
- Chantal Akoua-Koffi
- Pasteur Institute of Ivory Coast/Medical Sciences Training and Research Unit of Bouake, Abidjan, Republic of Ivory Coast
| | - Vincent Asse Kouadio
- Medical Pediatrics Department, Northern Abobo Hospital, Abidjan, Republic of Ivory Coast
| | - Jean Jacques Yao Atteby
- Department of Pediatrics, University Teaching Hospital of Treichville/Medical Sciences Training and Research Unit of Abidjan, Abidjan, Republic of Ivory Coast
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Severe acute rotavirus gastroenteritis in children less than 5 years in southern Ghana: 2006-2011. Pediatr Infect Dis J 2014; 33 Suppl 1:S9-S13. [PMID: 24343622 DOI: 10.1097/inf.0000000000000045] [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: 11/26/2022]
Abstract
BACKGROUND Rotavirus is a major cause of acute gastroenteritis (AGE) globally. Local data on disease burden will guide recommendations for rotavirus vaccination and monitoring impact of the intervention. METHODS Prospective surveillance for rotavirus gastroenteritis was conducted in 3 hospitals in southern Ghana during the period August 2006 to December 2011, as part of the African Rotavirus Surveillance Network. Clinical data and stool specimens were collected from children <5 years of age and hospitalized with AGE (defined as 3 or more watery stools for up to 7 days). Stool was tested for rotavirus by enzyme immunoassay and rotavirus genotype identified by reverse-transcriptase polymerase chain reaction. RESULTS We tested 3044 stool samples from 3939 children. Rotavirus was detected in 45.6%, 51.3% and 48.5% of cases at the primary, secondary and tertiary care hospital, respectively. Both genders were equally affected; 75% (2954/3939) of the cohort were aged 3-18 months. Overall, rotavirus was detected in 49.4% (1504/3044) of cases, caused over 30% of AGE hospitalizations all year round and up to 70% of cases during peak seasons. Peak season occurred during cool dry months in 2008, 2010 and 2011 and the rainy season in 2009. Mortality from AGE occurred in 1.5% (45/3044) of cases and 48.9% (22/45) of these were rotavirus positive. CONCLUSIONS Rotavirus causes significant morbidity and mortality in young Ghanaian children. As Ghana introduced rotavirus vaccination in the national immunization program in 2012, continued surveillance is required to monitor the impact of this intervention.
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Magzoub MA, Bilal NE, Bilal JA, Osman OF. Rotavirus infection among Sudanese children younger than 5 years of age: a cross sectional hospital-based study. Pan Afr Med J 2013; 16:88. [PMID: 24711878 PMCID: PMC3976662 DOI: 10.11604/pamj.2013.16.88.2519] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 11/04/2013] [Indexed: 02/05/2023] Open
Abstract
Introduction In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Rotavirus A is well known as the leading cause of diarrhea in young children worldwide. It was estimated to account for 41% of hospitalized cases of acute gastroenteritis among children in Sub-Saharan Africa. This study aimed to determine the prevalence and the common clinical presentations of rotavirus A infection among Sudanese children with gastroenteritis seeking management in hospitals. Methods 755 Sudanese children less than 5 years of age suffering from acute gastroenteritis in hospital settings were included. The positive stool specimens for rotavirus A was used for extract Ribonucleic acid (RNA) and the RNA product was loaded on formaldehyde agarose gel and visualized under UV illumination. Results Of the 755 children, 430(57%) were males while 325(43%) were female. The age of children ranged from 1 to 60 months. There were 631 (84%) children who were less than 24 months of age. Out of the 755 stool samples, 121(16%) were positive for rotavirus. Of the 121 infected children with rotavirus, 79(65.3%) were male and 42(34.7%) were female and the highest infection rate was seen among 91(75.2%) of children up to 12 months of age. Children of illiterate parents were more infected with rotavirus than children of educated parents. Severe dehydration present among 70% of infected children with rotavirus. Conclusion Since this study is hospital-based, the 16% prevalence rate may not reflect the true prevalence among Sudanese children, thus a community-based surveillance is needed.
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Affiliation(s)
| | - Naser Eldin Bilal
- Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Khartoum University P.O. Box 11081, Khartoum, Sudan
| | - Jalal Ali Bilal
- Pediatric Department, college of Medicine, Qassim University, P.O. Box 6699 Buraydah 51452, Saudi Arabia
| | - Omran Fadl Osman
- Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Khartoum University P.O. Box 11081, Khartoum, Sudan
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Musawi MA, Zainaldeen H, Shafi F, Anis S, Deantonio R. Rotavirus gastroenteritis in children under 5 years in the Kingdom of Bahrain: hospital-based surveillance. Clin Epidemiol 2013; 5:269-75. [PMID: 23950659 PMCID: PMC3741035 DOI: 10.2147/clep.s46822] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Rotavirus (RV) is the leading cause of morbidity and mortality in children under 5 years of age worldwide. This study assessed the role of RV as a cause of gastroenteritis (GE)-associated hospitalization in children, generating baseline information to evaluate the potential impact of the RV vaccine in reducing RVGE disease burden in the Kingdom of Bahrain. Methods This single, pediatric hospital-based surveillance study was conducted over a period of 12 months beginning April 1, 2006. A total of 314 children aged under 5 years and hospitalized due to GE were enrolled in the study, following collection of written informed consent from parents/guardians. Stool samples were tested for the presence of RV using enzyme immunoassay, and a random subset of RV-positive samples was further genotyped using reverse transcriptase-polymerase chain reaction and reverse hybridization assay. Results Of 314 enrolled children, 239 were included in the final analysis. RV was detected in 107 children (44.8%), mostly in the 6–23 months age group (82/107; 76.6%). RVGE occurred throughout the year, with the highest proportion occurring during April (26/42; 61.9%). G1P[8[ was the most commonly detected RV strain (10/17; 58.8%) in the limited number of samples analyzed. Vomiting and severe RVGE were more commonly observed in RV-positive than RV-negative children before hospitalization (P = 0.0008 and 0.0204, respectively). Conclusion In our study, RV accounted for over 40% of GE-associated hospitalizations and particularly affected children under 2 years of age. These data will serve as a baseline for assessing the potential changes in the epidemiology of RV disease and for evaluating the potential impact of the introduction of RV vaccination.
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Affiliation(s)
- Muna Al Musawi
- Public Health Directorate, Ministry of Health, Manama, the Kingdom of Bahrain
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Al-Thani A, Baris M, Al-Lawati N, Al-Dhahry S. Characterising the aetiology of severe acute gastroenteritis among patients visiting a hospital in Qatar using real-time polymerase chain reaction. BMC Infect Dis 2013; 13:329. [PMID: 23865805 PMCID: PMC3734054 DOI: 10.1186/1471-2334-13-329] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 07/05/2013] [Indexed: 12/13/2022] Open
Abstract
Background Acute gastroenteritis (AGE) remains a common cause of clinic visits and hospitalizations, though its aetiology has not been determined in Qatar. Methods We performed a prospective, emergency department–based study of 288 children and adults with AGE. Stool specimens were collected at presentation from June to November 2009. Faecal specimens were tested, using real-time PCR, for a panel of four viral (norovirus, adenovirus, astrovirus and rotavirus) and bacterial pathogens. Results Viral and bacterial pathogens were detected in 131 (45.5%) and 34 (12.2%) of the 288 patients recruited. The most commonly detected pathogens were norovirus (28.5%), rotavirus (10.4%), followed by adenovirus (6.25%) and astrovirus (0.30%). Norovirus was the most commonly detected viral pathogen amongst all the age groups with an almost even distribution in all age groups. Rotavirus and adenovirus were more common in children under 5 yr of age. Astrovirus was found in only one person. Conclusions Viruses, especially noroviruses, are associated with severe diarrhoea in children and adults in Qatar. Further studies to confirm the findings and to explore the causes of illness among patients from whom a pathogen cannot be determined are needed.
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Rheingans R, Kukla M, Adegbola RA, Saha D, Omore R, Breiman RF, Sow SO, Onwuchekwa U, Nasrin D, Farag TH, Kotloff KL, Levine MM. Exploring household economic impacts of childhood diarrheal illnesses in 3 African settings. Clin Infect Dis 2013; 55 Suppl 4:S317-26. [PMID: 23169944 PMCID: PMC3502313 DOI: 10.1093/cid/cis763] [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] [Indexed: 11/12/2022] Open
Abstract
Beyond the morbidity and mortality burden of childhood diarrhea in sub-Saharan African are significant economic costs to affected households. Using survey data from 3 of the 4 sites in sub-Saharan Africa (Gambia, Kenya, Mali) participating in the Global Enteric Multicenter Study (GEMS), we estimated the direct medical, direct nonmedical, and indirect (productivity losses) costs borne by households due to diarrhea in young children. Mean cost per episode was $2.63 in Gambia, $6.24 in Kenya, and $4.11 in Mali. Direct medical costs accounted for less than half of these costs. Mean costs understate the distribution of costs, with 10% of cases exceeding $6.50, $11.05, and $13.84 in Gambia, Kenya, and Mali. In all countries there was a trend toward lower costs among poorer households and in 2 of the countries for diarrheal illness affecting girls. For poor children and girls, this may reflect reduced household investment in care, which may result in increased risks of mortality.
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Affiliation(s)
- Richard Rheingans
- Department of Environmental and Global Health, University of Florida, Gainesville, FL 32610, USA.
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Afifi R, Nabiha M. The burden of Rotavirus gastroenteritis among hospitalized pediatric patients in a tertiary referral hospital in Jeddah. Ann Saudi Med 2013; 33:241-6. [PMID: 23793425 PMCID: PMC6078525 DOI: 10.5144/0256-4947.2013.241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the burden of Rotavirus gastroenteritis (GE) among pediatric hospital admissions. DESIGN AND SETTINGS This is a retrospective observational study, in which all pediatric cases admitted to one of the biggest tertiary hospitals in Jeddah, with the diagnosis of GE, in the year 2010, were enrolled. PATIENTS AND METHODS This is a retrospective observational study in which all pediatric cases admitted with the diagnosis of GE in the year 2010 were enrolled. Clinical data and laboratory findings were compared between Rota positive and Rota negative cases. The data was statistically analyzed. RESULTS GE cases represented 8.8% of all pediatric hospital admissions in 2010. Almost 43% (42.9%) of these cases proved to have Rotavirus GE. Rotavirus infection alone, adenovirus infection alone, combined Rotavirus and adenovirus infection, and other causes of GE were present in 101 (33.6%), 21 (7%), 28 (9.3%), and 151 (50.2%) patients respectively. Coinfection with adenovirus was higher in Rota-positive GE (RPG; P=.039). Vaccination against Rotavirus was protective against Rotavirus GE (P=.042). CONCLUSIONS Rotavirus infection is the most important causative organism of GE in our community that accounted for 42.9% of children hospitalized for GE in our study, either alone or with other infections. Among our patients, vaccination against Rotavirus appeared to be protective against Rotavirus GE. In view of the high disease prevalence among children, locally and worldwide, we recommend routine Rotavirus vaccination as the most effective available means of control despite improvement in sanitation and hygiene.
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Affiliation(s)
- Rasha Afifi
- Pediatrics, Dr. Erfan Hospital,, King Fahad Street, Jeddah, Saudi Arabia.
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A Survey on Rotavirus Associated Diarrhea in 5 Main Cities of Iran. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2013. [DOI: 10.5812/pedinfect.6431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hospital-based surveillance study of rotavirus gastroenteritis in children under 5 years of age in Lebanon. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.trivac.2013.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Estimating and comparing the clinical and economic impact of paediatric rotavirus vaccination in Turkey using a simple versus an advanced model. Vaccine 2012; 31:979-86. [PMID: 23219433 DOI: 10.1016/j.vaccine.2012.11.071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/20/2012] [Accepted: 11/25/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND The burden of rotavirus disease is high in Turkey, reflecting the large birth cohort (>1.2 million) and the risk of disease. Modelling can help to assess the potential economic impact of vaccination. We compared the output of an advanced model with a simple model requiring fewer data inputs. If the results are similar, this could be helpful for countries that have few data available. METHODS The advanced model was a previously published static Markov cohort model comparing costs and quality-adjusted life-year (QALY) outcomes of vaccination versus no vaccination. In contrast, the simple model used only a decision tree. Both models included data on demography, epidemiology, vaccine efficacy, resource use, unit costs, and utility scores from national databases and published papers. Only the perspective of the health care payer was considered in the analysis. The simple model had 23 variables, compared with 103 in the advanced model to allow additional comparisons of different vaccine types, dose schemes and vaccine waning. RESULTS With the same input data, both models showed that rotavirus vaccination in Turkey would improve health outcomes (fewer QALYs lost to rotavirus disease). The projected annual cost offsets were $29.9 million in the simple and $29.4 million in the advanced model. Sensitivity analysis indicated that in both models the main cost driver was disease incidence followed by cost for hospital care and medical visits. Vaccine efficacy had a smaller effect. CONCLUSION Both models reached similar conclusions. Both projected that rotavirus vaccination in Turkey would improve health outcomes and may result in savings in direct healthcare costs to offset the cost of vaccination. The analysis indicated that the simple model can produce meaningful economic results in conditions where few data are available.
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Soltani M, Bouanene I, Trabelsi A, Harbi A, Hachicha M, Amri F, Boussnina S, Gueddiche MN, Sfar MT, Teleb N, Ben Ghorbel M, Ben Hamida E. [Epidemiology of rotavirus gastroenteritis among children under 5 years of age in Tunisia - results of sentinel hospital surveillance 2009 to 2011]. Rev Epidemiol Sante Publique 2012; 60:473-80. [PMID: 23141818 DOI: 10.1016/j.respe.2012.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 03/02/2012] [Accepted: 04/05/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Rotavirus is the major cause of severe acute gastroenteritis among young children. The objectives of this study were to assess the epidemiology, clinical and virological features of community-acquired rotavirus acute gastroenteritis, in children under 5 years of age, hospitalized in Tunisia. METHODS A multicenter prospective observational study was conducted from April 2009 to March 2011, in 11 sentinel pediatric departments. Clinical data and stool samples were collected for all children under 5 years, admitted for acute gastroenteritis. Rotavirus was detected by Elisa immunoassay test and genotyped for G and P by semi-nested multiplex RT-PCR. RESULT A total of 621 children were enrolled in this study. Rotavirus was detected in 30.3% of cases (95% CI [26.7-33.9]). The estimated incidence rate of rotavirus acute gastroenteritis was 11 cases/100,000 child-years (95% CI [9.43-12.57]). This infection affected predominantly children aged under 24 months, and occurred mainly in winter (55.3%). Vomiting, fever and dehydration were observed in 79.6%, 69.5% and 57% respectively. Genotype analysis identified four G types (G1, G2, G3 and G4) and 4 P types (P[4], P[6], P[8] and P[9]). The most common G/P combination was G3P[8] (24.4%), followed by G4P[8] (13.3%) and G1P[8] (6.5%). CONCLUSION These results highlight the frequency and potential severity of rotavirus acute gastroenteritis in pediatric hospital settings. The present study could provide a sufficient database to make a decision related to the introduction of rotavirus vaccine in Tunisian national immunization program.
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Affiliation(s)
- M Soltani
- Service de médecine préventive et d'épidémiologie, CHU Fattouma Bourguiba, 5000 Monastir, Tunisie.
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Age Distribution and Seasonal Pattern of Rotavirus Infection in Children Under 5 Years. Jundishapur J Microbiol 2012. [DOI: 10.5812/jjm.4626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ansari S, Sherchand JB, Rijal BP, Parajuli K, Mishra SK, Dahal RK, Shrestha S, Tandukar S, Chaudhary R, Kattel HP, Basnet A, Pokhrel BM. Characterization of rotavirus causing acute diarrhoea in children in Kathmandu, Nepal, showing the dominance of serotype G12. J Med Microbiol 2012; 62:114-120. [PMID: 23038804 DOI: 10.1099/jmm.0.048124-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Diarrhoeal diseases are a major problem in developing countries. Though precise data on childhood mortality associated with diarrhoeal diseases in Nepal are not available, it has been estimated that approximately 25 % of child deaths are associated with diarrhoeal disease, particularly acute diarrhoea. The purpose of this study was to assess the incidence of rotavirus causing acute diarrhoea in children less than 5 years of age. A total of 525 children with acute diarrhoea in a children's hospital of Kathmandu, Nepal, were enrolled between April and September 2011. The incidence of acute diarrhoea due to rotavirus was 25.9 % (136/525) as determined by ELISA. The percentage of rotavirus-infected males was higher (64.5 %) than females (35.5 %). The frequency of rotavirus cases was higher in children less than 2 years of age, among which the majority of cases (80.2 %) were in children between 6 and 24 months old (P<0.01). Genotypic characterization by RT-PCR revealed that the serotype G12 represented 55.9 % of cases in this study associated with P-types of either P[6], P[4] or P[8]. Further to this, a total of eight G/P combinations were identified, G12P[6] being the most common strain type of rotavirus in Nepal, with a prevalence rate of 46.4 %. The aim of this study was to find out the major genotypes of rotavirus causing acute diarrhoea in children.
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Affiliation(s)
- Shamshul Ansari
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Jeevan Bahadur Sherchand
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Basista Prasad Rijal
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Keshab Parajuli
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Shyam Kumar Mishra
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajan Kumar Dahal
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Shovita Shrestha
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sarmila Tandukar
- Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Raina Chaudhary
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Hari Prasad Kattel
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Amul Basnet
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bharat Mani Pokhrel
- Department of Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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Howidi M, Al Kaabi N, El Khoury AC, Brandtmüller A, Nagy L, Richer E, Haddadin W, Miqdady MS. Burden of acute gastroenteritis among children younger than 5 years of age--a survey among parents in the United Arab Emirates. BMC Pediatr 2012; 12:74. [PMID: 22708988 PMCID: PMC3407526 DOI: 10.1186/1471-2431-12-74] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 06/18/2012] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite its high incidence among children under the age of five, little is known about the burden of pediatric gastroenteritis outside the medical setting. The objective of this study was to describe the burden of acute gastroenteritis among children residing in the United Arab Emirates, including those not receiving medical care. METHODS A quantitative cross-sectional survey of 500 parents of children under 5 years of age who had suffered from acute gastroenteritis the preceding three months was conducted in the cities of Abu Dhabi and Al Ain. Data collected included respondent characteristics, disease symptoms, medical care sought, and parental expenditures and work loss. Data were analyzed using parametric and non-parametric statistical methods. RESULTS Vomiting and diarrhea episodes lasted on average between 3 and 4 days. Overall, 87% of parents sought medical care for their children; 10% of these cases required hospitalization with an average length of stay of 2.6 days. When medical care was sought, the average parental cost per gastroenteritis episode was US$64, 4.5 times higher than with home care only (US$14). Nearly 60% of this difference was attributable to co-payments and medication use: 69% of children used oral rehydration solution, 68% antiemetics, 65% antibiotics and 64% antidiarrheals. Overall, 38 parents missed work per 100 gastroenteritis episodes for an average of 1.4 days. CONCLUSIONS Given its high incidence, pediatric gastroenteritis has an important financial and productivity impact on parents in the United Arab Emirates. To reduce this impact, efforts should be made both to prevent acute gastroenteritis and to optimize its treatment.
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