Background Diarrhea is the second leading cause of death in children under five years of age globally. The burden of diarrheal mortality is concentrated in low-resource settings. Little is known about the risk factors for childhood death from diarrheal disease in low and middle-income countries. Methods Data from the WHO-coordinated Global Rotavirus and Pediatric Diarrhea Surveillance Networks, which are composed of active, sentinel, hospital-based surveillance sites, were analyzed to assess mortality in children less than five years of age who were hospitalized with diarrhea between 2008-2018. Case fatality risks were calculated, and multivariable logistic regression was performed to identify risk factors for mortality. Results This analysis is comprised of 234,781 cases, including 1,219 deaths, across 57 countries. The overall case fatality risk was found to be 0.5%. Risk factors for death in the multivariable analysis included younger age (for <6 months compared with older ages, OR = 3.54; 95% CI = 2.81-4.50), female sex (OR = 1.18; 95% CI= 1.06-1.81), presenting with persistent diarrhea (OR = 1.91; 95% CI= 1.01-3.25), no vomiting (OR = 1.13, 95% CI= 0.98-1.30), severe dehydration (OR = 3.79; 95% CI = 3.01-4.83), and being negative for rotavirus on an ELISA test (OR = 2.29; 95% CI= 1.92-2.74). Cases from the African Region had the highest odds of death compared with other WHO Regions (OR = 130.62 comparing the African Region to the European region; 95% CI= 55.72-422.73), while cases from the European region had the lowest odds of death. Conclusions Our findings support known risk factors for childhood diarrheal mortality and highlight the need for interventions to address dehydration and rotavirus-negative diarrheal infections.

Background Despite the disproportionate morbidity and mortality experienced by American Indian and Alaska Native (AI/AN) persons during the COVID-19 pandemic, few studies have reported vaccine effectiveness (VE) estimates among these communities. Methods We conducted a test-negative case-control analysis among AI/AN persons aged ≥12 years presenting for care from January 1, 2021 through November 30, 2021 to evaluate effectiveness of mRNA COVID-19 vaccines against COVID-19-associated outpatient visits and hospitalizations. Cases and controls were patients with ≥1 symptom consistent with COVID-19-like illness; cases were defined as those test-positive for SARS-CoV-2 and controls were defined as those test-negative for SARS-CoV-2. We used unconditional multivariable logistic regression to estimate VE, defined as 1 minus the adjusted odds ratio for vaccination among cases versus controls. Results The analysis included 207 cases and 267 test-negative controls. Forty-four percent of cases and 78% of controls received two doses of either BNT162b2 or mRNA-1273 vaccine. VE point estimates for two doses of mRNA vaccine were higher for hospitalized participants (94.6% [88.0–97.6]) than outpatient participants (86.5% [63.0–95.0]), but confidence intervals overlapped. Conclusions Among AI/AN persons, mRNA COVID-19 vaccines were highly effective in preventing COVID-associated outpatient visits and hospitalizations. Maintaining high vaccine coverage, including booster doses, will reduce the burden of disease in this population.

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