Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction.
J Infect Dis
; 216(2): 220-227, 2017 07 15.
Article
in En
| MEDLINE
| ID: mdl-28838152
ABSTRACT
Background:
The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction.Methods:
We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal stools sampled from 14643 episodes captured by surveillance of children <5 years of age during 2013-2014 from 16 countries. We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific weighted attributable fractions (AFs).Results:
Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%-44.3%]), though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9-15.6]), based on samples from a country with universal rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8-9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0-7.6]), Shigella (AF, 4.7 [95% CI, 2.8-6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0-6.1]), and adenovirus 40/41 (AF, 4.2 [95% CI, 2.9-5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%-61.5%) in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%-30.4%) in age-eligible children.Conclusions:
Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction. Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance can help identify priorities for further reducing the burden of diarrhea.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rotavirus Infections
/
Rotavirus Vaccines
/
Diarrhea
Type of study:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Country/Region as subject:
Africa
/
America do sul
/
Asia
/
Brasil
Language:
En
Journal:
J Infect Dis
Year:
2017
Document type:
Article