Clinical characteristics and complications of rotavirus gastroenteritis in children in east London: A retrospective case-control study.

BACKGROUND: Rotavirus is the leading cause of acute gastroenteritis in children and is associated with neurological complications such as seizures and encephalopathy. The aim of this study was to investigate the presentation and complications of rotavirus compared to non-rotavirus gastroenteritis in UK children. METHODS: This was a retrospective, case-control, hospital-based study conducted at three sites in east London, UK. Cases were children aged 1 month to 16 years diagnosed with acute gastroenteritis between 1 June 2011 and 31 December 2013, in whom stool virology investigations confirmed presence of rotavirus by PCR. They were matched by age, gender and month of presentation to controls with rotavirus-negative gastroenteritis. RESULTS: Data were collected from 116 children (50 cases and 66 controls). Children with rotavirus gastroenteritis tended to present more frequently with metabolic acidosis (pH 7.30 vs 7.37, P = 0.011) and fever (74% versus 46%; P = 0.005) and were more likely to require hospitalisation compared to children with non-rotavirus gastroenteritis (93% versus 73%; P = 0.019). Neurological complications were the most common extra-intestinal manifestations, but did not differ significantly between children with rotavirus-positive gastroenteritis (RPG) and rotavirus-negative gastroenteritis (RNG) (24% versus 15%, respectively; P = 0.24). Encephalopathy occurred only in children with rotavirus infection (n = 3, 6%). CONCLUSION: Rotavirus causes longer and more severe disease compared to other viral pathogens. Seizures and milder neurological signs were surprisingly common and associated with multiple pathogens, but encephalopathy occurred only in children with rotavirus gastroenteritis. Rotavirus vaccination may reduce seizures and presentation to hospital, but vaccines against other pathogens causing gastroenteritis are required.AJP receives funding from the Wellcome Trust (grant 108065/Z/15/Z)

Beyond the Millennium Development Goals: public health challenges in water and sanitation.

Over 1 billion people lack access to improved water sources and 2.6 billion lack access to appropriate sanitation, greatly contributing to the global burden of disease. The international community has committed to reducing by half the proportion of the world's population lacking access to water and sanitation as a part of the Millennium Development Goals (MDGs). However, the disease burden due to poor access, is borne primarily by the poorest countries and the poorest people within them. Simply reducing the proportion of people without adequate access will not automatically result in proportional reductions in the related disease burden. The public health challenge inherent in meeting the MDG targets is ensuring that improvements result in access to water and sanitation for the critical at-risk populations. Innovative approaches are required to ensure the availability of low-cost, simple, and locally acceptable water and sanitation interventions and integrating these approaches into existing social institutions, such as schools, markets, and health facilities

Demographic Variability, Vaccination, and the Spatiotemporal Dynamics of Rotavirus Epidemics

Historically, annual rotavirus activity in the United States has started in the southwest in late fall and ended in the northeast 3 months later; this trend has diminished in recent years. Traveling waves of infection or local environmental drivers cannot account for these patterns. A transmission model calibrated against epidemiological data shows that spatiotemporal variation in birth rate can explain the timing of rotavirus epidemics. The recent large-scale introduction of rotavirus vaccination provides a natural experiment to further test the impact of susceptible recruitment on disease dynamics. The model predicts a pattern of reduced and lagged epidemics postvaccination, closely matching the observed dynamics. Armed with this validated model, we explore the relative importance of direct and indirect protection, a key issue in determining the worldwide benefits of vaccination

Ampleur de la gastroenterite a rotavirus chez les enfants Togolais ages de moins de 5 ans

Contexte: le rotavirus est la principale cause de gastroentérite sévère et de déshydratation chez l’enfant dans le monde. Le vaccin monovalent antirotavirus a été introduit dans le calendrier vaccinal du Togo depuis juin 2014. La disponibilité de données de base a permis d’examiner la charge de morbidité et de mortalité causée par le rotavirus chez les enfants togolais.Méthode: nous avons effectué une étude cas-témoins à travers la surveillance sentinelle active de la gastroentérite aiguë et de la gastroentérite à rotavirus chez des enfants de moins de 5 ans au CHU Sylvanus Olympio et à l'Hôpital secondaire de Be à Lomé (Togo) d'octobre 2010 à septembre 2016, selon le protocole générique de l’OMS. Le rotavirus a été détecté dans les échantillons de selles par le test ELISA. La caractérisation des souches par génotypage a été réalisée au Noguchi Memorial Institute à Accra (Ghana) et au Medunsa campus à Pretoria (Afrique du Sud). Les cas testés rotavirus-positifs ont été comparés aux témoins testés rotavirus-négatifs.Résultats: au cours des six années de la surveillance, 1409 enfants atteints de gastroentérite aiguë ont été enregistrés; et 692 (49%) ont été testés positifs pour le rotavirus. La différence d'âge entre les enfants atteints de gastroentérite à rotavirus et ceux atteints de gastroentérite non-rotavirus a été significative (p <0,001) ; les enfants atteints de gastroentérite à rotavirus ont été plus jeunes. De novembre à mars, les cas de gastroentérite à rotavirus (68%, p <0,002) ont été significativement plus nombreux que dans les autres mois de l'année. La déshydratation (p <0,05) a été plus fréquente chez les enfants atteints de gastroentérite à rotavirus que chez ceux atteints de gastroentérite non-rotavirus. Les combinaisons génotypiques les plus courantes ont été G12P [8] (29%), G1P [6] (16%), G1P [8] (13%), G3P [6] (6%) et G12P [6] (5%).Conclusion: la prévalence du rotavirus a été élevée chez les enfants togolais ayant souffert de gastroentérite aiguë. La surveillance continue de la gastroentérite à rotavirus sera importante pour évaluer l'impact et l'efficacité du vaccin à travers un suivi des modifications dans l’évolution des tendances de la maladie.Mots clés: gastroentérite, rotavirus, ampleur, Togo, Afrique sub-saharienneEnglish Title: Burden of acute gastroenteritis among Togolese children younger than 5 years of ageEnglish AbstractBackground: Rotavirus is the leading cause of severe gastroenteritis and dehydration in young children worldwide. The monovalent rotavirus vaccine was introduced in Togolese immunization schedule since June 2014. The availability of baseline data has enable rotavirus disease burden examination among Togolese under-five year children.Method: We conducted cases-controls study through active sentinel surveillance for acute gastroenteritis and rotavirus associated gastroenteritis among children <5 years of age at Sylvanus Olympio Teaching Hospital and Be Hospital in Lome (Togo) from October 2010 through September 2016, based on the World Health Organization’s generic protocol. Rotavirus was detected in stool specimens by ELISA. The strains characterization by genotyping was performed at Noguchi Memorial Institute for Medical Research in Accra (Ghana) and at Medunsa campus in Pretoria (South Africa). Laboratory-confirmed rotavirus cases were compared with rotavirus-negative controls.Results: During the six-year surveillance, 1409 children with acute gastroenteritis were enrolled; and 692 (49%) were tested positive for rotavirus. The difference of age among children with rotavirus and non-rotavirus gastroenteritis was significant (p<0.001) with rotavirus cases younger than non-rotavirus cases. From November to March, significantly (68%, p<0.002) more cases of rotavirus gastroenteritis were enrolled compared with other months of the year. Dehydration (p<0.05) was more common in children with rotavirus than non-rotavirus gastroenteritis. The most common G-P combinations were G12P [8] (29%), G1P [6] (16%), G1P [8] (13%), G3P [6] (6%), and G12 P[6] (5%).Conclusion: The prevalence of rotavirus is high among Togolese children with acute gastroenteritis. Continued rotavirus gastroenteritis surveillance will be important to evaluate vaccine impact and efficacy through monitoring of changes in rotavirus disease trends.Keywords: gastroenteritis, rotavirus, burden, Togo, sub-Saharan Afric