Impact of Rotavirus Vaccine Introduction and Postintroduction Etiology of Diarrhea Requiring Hospital Admission in Haydom, Tanzania, a Rural African Setting

Platts-Mills, James A; Amour, Caroline; Gratz, Jean; Nshama, Rosemary; Walongo, Thomas; Mujaga, Buliga; Maro, Athanasia; McMurry, Timothy L.; Liu, Jie; Mduma, Estomih; Houpt, Eric R.

doi:10.1093/cid/cix494

Cited by 40 publications

(44 citation statements)

References 45 publications

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“…The high norovirus prevalence corresponds well with other studies in high-and middle-income countries where norovirus has become the most common aetiology in severe childhood diarrhoea [12][13][14]. Other studies from Malawi and Tanzania have shown lower prevalence of norovirus compared to this study, but used other detection methods that might not be directly comparable [27,28]. Most of the rotavirus positive children (55%) in this study were symptomatically infected despite having received a full three-dose regimen of rotavirus vaccine, indicating a less than optimal protective effect of the vaccine.…”

Section: Discussionsupporting

confidence: 83%

Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso

et al. 2020

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Several studies report norovirus as the new leading cause of severe gastroenteritis in children after the global introduction of rotavirus vaccines. Burkina Faso introduced general rotavirus vaccination with the oral pentavalent vaccine RotaTeq in November 2013 and quickly reached a vaccine coverage of >90%. This study describes detection rates, clinical profiles and the molecular epidemiology of norovirus and rotavirus infections in 146 children aged <5 years with severe acute gastroenteritis in Ouagadougou, consecutively enrolled from a hospital between January 2015 and December 2015. Virus detection was performed with an antigen test or real-time polymerase chain reaction (PCR) and genotyping was performed by nucleotide sequencing or multiplex PCR. Rotavirus was found in 14% and norovirus in 20% of faecal samples. Norovirus infection was significantly more associated with severe dehydration compared to rotavirus (P < 0.001). Among genotyped norovirus samples 48% (12/25) belonged to GII.4 which caused significantly more diarrhoeal episodes than non-GII.4 genotypes (P = 0.01). The most common rotavirus genotypes were G2P[4] (30%), G12P[6] (25%) and G12P[8] (20%). Fifty percent of the rotavirus positive children were infected with fully or partly heterotypic strains. In conclusion, this study found a higher proportion of norovirus causing more severe symptoms in children with diarrhoea in Burkina Faso after the introduction of rotavirus vaccination.

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Section: Discussionsupporting

confidence: 83%

Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso

et al. 2020

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“…While some reports have associated DAEC with diarrhea [11,33,34], another ones have appointed for similar proportions of DAEC in case and controls [9] in alignment with our findings. In contrast with our findings, recent studies conducted in sub-Saharan Africa associated EIEC to diarrhea [35,36]. At least, the lower circulation of EHEC is not surprisingly, since previous studies conducted in Mozambique revealed low circulation of this pathotype in Manhiça [5] and absence in Maputo city [11,14,15].…”

Section: Discussioncontrasting

confidence: 99%

Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study

et al. 2020

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Background Diarrheagenic Escherichia coli (DEC) are among the leading pathogens associated with endemic diarrhea in low income countries. Yet, few epidemiological studies have focused the contribution of enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli (EIEC) and diffusely adherent E. coli (DAEC). Methods We assessed the contribution of EHEC, EIEC and DAEC isolated from stool samples from a case-control study conducted in children aged < 5 years in Southern Mozambique between December 2007 and November 2012. The isolates were screened by conventional PCR targeting stx1 and stx2 (EHEC), ial and ipaH (EIEC), and daaE (DAEC) genes. Results We analyzed 297 samples from cases with less-severe diarrhea (LSD) matched to 297 controls, and 89 samples from cases with moderate-to-severe diarrhea (MSD) matched to 222 controls, collected between November 3, 2011 and November 2, 2012. DEC were more common among LSD cases (2.7%, [8/297] of cases vs. 1.3% [4/297] of controls; p = 0.243]) than in MSD cases (0%, [0/89] of cases vs. 0.4%, [1/222] of controls; p = 1.000). Detailed analysis revealed low frequency of EHEC, DAEC or EIEC and no association with diarrhea in all age strata. Although the low frequency, EIEC was predominant in LSD cases aged 24–59 months (4.1% for cases vs. 0% for controls), followed by DAEC in similar frequency for cases and controls in infants (1.9%) and lastly EHEC from one control. Analysis of a subset of samples from previous period (December 10, 2007 and October 31, 2011) showed high frequency of DEC in controls compared to MSD cases (16.2%, [25/154] vs. 11.9%, [14/118], p = 0.383, respectively). Among these, DAEC predominated, being detected in 7.7% of cases vs. 17.6% of controls aged 24–59 months, followed by EIEC in 7.7% of cases vs. 5.9% of controls for the same age category, although no association was observed. EHEC was detected in one sample from cases and two from controls. Conclusions Our data suggests that although EHEC, DAEC and EIEC are less frequent in endemic diarrhea in rural Mozambique, attention should be given to their transmission dynamics (e.g. the role on sporadic or epidemic diarrhea) considering that the role of asymptomatic individuals as source of dissemination remains unknown.

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“…Similar findings were observed in Tanga, where the prevalence of RVA declined from 29-41% [20,37] to 10-29% [37]. These results are complemented by other similar case control studies conducted in the post-vaccination era, which found a 44.9% reduction in rotavirus hospitalization in Manyara in 2015 [47] and reductions of 40%, 46%, and 69% in Zanzibar in 2013, 2014, and 2015, respectively [33]. The progressive reduction in rotavirus hospitalizations in Zanzibar, Mbeya, Dodoma and Moshi could be attributed to the increasing coverage of the rotavirus vaccine.…”

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vasupporting

confidence: 85%

“…Similar findings in the delay of the seasonal peak after vaccine introduction have been reported in the United States [52]. Before vaccine introduction, the peak months were May 2009 and August 2011 in Tanga, May 2012 in Mwanza, May-July of 2010-2012 in Manyara and July 2010 and May of 2011-2012 in Zanzibar [33,37,47]. After vaccine introduction, the peaks in rotavirus cases were delayed for 1-4 months towards the end of the year; in Tanga, the peak was in September of 2014-2015; in Mwanza, it was in July 2014 and July and August of 2015; in Manyara, it was in August-October of 2013-2015 and in Zanzibar, it was in June and July of 2013, September 2014 and October 2015 [33,37].…”

Section: Trends Of Rotavirus Infection and Impact Of The Rotavirus Vasupporting

confidence: 79%

Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

et al. 2019

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In Tanzania, rotavirus infections are responsible for 72% of diarrhea deaths in children under five. The Rotarix vaccine was introduced in early 2013 to mitigate rotavirus infections. Understanding the disease burden and virus genotype trends over time is important for assessing the impact of rotavirus vaccine in Tanzania. When assessing the data for this review, we found that deaths of children under five declined after vaccine introduction, from 8171/11,391 (72% of diarrhea deaths) in 2008 to 2552/7087 (36% of diarrhea deaths) in 2013. Prior to vaccination, the prevalence of rotavirus infections in children under five was 18.1–43.4%, 9.8–51%, and 29–41% in Dar es Salaam, Mwanza and Tanga, respectively, and after the introduction of vaccines, these percentages declined to 17.4–23.5%, 16–19%, and 10–29%, respectively. Rotaviruses in Tanzania are highly diverse, and include genotypes of animal origin in children under five. Of the genotypes, 10%, 28%, and 7% of the strains are untypable in Dar es Salaam, Tanga, and Zanzibar, respectively. Mixed rotavirus genotype infection accounts for 31%, 29%, and 12% of genotypes in Mwanza, Tanga and Zanzibar, respectively. The vaccine effectiveness ranges between 53% and 75% in Mwanza, Manyara and Zanzibar. Rotavirus vaccination has successfully reduced the rotavirus burden in Tanzania; however, further studies are needed to better understand the relationship between the wildtype strain and the vaccine strain as well as the zoonotic potential of rotavirus in the post-vaccine era.

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Impact of Rotavirus Vaccine Introduction and Postintroduction Etiology of Diarrhea Requiring Hospital Admission in Haydom, Tanzania, a Rural African Setting

Cited by 40 publications

References 45 publications

Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso

Norovirus and rotavirus in children hospitalised with diarrhoea after rotavirus vaccine introduction in Burkina Faso

Low frequency of enterohemorrhagic, enteroinvasive and diffusely adherent Escherichia coli in children under 5 years in rural Mozambique: a case-control study

Rotavirus Burden, Genetic Diversity and Impact of Vaccine in Children under Five in Tanzania

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