Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction

Details

• Alternative Title:
  J Infect Dis
• Personal Author:
  Operario, Darwin J ; Platts-Mills, James A ; Nadan, Sandrama ; Page, Nicola ; Seheri, Mapaseka ; Mphahlele, Jeffrey ; Praharaj, Ira ; Kang, Gagandeep ; Araujo, Irene T ; Leite, Jose Paulo G ; Cowley, Daniel ; Thomas, Sarah ; Kirkwood, Carl D ; Dennis, Francis ; Armah, George ; Mwenda, Jason M ; Wijesinghe, Pushpa Ranjan ; Rey, Gloria ; Grabovac, Varja ; Berejena, Chipo ; Simwaka, Chibumbya J ; Uwimana, Jeannine ; Sherchand, Jeevan B ; Thu, Hlaing Myat ; Galagoda, Geethani ; Bonkoungou, Isidore J O ; Jagne, Sheriffo ; Tsolenyanu, Enyonam ; Diop, Amadou ; Enweronu-Laryea, Christabel ; Borbor, Sam-Aliyah ; Liu, Jie ; McMurry, Timothy ; Lopman, Benjamin ; Parashar, Umesh ; Gentsch, John ; Steele, A Duncan ; Cohen, Adam ; Serhan, Fatima ; Houpt, Eric R
• Description:
  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.
  
  
• Subjects:
  Child, Preschool Diarrhea Feces Female Global Health Humans Infant Logistic Models Major Articles Male Polymerase Chain Reaction Retrospective Studies Rotavirus Infections Rotavirus Vaccines

  More +
• Source:
  J Infect Dis. 2017; 216(2):220-227.
• Pubmed ID:
  28838152
• Pubmed Central ID:
  PMC5853801
• Document Type:
  Journal Article
• Funding:
  001/World Health Organization/International ; K23 AI114888/AI/NIAID NIH HHS/United States
• Name as Subject:
  World Health Organization.
• Place as Subject:
  Africa ; Asia ; Brazil
• Volume:
  216
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:cd94238224f1f5fdd9e5489ca6e740e23630b36dbdd47361ffe9f5fe9e10afb6
• Download URL:
  https://stacks.cdc.gov/view/cdc/52802/cdc_52802_DS1.pdf
• File Type:
  [PDF - 245.67 KB ]