1
|
Cohen AL, Platts-Mills JA, Nakamura T, Operario DJ, Antoni S, Mwenda JM, Weldegebriel G, Rey-Benito G, de Oliveira LH, Ortiz C, Daniels DS, Videbaek D, Singh S, Njambe E, Sharifuzzaman M, Grabovac V, Nyambat B, Logronio J, Armah G, Dennis FE, Seheri ML, Magagula N, Mphahlele J, Fumian TM, Maciel ITA, Gagliardi Leite JP, Esona MD, Bowen MD, Samoilovich E, Semeiko G, Abraham D, Giri S, Praharaj I, Kang G, Thomas S, Bines J, Liu N, Kyu HH, Doxey M, Rogawski McQuade ET, McMurry TL, Liu J, Houpt ER, Tate JE, Parashar UD, Serhan F. Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network. BMJ Glob Health 2022; 7:e009548. [PMID: 36660904 PMCID: PMC9445824 DOI: 10.1136/bmjgh-2022-009548] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/13/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Diarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions. METHODS We established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale. RESULTS During 2017-2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed by Shigella (9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies were Shigella (19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853 Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516). CONCLUSIONS Despite the substantial impact of rotavirus vaccine introduction, rotavirus remained the leading cause of paediatric diarrhoea hospitalisations. Improving the efficacy and coverage of rotavirus vaccination and prioritising interventions against Shigella, norovirus and adenovirus could further reduce diarrhoea morbidity and mortality.
Collapse
Affiliation(s)
- Adam L Cohen
- National Center for Immunization and Respiratory Diseases, Influenza Division, CDC, Atlanta, Georgia, USA
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Darwin J Operario
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | | | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Gloria Rey-Benito
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Lucia H de Oliveira
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Claudia Ortiz
- World Health Organization Regional Office for the Americas, Washington, DC, USA
| | - Danni S Daniels
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Dovile Videbaek
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Simarjit Singh
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Emmanuel Njambe
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | | | - Varja Grabovac
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Batmunkh Nyambat
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Josephine Logronio
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - George Armah
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Francis E Dennis
- University of Ghana Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | | | | | | | | | | | | | - Matthew D Esona
- Divison of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michael D Bowen
- Divison of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elena Samoilovich
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | - Galina Semeiko
- Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus
| | | | | | - Ira Praharaj
- Indian Council of Medical Research Regiona lMedical Research Centre, Bhubaneswar, India
| | | | - Sarah Thomas
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julie Bines
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Na Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hmwe H Kyu
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Matthew Doxey
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Timothy L McMurry
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jie Liu
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
- Qingdao University, Qingdao, Shandong, China
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Jacqueline E Tate
- Divison of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh D Parashar
- Divison of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|