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Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya

By D. James Nokes, John Abwao, Allan Pamba, Ina Peenze, John Dewar, J. Kamino Maghenda, Hellen Gatakaa, Evasius Bauni, J. Anthony G. Scott, Kathryn Maitland and Thomas N. Williams


Background\ud Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with\ud the greatest burden falling on young children living in less-developed countries. Vaccines\ud directed against this virus have shown promise in recent trials, and are undergoing\ud effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are\ud available on the incidence and clinical characteristics of severe group A rotavirus disease.\ud Advocacy for vaccine intervention and interpretation of effectiveness following implementation\ud will benefit from accurate base-line estimates of the incidence and severity of rotavirus\ud paediatric admissions in relevant populations. The study objective was to accurately define the\ud incidence and severity of group A rotavirus disease in a resource-poor setting necessary to\ud make informed decisions on the need for vaccine prevention.\ud Methods and Findings\ud Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus\ud infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as\ud "cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated\ud the incidence of hospital admission with group A rotavirus using data from a demographic\ud surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296\ud (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%)\ud were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95%\ud confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000\ud children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478\ud (437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with\ud rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting\ud illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance\ud except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9%\ud among rotavirus-negative children.\ud Conclusions\ud In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first\ud 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across\ud Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is\ud associated with acute life-threatening metabolic derangement in otherwise healthy children.\ud Although mortality is low in this clinical research setting this may not be generally true in\ud African hospitals lacking rapid and appropriate management

Topics: RA
Publisher: Public Library of Science
Year: 2008
OAI identifier: oai:wrap.warwick.ac.uk:4430

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  4. (2005). Assessment of severe malnutrition among hospitalized children in rural Kenya: comparison of weight for height and mid upper arm circumference. doi
  5. (2005). Bacteremia among children admitted to a rural hospital in Kenya. doi
  6. (2004). Capillary refill: prognostic value in Kenyan children. doi
  7. (2003). Causes and outcome of young infant admissions to a Kenyan district hospital. doi
  8. (1977). Clinical features of acute gastroenteritis associated with human reoviruslike agent in infants and young children. doi
  9. (2002). Detection and characterization of rotaviruses in hospitalized neonates in Blantyre, doi
  10. (2001). Effect of concomitant HIV infection on presentation and outcome of rotavirus gastroenteritis in Malawian children. doi
  11. (2006). Effectiveness of Haemophilus influenzae type b Conjugate vaccine introduction into routine childhood immunization in Kenya. doi
  12. (1999). Epidemiological study of the G serotype distribution of group A rotaviruses in Kenya from doi
  13. (1997). Epidemiological study on infectious diarrheal diseases in children in a coastal rural area of Kenya. doi
  14. (1980). Epidemiology of acute gastroenteritis in early childhood in Kenya: aetiological agents. doi
  15. (1998). Epidemiology of rotavirus diarrhoea in Africa: a review to assess the need for rotavirus immunization.
  16. (1998). Extended excretion of rotavirus after severe diarrhoea in young children. doi
  17. (2003). Global illness and deaths caused by rotavirus disease in children. doi
  18. (2003). Hypothetical performance of syndrome-based management of acute paediatric admissions of children aged more than 60 days in a Kenyan district hospital.
  19. (2003). Kenya demographic and health survey. doi
  20. (1987). Molecular epidemiology of rotavirus in black infants in South Africa.
  21. (2006). Phase III clinical trials of rotavirus vaccines and efforts to accelerate introduction to the developing world.
  22. Population Division/International Programs Center. Available: http:// www.census.gov/ipc/www/idb/country/keportal.html. doi
  23. (2003). Prognostic indicators of early and late death in children admitted to district hospital in Kenya: cohort study. doi
  24. (2006). Rotavirus and severe childhood diarrhea.
  25. (2003). Rotavirus strains circulating in Africa during 1996–1999: emergence of G9 strains and P[6] strains. doi
  26. (2006). Safety and efficacy of a pentavalent human-bovine (WC3) reassortant rotavirus vaccine. doi
  27. (2006). Safety and efficacy of an attenuated vaccine against severe rotavirus gastroenteritis. doi
  28. (2003). Severe P. falciparum malaria in Kenyan children: evidence for hypovolaemia. doi
  29. (2000). South African G4P[6] asymptomatic and symptomatic neonatal rotavirus strains differ in their NSP4, VP8*, and VP7 genes. doi
  30. (1992). Viral gastrointestinal infections.
  31. (2000). World Health Organisation doi

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