Household Transmission of Rotavirus in a Community with Rotavirus Vaccination in Quininde, Ecuador

Background: We studied the transmission of rotavirus infection in households in peri-urban Ecuador in the vaccination era. Methods: Stool samples were collected from household contacts of child rotavirus cases, diarrhea controls and healthy controls following presentation of the index child to health facilities. Rotavirus infection status of contacts was determined by RT-qPCR. We examined factors associated with transmissibility (index-case characteristics) and susceptibility (householdcontact characteristics). Results: Amongst cases, diarrhea controls and healthy control household contacts, infection attack rates (iAR) were 55%, 8% and 2%, (n = 137, 130, 137) respectively. iARs were higher from index cases with vomiting, and amongst siblings. Disease ARs were higher when the index child was ,18 months and had vomiting, with household contact ,10 years and those sharing a room with the index case being more susceptible. We found no evidence of asymptomatic infections leading to disease transmission. Conclusion: Transmission rates of rotavirus are high in households with an infected child, while background infections are rare. We have identified factors associated with transmission (vomiting/young age of index case) and susceptibility (young age/sharing a room/being a sibling of the index case). Vaccination may lead to indirect benefits by averting episodes or reducing symptoms in vaccinees

Aetiology and incidence of diarrhoea requiring hospitalisation in children under 5 years of age in 28 low-income and middle-income countries: findings from the Global Pediatric Diarrhea Surveillance network.

Introduction: Diarrhoea remains a leading cause of child morbidity and mortality. Systematically collected and analysed data on the aetiology of hospitalised diarrhoea in low-income and middle-income countries are needed to prioritise interventions. Methods: We established the Global Pediatric Diarrhea Surveillance network, in which children under 5 years hospitalised with diarrhoea were enrolled at 33 sentinel surveillance hospitals in 28 low-income and middle-income countries. Randomly selected stool specimens were tested by quantitative PCR for 16 causes of diarrhoea. We estimated pathogen-specific attributable burdens of diarrhoeal hospitalisations and deaths. We incorporated country-level incidence to estimate the number of pathogen-specific deaths on a global scale. Results: During 2017–2018, 29 502 diarrhoea hospitalisations were enrolled, of which 5465 were randomly selected and tested. Rotavirus was the leading cause of diarrhoea requiring hospitalisation (attributable fraction (AF) 33.3%; 95% CI 27.7 to 40.3), followed by Shigella (9.7%; 95% CI 7.7 to 11.6), norovirus (6.5%; 95% CI 5.4 to 7.6) and adenovirus 40/41 (5.5%; 95% CI 4.4 to 6.7). Rotavirus was the leading cause of hospitalised diarrhoea in all regions except the Americas, where the leading aetiologies were Shigella (19.2%; 95% CI 11.4 to 28.1) and norovirus (22.2%; 95% CI 17.5 to 27.9) in Central and South America, respectively. The proportion of hospitalisations attributable to rotavirus was approximately 50% lower in sites that had introduced rotavirus vaccine (AF 20.8%; 95% CI 18.0 to 24.1) compared with sites that had not (42.1%; 95% CI 33.2 to 53.4). Globally, we estimated 208 009 annual rotavirus-attributable deaths (95% CI 169 561 to 259 216), 62 853 Shigella-attributable deaths (95% CI 48 656 to 78 805), 36 922 adenovirus 40/41-attributable deaths (95% CI 28 469 to 46 672) and 35 914 norovirus-attributable deaths (95% CI 27 258 to 46 516). Conclusions: Despite the substantial impact of rotavirus vaccine introduction, rotavirus remained the leading cause of paediatric diarrhoea hospitalisations. Improving the efficacy and coverage of rotavirus vaccination and prioritising interventions against Shigella, norovirus and adenovirus could further reduce diarrhoea morbidity and mortality

Household Transmission of Rotavirus in a Community with Rotavirus Vaccination in Quininde, Ecuador

Abstract Background: We studied the transmission of rotavirus infection in households in peri-urban Ecuador in the vaccination era

Household Transmission of Rotavirus in a Community with Rotavirus Vaccination in Quininde, Ecuador

Abstract Background: We studied the transmission of rotavirus infection in households in peri-urban Ecuador in the vaccination era

Disease attack rates^* amongst household contacts by their own characteristics and index case characteristics.

*<p>There was not sufficient power to fit regression model when using the definition of disease of symptomatic and RT-qPCR positive, as only 8 contacts met this definition. However, the simple frequency tabulations with this outcome were consistent with the disease (regardless of test result) outcome analysis. Attack rates were higher from children who were younger (24% (6/25) from children <18 months compared to 2% (2/106) from children ≥18 months), had multiple episodes of vomiting (15% (8/82) compared to 0% from children with 1 or no episodes of vomiting (0/79)) and amongst contacts aged less than 10 years (27% (7/26) compared to contacts aged 10 years or older (0%; 0/91)).</p><p>Odds ratios, 95% confidence intervals and Wald-test p values are given for (a) univariate models, multivariate models of (b) other case <i>or</i> contact characteristics and (c) other case <i>and</i> contact characteristics.</p

Infection and disease households with a rotavirus index case.

<p>Each line represents infection and disease events in one household. Index cases are plotted in black (n = 39). Other cases of rotavirus gastroenteritis in the household are plotted in red and are plotted on the time axis in terms of time of onset relative to time of onset of the index case. Household contacts with asymptomatic infection are plotted in blue (off the time scale, since we cannot know at what time they become infected) and contacts remaining uninfected are plotted in grey. The size of the points are relative to the number of individuals with a given outcome; for reference the size of the index cases (black dots) represents a single individual.</p

Calendar month distribution of index cases (n = 39) diarrhea controls (n = 40) and healthy controls (n = 40).

<p>Calendar month distribution of index cases (n = 39) diarrhea controls (n = 40) and healthy controls (n = 40).</p

Infection attack rates amongst household contacts by their own characteristics and index case characteristics.

<p>Odds ratios, 95% confidence intervals and Wald-test p values are given for (a) univariate models, multivariate models of (b) other case <i>or</i> contact characteristics and (c) other case <i>and</i> contact characteristics.</p

Genotype (G- and P-type) profiles of infections amongst rotavirus index cases and household contacts.

<p>The first 2 columns represent the G and P types (respectively) of the typeable index cases (n = 35) and, with each typeable household contact (n = 57) shown to the right of the index case. Single G and P-tpye infections are color-coded; mixed infections are in black and un-typeable G- or P-types are in grey.</p