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Clark A, Black R, Tate J, Roose A, Kotloff K, Lam D, Blackwelder W, Parashar U, Lanata C, Kang G, Troeger C, Platts-Mills J, Mokdad A, Sanderson C, Lamberti L, Levine M, Santosham M, Steele D. Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS One 2017; 12:e0183392. [PMID: 28892480 PMCID: PMC5593200 DOI: 10.1371/journal.pone.0183392] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/03/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year. METHODS AND FINDINGS We compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83-90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57-74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95-98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31-36%). This increased by a factor of 1.08 (95% CI 1.02-1.14) when the GEMS results were reanalysed using a more sensitive molecular test. CONCLUSIONS We developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.
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Affiliation(s)
- Andrew Clark
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jacqueline Tate
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Anna Roose
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Karen Kotloff
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Diana Lam
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - William Blackwelder
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Umesh Parashar
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Claudio Lanata
- Instituto de Investigacion Nutricional, Lima, Peru
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - James Platts-Mills
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Ali Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
| | | | - Colin Sanderson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura Lamberti
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Myron Levine
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Duncan Steele
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
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