Abstract
Despite rotavirus vaccination, diarrhea remains a leading cause of child mortality. We collected stool specimens from 684 children <5 years of age hospitalized with diarrhea (cases) and 527 asymptomatic community controls for 4 years after rotavirus vaccine introduction in Malawi. Specimens were tested for 29 pathogens, using polymerase chain reaction analysis. Three or more pathogens were detected in 71% of cases and 48% of controls. Pathogens significantly associated with diarrhea included rotavirus (in 34.7% of cases and 1.5% of controls), enteric adenovirus (in 29.1% and 2.7%, respectively), Cryptosporidium (in 27.8% and 8.2%, respectively), heat-stable enterotoxin-producing Escherichia coli (in 21.2% and 8.5%, respectively), typical enteropathogenic E. coli (in 18.0% and 8.3%, respectively), and Shigella/enteroinvasive E. coli (in 15.8% and 5.7%, respectively). Additional interventions are required to prevent diarrhea due to rotavirus and other common causal pathogens.
Highlights
Malawi is a low-income country in sub-Saharan Africa
We have shown that, following rotavirus vaccine introduction in Malawi, rotavirus remains the leading pathogen detected in children
This is in agreement with data from 2 smaller studies, including one, performed in Tanzania, that assessed 146 diarrhea cases in 2015 and another, reported by the Global Rotavirus Surveillance Network, that analyzed a total of 327 samples collected from 10 African countries between 2013 and 2014 [2, 3]
Summary
Malawi is a low-income country in sub-Saharan Africa. Among adults, it has one of the highest prevalence rates of human immunodeficiency virus (HIV) infection, with or without AIDS, globally; 17.8% of women 15–49 years of age living in urban Malawi are infected with HIV [4]. In children
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