Changes in Childhood Diarrhea Incidence in Nicaragua Following 3 Years of Universal Infant Rotavirus Immunization

Becker‐Dreps, Sylvia; Paniagua, Margarita; Dominik, Rosalie; Cao, Hongyuan; Shah, Naman K.; Morgan, Douglas R.; Moreno, Gilberto; Espinoza, Félix

doi:10.1097/inf.0b013e3181f87ffe

Cited by 22 publications

(22 citation statements)

References 24 publications

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“…Nicaraguan infants are offered the vaccine at the age of 2, 4, and 6 months through the country’s Expanded Program on Immunization (EPI).Two studies conducted in Nicaraguan hospitals after the vaccine’s introduction found RV5 effectiveness was 58% and 76% against severe rotavirus diarrhea among children eligible to have received RV5 (2007 to 2008 [12], 2007 to 2009 [13]). In agreement with these studies, the incidence of diarrhea visits to health facilities had a modest decrease during the dry “rotavirus seasons” following the vaccine’s introduction and the prevalence of rotavirus diarrhea in primary care clinics declined from 14% to 4% [14, 15]. …”

Section: Introductionmentioning

confidence: 61%

Etiology of Childhood Diarrhea After Rotavirus Vaccine Introduction

Becker‐Dreps¹,

Bucardo²,

Vílchez³

et al. 2014

Pediatric Infectious Disease Journal

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102

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Background Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods We followed a population-based sample of children less than 5 years in León, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial, and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least one enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (EPEC, 11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%), and enterotoxigenic E.coli (ETEC, 7.7%), with rotavirus detected among 5.3% of diarrheal stools. EPEC and ETEC were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (< 2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions In this Central American community following RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.

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Section: Introductionmentioning

confidence: 61%

Etiology of Childhood Diarrhea After Rotavirus Vaccine Introduction

Becker‐Dreps¹,

Bucardo²,

Vílchez³

et al. 2014

Pediatric Infectious Disease Journal

Self Cite

102

View full text Add to dashboard Cite

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“…1 In addition to the benefit of ORS usage, improvement may be due to regional improvements in education and sanitation, 17 diarrheal disease or cholera control programs, 18 and the introduction of rotavirus vaccine, which has effectively reduced rotavirus-associated diarrhea incidence and pediatric-associated hospitalization. 19,20 Although these successes are to be applauded, our prevalence maps highlight areas where prevention efforts should be redoubled or new interventions undertaken.…”

Section: Discussionmentioning

confidence: 99%

Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica

Colombara¹,

Hernández²,

McNellan³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ 2 tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.

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“…The final complete dataset for children 0-1 years of age included 15 studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] from six countries (United States, Brazil, Nicaragua, El Salvador, Panama, Mexico). While our initial search and coding included data for children under 5, data points for children older than 1 year of age were excluded due to inconsistencies between mortality and coverage data, and in order to include the largest number of studies possible given the variability across studies in how age groups were divided.…”

Section: Data Abstraction Synthesis and Analysismentioning

confidence: 99%