Abstract
BackgroundDespite significant reduction of rotavirus (RV) infections following implementation of RotaTeq vaccination in Nicaragua, a large burden of patients with diarrhea persists.MethodsWe conducted a community- and hospital-based study of the burden of RV, norovirus (NV) and sapovirus (SV) infections as cause of sporadic acute gastroenteritis (GE) among 330 children ≤ 5 years of age between September 2009 and October 2010 in two major cities of Nicaragua with a RotaTeq coverage rate of 95%.ResultsWe found that NV, SV and RV infections altogether accounted for 45% of cases of GE. Notably, NV was found in 24% (79/330) of the children, followed by SV (17%, 57/330) and RV (8%, 25/330). The detection rate in the hospital setting was 27%, 15% and 14% for NV, SV and RV respectively, whereas in the community setting the detection rate of RV was < 1%. Among each of the investigated viruses one particular genogroup or genotype was dominant; GII.4 (82%) for NV, GI (46%) for SV and G1P[8] (64%) in RV. These variants were also found in higher proportions in the hospital setting compared to the community setting. The GII.4.2006 Minerva strain circulating globally since 2006 was the most common among genotyped NV in this study, with the GII.4-2010 New Orleans emerging in 2010.ConclusionsThis study shows that NV has become the leading viral cause of gastroenteritis at hospital and community settings in Nicaragua after implementation of RV vaccination.
Highlights
Acute gastroenteritis (GE) is one of the leading causes of morbidity and mortality in children in the developing countries, with rotavirus (RV) and norovirus (NV) being the major causes of pediatric viral GE, altogether associated with approximately 800,000 deaths in young children every year [1,2,3]
A major reduction of severe RVGE has been observed in countries with high vaccine coverage but comprehensive analysis in several clinical trials indicates the vaccine efficacy to be lower in countries with high RV mortality [9,10]
Norovirus was the major cause of pediatric gastroenteritis
Summary
Acute gastroenteritis (GE) is one of the leading causes of morbidity and mortality in children in the developing countries, with rotavirus (RV) and norovirus (NV) being the major causes of pediatric viral GE, altogether associated with approximately 800,000 deaths in young children every year [1,2,3]. A major reduction of severe RVGE has been observed in countries with high vaccine coverage but comprehensive analysis in several clinical trials indicates the vaccine efficacy to be lower in countries with high RV mortality [9,10]. A case control study evaluating RotaTeq in 2007– 2008 in Nicaragua showed that vaccination was associated with a lower risk of RVGE in children younger than 2 years [12], but to a lesser extent than observed in clinical trials in Europe and USA [13]. The efficacy in Nicaragua against severe RV diarrhea was only 58%, which is similar to other studies from Asian and African countries [12,14,15]. Despite significant reduction of rotavirus (RV) infections following implementation of RotaTeq vaccination in Nicaragua, a large burden of patients with diarrhea persists
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