Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
Background: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluatio...
| Príomhchruthaitheoirí: | , , , , , , , , , , |
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| Formáid: | Journal article |
| Teanga: | English |
| Foilsithe / Cruthaithe: |
Public Library of Science
2008
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| Ábhair: |
| _version_ | 1826291456369754112 |
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| author | Nokes, D Abwao, J Pamba, A Peenze, I Dewar, J Maghenda, J Gatakaa, H Bauni, E Scott, J Maitland, K Williams, T |
| author_facet | Nokes, D Abwao, J Pamba, A Peenze, I Dewar, J Maghenda, J Gatakaa, H Bauni, E Scott, J Maitland, K Williams, T |
| author_sort | Nokes, D |
| collection | OXFORD |
| description | Background: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. Methods and Findings: Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children , < 13 y of age were eligible as ‘‘cases’’ if admitted with diarrhoea, and ‘‘controls’’ if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478 (437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children. Conclusions: In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management. |
| first_indexed | 2024-03-07T02:59:39Z |
| format | Journal article |
| id | oxford-uuid:b0835d6d-9d6e-49e8-a1c6-6cc449d8b0ab |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T02:59:39Z |
| publishDate | 2008 |
| publisher | Public Library of Science |
| record_format | dspace |
| spelling | oxford-uuid:b0835d6d-9d6e-49e8-a1c6-6cc449d8b0ab2022-03-27T03:57:10ZIncidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, KenyaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:b0835d6d-9d6e-49e8-a1c6-6cc449d8b0abBiologyTropical medicineMedical sciencesPaediatricsEnglishOxford University Research Archive - ValetPublic Library of Science2008Nokes, DAbwao, JPamba, APeenze, IDewar, JMaghenda, JGatakaa, HBauni, EScott, JMaitland, KWilliams, TBackground: Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention. Methods and Findings: Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children , < 13 y of age were eligible as ‘‘cases’’ if admitted with diarrhoea, and ‘‘controls’’ if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478 (437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children. Conclusions: In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management. |
| spellingShingle | Biology Tropical medicine Medical sciences Paediatrics Nokes, D Abwao, J Pamba, A Peenze, I Dewar, J Maghenda, J Gatakaa, H Bauni, E Scott, J Maitland, K Williams, T Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title | Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title_full | Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title_fullStr | Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title_full_unstemmed | Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title_short | Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya |
| title_sort | incidence and clinical characteristics of group a rotavirus infections among children admitted to hospital in kilifi kenya |
| topic | Biology Tropical medicine Medical sciences Paediatrics |
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