Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence.

Llorenç Quintò,Quique Bassat,Adriana Calderaro,Karen L Kotloff,Delfino Vubil,Sozinho Acácio,Pedro L Alonso,Tacilta Nhampossa,Tamer Farag,James P Nataro,Myron M Levine,Sandra Panchalingam,Inácio Mandomando,Marcelino Garrine,Sharon M Tennant

doi:10.1371/journal.pone.0249714

Abstract

BackgroundRotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction.MethodsA case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0–59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1–3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed.ResultsOverall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85–37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02–25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD.ConclusionThe implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.

Highlights

Despite the decreasing trends observed throughout the last few decades, diarrheal diseases remain among the major causes of morbidity and mortality among children aged 0–59 months worldwide [1]
The implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact
We hereby report the burden of rotavirus associated diarrhea among children less than 5 years of age enrolled as part of the Global Enteric Multicenter Study (GEMS) [12], a large and comprehensive multicenter case-control study on the etiology and epidemiology of diarrheal diseases conducted between 2007 and 2012 in Manhica district

Summary

Background

Rotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction

Methods

Results

Introduction

Study design

Laboratory methods for detection of rotavirus

Ethical statement

Discussion

Rotavirus vaccines WHO position paper