Increasing evidence from impact studies shows the significant impact of rotavirus vaccination on hospitalizations and economic burden because of rotavirus gastroenteritis in LMICs. Universal rotavirus vaccination is recommended, and introductions should be monitored by robust surveillance systems to measure effectiveness and impact.

Highlights Prelicensure trials of ROTAVAC® not powered to assess risk of intussusception. During ROTAVAC® rollout we assessed risk of intussusception in infants in 3 states. No increased risk of intussusception within 21 days of 1st and 2nd dose. No increased risk of intussusception within 21 days of any single dose or all 3 doses.

Background Blood culture, despite low sensitivity, is the gold standard for enteric fever diagnosis. Understanding predictors of blood culture positivity may help design strategies to optimize enteric fever diagnosis. Methods A cohort of 6760 children aged 0.5–15 years was followed for 3 years for enteric fever with blood cultures in an automated system, for fevers >3 days. Factors affecting test positivity in fevers and participant-level predictors for culture refusals were analyzed using regression models. Results Overall, 6097 suspected typhoid/paratyphoid fever (STF) episodes were reported, of which 5703 (93.5%) STFs had sampling for blood cultures, with 394 (6.5%) refusals. Salmonella enterica serovar Typhi/Paratyphi positivity was culture-confirmed in 3.8% (218/5703) of STF episodes. Older children (odds ratio [OR], 1.96 [95% CI, 1.39–2.77]), larger blood volume inoculated (OR, 2.82 [95% CI, 1.71–4.66]), higher temperatures during fever (OR, 3.77 [95% CI, 2.89–4.91]), and fevers diagnosed as suspected typhoid or acute undifferentiated fever (OR, 6.06 [95% CI, 3.11–11.78]) had a higher probability of culture positivity. Antibiotics before culture did not decrease culture positivity. Blood culture refusals were higher for children from wealthier households or with milder illness. Conclusions Performing blood cultures in older children with fever, especially those fevers with toxic presentation and increasing blood volume for inoculation are strategies to improve enteric fever detection in surveillance settings.

Background Typhoid is known to be heterogenous in time and space, with documented spatiotemporal clustering and hotspots associated with environmental factors. This analysis evaluated spatial clustering of typhoid and modeled incidence rates of typhoid from active surveillance at 4 sites with child cohorts in India. Methods Among approximately 24 000 children aged 0.5–15 years followed for 2 years, typhoid was confirmed by blood culture in all children with fever >3 days. Local hotspots for incident typhoid cases were assessed using SaTScan spatial cluster detection. Incidence of typhoid was modeled with sociodemographic and water, sanitation, and hygiene–related factors in smaller grids using nonspatial and spatial regression analyses. Results Hotspot households for typhoid were identified at Vellore and Kolkata. There were 4 significant SaTScan clusters (P < .05) for typhoid in Vellore. Mean incidence of typhoid was 0.004 per child-year with the highest incidence (0.526 per child-year) in Kolkata. Unsafe water and poor sanitation were positively associated with typhoid in Kolkata and Delhi, whereas drinking untreated water was significantly associated in Vellore (P = .0342) and Delhi (P = .0188). Conclusions Despite decades of efforts to improve water and sanitation by the Indian government, environmental factors continue to influence the incidence of typhoid. Hence, administration of the conjugate vaccine may be essential even as efforts to improve water and sanitation continue.

Background In resource-constrained settings, quality and timeliness of data are the main concerns related to the use of information systems for decision making. Many different tools are available to improve such systems, but their usefulness is only been recently explored. In this paper, we describe our implementation of an electronic platform, open data kit (ODK) for data collection and its feasibility in data management for a population-based household health expenditure survey. Methods We evaluated the use of ODK based data collection in households located in two areas (one urban and one rural) in Vellore, Tamil Nadu, India. From each area, we selected a sample of 60 households for piloting the ODK based questionnaires. The household survey questionnaires were programmed using the Microsoft Excel for data collection in the ODK collect android application. The ODK aggregate was used for data storage and data transfer. A team of six field workers was recruited, and trained to use the ODK collect application for survey data collection. After the training, the field workers pilot tested the questionnaires, both in the form of mock surveys and real on-field testing. Results Under mock-interviews, there were no significant differences in time –to completion between the six field workers. A total of 60 households participated in field testing that showed field workers were able to complete the questionnaires in a timely manner, (mean 32 minutes (SD=18)) with minimal errors, and all field workers found the ODK form easy to use. There were no major technical issues in the ODK implementation or with electronic devices. Conclusions Results from both mock interviews and on-field testing of our data collection platform show the feasibility of using this approach in resource-constrained settings. The approach used to implement, integrate, and test this platform can benefit other health researchers in developing settings intending to move from paper-based methods toward electronic data collection systems.