Impact of rotavirus vaccination on child mortality, morbidity, and rotavirus-related hospitalizations in Bolivia.

BACKGROUND: The public health impact of rotavirus vaccination in countries with high child mortality rates remains to be established. The RV1 rotavirus vaccine was introduced in Bolivia in August 2008. This study describes the trends in deaths, hospitalizations, and healthcare visits due to acute gastroenteritis (AGE) and in rotavirus-related hospitalizations, among children <5 years of age, during the pre- and post-vaccination periods. METHODS: Data were obtained from the National Health Information System to calculate vaccine coverage and AGE-related health indicators. Trend reductions in the main health indicators were examined using the pre-vaccine period as baseline. The effect of vaccination on the epidemiology of rotavirus-related AGE was assessed using data from the active surveillance hospitals. RESULTS: Compared with the 2001-2008 pre-vaccine baseline, the mean number of rotavirus-related hospitalizations was reduced by 40.8% (95% confidence interval (CI) 21.7-66.4%) among children <5years of age in the post-vaccine period (2009-2013). Reductions were most pronounced in children <1year of age, eligible for vaccination. The mean proportions of AGE-related deaths, AGE-related hospitalizations, and AGE-related healthcare visits during 2009-2014 were reduced by 52.5% (95% CI 47.4-56.3), 30.2% (95% CI 23.5-36.1), and 12.9% (95% CI 12.0-13.2), respectively. The greatest effect in reduction of AGE-related deaths was found during the months with seasonal peaks of rotavirus disease. Over the post-vaccine period, changes in rotavirus epidemiology were observed, manifested by variations in seasonality and by a shift in the mean age of those with rotavirus infection. CONCLUSIONS: The significant decrease in main AGE-related health indicators in children <5years of age after the introduction of rotavirus vaccine provides evidence of a substantial public health impact of rotavirus vaccination in Bolivia, as a measure for protecting children against AGE.

Multiresistencia antimicrobiana asociada a integrones en enteropatógenos de la diarrea infantil y Escherichia coli de la flora normal en niños menores de 5 años en la ciudad de La Paz / Antimicrobic multiresistence assocised to integrons in enteropathogens of the childrens diarrea and escherichia coli of the normal flora in children under 5 years of age in thy ciy of La Paz

Con el objeto de evaluar la resistencia antimicrobiana a 11 antibióticos y su relación con la presencia de integrones (clase 1-3), se analizó un total de 138 muestras que incluyen enteropatógenos (Shigella spp, EPEC, ETEC y EHEC) aislados de heces de niños con diarrea, así como E. coli no diarreogénica, aislada de heces de niños sanos de la ciudad de La Paz. Entre los marcadores de resistencia más frecuentemente encontrados, se destacan Ampicilina (95%) y Estreptomicina (90%) seguido por Cotrimoxazol (60%). Se encontró un elevado porcentaje (96%) de aislados resistentes al menos a 1 antibiótico, donde la multiresistencia de 3 hasta 6 antibióticos representó el 82%. Los aislados de Shigella spp y E. coli no diarreogénica presentaron perfiles de resistencia similares, predominando la multiresistencia (a 4 antibióticos, en contraste a ETEC y EPEC, con menores porcentajes de resistencia. Esto sugiere que E. coli no diarreogénica puede servir de reservorio de genes de multiresistencia a otros patógenos y viceversa y que la expansión de la multiresistencia estaría relacionada a la prevalencia de enteropatógenos circulantes. Se observó una asociación significativa entre la presencia del integrón de clase 2 con la multiresistencia (a 4 antibióticos en todos los aislados analizados y con el integrón de clase 1 (Shigella spp y E. coli no diarreogénica). La presencia de integrones estuvo asociada en mayor frecuencia a aislados resistentes a 7 antibióticos analizados. Este estudio constituye el primer reporte en nuestro medio de la multiresistencia antimicrobiana asociada a integrones detectados por métodos moleculares, y refleja la amplia distribución de los mismos, tanto en la flora normal como patogénica de la población infantil de la ciudad de La Paz. En conjunto, los datos obtenidos tienen relevancia para el tratamiento antimicrobiano de enfermedades diarreicas y control de la diseminación de la resistencia.

A total of 138 samples collected in the city of La Paz, including enteropathogens isolated from stools of children with diarrhea as well as fecal E. coli from healthy children, were analyzed to evaluate integron-associated antimicrobial multi-resistance distribution. The highest rate of resistance was against Ampicillin (95%), Streptomycin (90%) followed by Cotrimoxazole (60%). A high percentage (96%) of antimicrobial resistance and that multi-resistance expansion may be associated with the circulating enteropathogens prevalence. In all isolates, a significant association among class 2 integron and (4 antibiotic multi-resistance was found, as well as between class 1 integron and isolates from Shigella and non-diarrheogenic E coli. Integron presence was associated with the resistance to 7 antibiotics. This is the first report of molecular detection of integrons among pathogenic and normal flora of child population of city of La Paz demonstrating isolates to at least one antibiotic and multiresistance to between 3-6 antibiotics (82%) was found. Resistance patterns were similar among Shigella spp and non-diarrheogenic E coli, showing high multi-resistance prevalence to (4 antibiotics, in contrast to ETEC and EPEC. These data suggest, that non-diarrheogenic E coli can serve as multi-resistance genes reservoir to other pathogens and vice versa, a wide integron-associated antimicrobial multi-resistance. These results are relevant to antimicrobial diarrhea treatment and resistance dissemination control.

Enfermedades diarreicas agudas asociadas a rotavirus / Rotavirus associated acute gastroenteritis

Un total de 1163 muestras de heces, fueron recolectadas de niños con enfermedades diarreicas agudas (EDA) menores a 5 años del Hospital Albina Patiño y otros centros de salud de la ciudad de Cochabamba en el período 2001-2002. La infección por rotavirus presentó una prevalencia general del 19 % (220) presentándose en un 24% en pacientes hospitalizados y en el 17% (143) en ambulatorios. Las infecciones por rotavirus se presentaron a lo largo de todo el período de estudio, las frecuencias mas altas de infección se observaron en los meses de invierno: abril (24%), mayo (34%) y junio (28%) y las más bajas (8-15%) en los meses de febrero, agosto y septiembre. El análisis de asociación de la infección por rotavirus. con parámetros climáticos, mostró que los picos más altos de infección. correlacionan con la época mas seca y fría. El mayor número de casos de infección por rotavirus se presentó en niños entre 7-12 meses de edad (36,3%). Los síntomas clínicos más comúnmente asociados a la diarrea rotaviral fueron: la deshidratación moderada. seguida de vómitos, y fiebre, siendo la primera más frecuente en pacientes hospitalizados que ambulatorios. El análisis de la distribución de genotipos G y P mediante el ensayo de reverso trascripción (RT-PCR), reveló la presencia de los genotipos G1 (44%), G2(6%) y P[8] (24%), P[6] (IS%). Se observó una coinfección P[8]P[6] en tres muestras (4%) y asociación del genotipo P[6] con los casos de procedencia ambulatoria. En conjunto estos hallazgos resaltan la importancia del rotavirus como causa de las EDA y permiten inferir que las vacunas anti-rotavirales actualmente vigentes, brindarían protección contra las cepas circulantes encontradas en la ciudad de Cochabamba.

In the period of 2001-2002, a total of 1163 fecal samples were collected from children less than five years of age with diarrhea, at the Hospital Albina Patiño and other health centers in Cochabamba city. Rotavirus infection general prevalence was 19 % (220), distributed among hospitalized children 24% (77) and outpatients 17% (143). Rotavirus infections were observed along the whole study period, with highest prevalence in coldest months: April (24 %), May (34%) and June (28%) and lowest frequencies (8-15%) in February, August, and September. Major rotavirus outbreak was significantly associated with the driest and colder season. The highest percentage of rotavirus infections (36,3%) was found among children between 7-12 months of age. Moderate dehydration, vomits and fever were the clinical symptoms more frequently associated with rotavirus acute gastroenteritis, being dehydration more cornmon in hospitalized patients. The distribution of' P and G genotypes analyzed by RT-PCR was: G1 (44%), G2 (6%), P[8] (24%) and P4 (15%). A co-infection P[8]P[6] was observed in 3 samples (4%). Genotype P[6] was found associated to outpatients. These findings, highlight that rotavirus is an important cause of acute gastroenteritis and that any of the currently available vaccines would potentially be protective against circulating strains found in the city of Cochabamba.