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- Title
Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction.
- Authors
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
- Abstract
<bold>Background: </bold>The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine introduction.<bold>Methods: </bold>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).<bold>Results: </bold>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.<bold>Conclusions: </bold>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
AFRICA; ASIA; BRAZIL; DIARRHEA in children; ROTAVIRUS diseases; ROTAVIRUSES; POLYMERASE chain reaction; ESCHERICHIA coli; NOROVIRUS diseases; MICROBIOLOGY; RETROVIRUS diseases; ROTAVIRUS vaccines; COMPARATIVE studies; DIARRHEA; FECES; RESEARCH methodology; MEDICAL cooperation; RESEARCH; RESEARCH funding; WORLD health; WORLD Health Organization; LOGISTIC regression analysis; EVALUATION research; RETROSPECTIVE studies; PREVENTION; VACCINATION; THERAPEUTICS
- Publication
Journal of Infectious Diseases, 2017, Vol 216, Issue 2, p220
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jix294