Rates of hospitalization and death for all-cause and rotavirus acute gastroenteritis before rotavirus vaccine introduction in Kenya, 2010\u20132013

Richard Omore,Jane Juma,Robert F Breiman,Billy Ogwel,Sammy Khagayi,Umesh D Parashar,Jacqueline E Tate,Stephen Munga,J Pekka Nuorti,Collins Tabu,John B Ochieng,Sergon Kibet,Reuben Onkoba,Jason M Mwenda,Frank Odhiambo

doi:10.1186/s12879-018-3615-6

Abstract

BackgroundRotavirus vaccine was introduced in Kenya immunization program in July 2014. Pre-vaccine disease burden estimates are important for assessing vaccine impact.MethodsChildren with acute gastroenteritis (AGE) (≥3 loose stools and/or ≥ 1 episode of unexplained vomiting followed by loose stool within a 24-h period), hospitalized in Siaya County Referral Hospital (SCRH) from January 2010 through December 2013 were enrolled. Stool specimens were tested for rotavirus (RV) using an enzyme immunoassay (EIA). Hospitalization rates were calculated using person-years of observation (PYO) from the Health Demographic Surveillance System (HDSS) as a denominator, while adjusting for healthcare utilization at household level and proportion of stool specimen collected from patients who met the case definition at the surveillance hospital. Mortality rates were calculated using PYO as the denominator and number of deaths estimated using total deaths in the HDSS, proportion of deaths attributed to diarrhoea by verbal autopsy (VA) and percent positive for rotavirus AGE (RVAGE) hospitalizations.ResultsOf 7760 all-cause hospitalizations among children < 5 years of age, 3793 (49%) were included in the analysis. Of these, 21% (805) had AGE; RV was detected in 143 (26%) of 541 stools tested. Among children < 5 years, the estimated hospitalization rates per 100,000 PYO for AGE and RVAGE were 2413 and 429, respectively. Mortality rate associated with AGE and RVAGE were 176 and 45 per 100,000 PYO, respectively.ConclusionAGE and RVAGE caused substantial health care burden (hospitalizations and deaths) before rotavirus vaccine introduction in Kenya.

Highlights

Rotavirus vaccine was introduced in Kenya immunization program in July 2014
A whole stool specimen was collected from each participant in a plastic diaper from which at least 2 ml of stool was scooped into a specimen container using a sterile spatula within 48 h of admission, transported on the same day to the enteric laboratory based at the Kenya Medical Research Institute (KEMRI)-Center for Global Health Research (CGHR), and tested for rotavirus using a commercial enzyme immunoassay (EIA) (Rotaclone Kit, Meridian Bioscience)
This study shows that acute gastroenteritis (AGE) and rotavirus AGE (RVAGE) associated hospitalization and deaths are high in this setting with children aged 6–11 months bearing the greatest burden

Summary

Introduction

Rotavirus vaccine was introduced in Kenya immunization program in July 2014. In 2013, RVAGE was estimated to cause 215,000 global deaths among children < 5 years of. Recent population-based data on pre-vaccine disease rates are not available in Kenya. Such data are needed to evaluate the impact of vaccination program and may help county and national level governments, regional and global decision makers with evidence needed to support investment in these vaccines. We examined baseline rates of AGE and RVAGE specific hospitalizations and deaths among children < 5 years in rural western Kenya from January 1, 2010 to December 31, 2013 before RV vaccine introduction in Kenya

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Discussion

Conclusion