Abstract
The World Health Organization (WHO) currently coordinates rotavirus diarrhea and invasive bacterial disease (IBD) surveillance at 178 sentinel sites in 60 countries. However, only 78 sites participate in both surveillance systems using a common sentinel site. Here, we explored the feasibility of extending a WHO-IBD surveillance platform to generate data on the burden of rotaviral diarrhea and its epidemiological characteristics to prepare the countries to measure the impact of rotaviral vaccine. A six-month (July to December, 2012) surveillance, managed by IBD team, collected stool samples and clinical data from under-five children with acute watery diarrhea at an IBD sentinel site. Samples were tested for rotavirus antigen by ELISA and genotyped by PCR at the regional reference laboratory (RRL). Specimens were collected from 79% (n = 297) of eligible cases (n = 375); 100% of which were tested for rotavirus by ELISA and 54% (159/297) of them were positive. At RRL, all the cases were confirmed by PCR and genotyped (99%; 158/159). The typing results revealed the predominance of G12 (40%; 64/159) genotype, followed by G1 (31%; 50/159) and G9 (19%; 31/159). All in all, this exploratory surveillance collected the desired demographic and epidemiological data and achieved almost all the benchmark indicators of WHO, starting from enrollment number to quality assurance through a number of case detection, collection, and testing of specimens and genotyping of strains at RRL. The success of this WHO-IBD site in achieving these benchmark indicators of WHO can be used by WHO as a proof-of-concept for considering integration of rotavirus surveillance with WHO-IBD platforms, specifically in countries with well performing IBD site and no ongoing rotavirus surveillance.
Highlights
Rotavirus (RV) is the leading etiological agent of severe diarrhea in young children [1]
During this pre-vaccination phase, it is important to establish a platform for generating baseline burden of RV diarrhea and its epidemiological characteristics to prepare countries to measure the impact of the vaccine during post-vaccination years
The six-month rotavirus surveillance using a World Health Organization (WHO)-invasive bacterial disease (IBD) surveillance sentinel site platform successfully revealed a high burden of rotavirus in this tertiary-level hospital
Summary
Rotavirus (RV) is the leading etiological agent of severe diarrhea in young children [1]. Most of the deaths and severe diseases occur in lowincome countries [3]. In the last two decades, improvements in oral rehydration solution use, access to healthcare and clean water supply with sanitation have reduced diarrheal incidence and mortality significantly in Bangladesh and many other countries [4, 5]. The incidence of RV infection has not declined substantially [6]. Such interventions do not have as much impact on rotavirus as these have on bacterial and parasitic agents [6], owing to the organism’s multiple modes of transmission [7] and ubiquity. Bangladesh is considering introduction of RV-vaccine in coming years
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