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

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Operario, DJ; Platts-Mills, JA; Nadan, S; Page, N; Seheri, M; Mphahlele, J; Praharaj, I; Kang, G; Araujo, IT; Leite, JPG; ...Date
2017-07-15Source Title
Journal of Infectious DiseasesPublisher
OXFORD UNIV PRESS INCAffiliation
Paediatrics (RCH)Metadata
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Operario, D. J., Platts-Mills, J. A., Nadan, S., Page, N., Seheri, M., Mphahlele, J., Praharaj, I., Kang, G., Araujo, I. T., Leite, J. P. G., Cowley, D., Thomas, S., Kirkwood, C. D., Dennis, F., Armah, G., Mwenda, J. M., Wijesinghe, P. R., Rey, G., Grabovac, V. ,... Houpt, E. R. (2017). Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction. JOURNAL OF INFECTIOUS DISEASES, 216 (2), pp.220-227. https://doi.org/10.1093/infdis/jix294.Access Status
Open AccessAbstract
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.
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