Molecular typing based on full-length VP1 sequences.

<p>Molecular typing based on full-length VP1 sequences.</p

Phylograms depicting the relationships between the studied HEV-C in different genomic regions.

<p>The percentage of bootstrap replicates is indicated at nodes if higher than 70%. The length of branches is proportional to the number of nucleotide changes (percent divergence). The sequences of CV-A10 and EV-19 (members of HEV species A and B, respectively) were introduced for correct rooting of the tree. Triangles indicate the prototype strains, circles the field strains; the VDPV strain MAD004 is labelled with open circles. Each color corresponds to a given HEV-C serotype. Below each tree, the region taken in consideration for alignment is highlighted in red in the schematic diagram of the genome.</p

Phylogenetic relationships between Madagascan CV-A13 field strains and other CV-A13 isolates for which sequences are available in GenBank, based on 3′ one-third of the VP1 region (∼300 nt).

<p>The length of the branches is proportional to the number of nucleotide changes (percent divergence). The percentage of bootstrap replicates is indicated if higher than 70%. The field strains isolated in Madagascar are indicated by full circles if isolated in 2002, by open circles if isolated in other years. For the other isolates, the location and year of isolation are indicated in the tree. Triangles indicate the prototype strains. The CV-A11 G9 sequence was introduced for correct rooting of the tree.</p

Phylogenetic relationships between Madagascan HEV-C field isolates collected in 2002 and other isolates for which sequences are available in GenBank, based on full-length VP1 sequences.

<p>The length of the branches is proportional to the number of nucleotide changes (percent divergence). The percentage of bootstrap replicates is indicated for the main nodes. Each area of grey shading corresponds to a serotype. The field strains isolated in Madagascar in 2002 are indicated by circles; the isolates whose full-length genome was subsequently sequenced are indicated in bold. For the other isolates, the location and year of isolation are indicated in the tree. Triangles indicate the prototype strains.</p

Comparison of weight-for-height or length (WHZ) scores at enrolment, and change in WHZ (ΔWHZ/WHZ₀) between enrolment and follow-up at 30 and 60 days, between children with diarrhea and their matched controls from Antananarivo and Moramanga, 2011–2014.

<p>Comparison of weight-for-height or length (WHZ) scores at enrolment, and change in WHZ (ΔWHZ/WHZ₀) between enrolment and follow-up at 30 and 60 days, between children with diarrhea and their matched controls from Antananarivo and Moramanga, 2011–2014.</p

Etiologies, Risk Factors and Impact of Severe Diarrhea in the Under-Fives in Moramanga and Antananarivo, Madagascar

<div><p>Background</p><p>Diarrheal disease remains a leading cause of death in children in low-income countries. We investigated the etiology, risk factors and effects on nutritional status of severe diarrhea in children from two districts in Madagascar.</p><p>Methods</p><p>We performed a matched case-control study in 2011 to 2014, on children under the age of five years from Moramanga and Antananarivo. The cases were children hospitalized for severe diarrhea and the controls were children without diarrhea selected at random from the community. Stool samples were collected from both groups. Anthropometric measurements were made during follow-up visits about one and two months after enrolment.</p><p>Results</p><p>We enrolled 199 cases and 199 controls. Rotavirus infection was the most frequently detected cause of diarrhea. It was strongly associated with severe diarrhea (OR: 58.3; 95% CI: 7.7–439.9), accounting for 42.4% (95% CI: 37.6–43.1) of severe diarrhea cases. At the household level, possession of cattle (OR = 0.3; 95% CI: 0.1–0.6) and living in a house with electricity (OR = 0.4; 95% CI: 0.2–0.8) were protective factors. The presence of garbage around the house was a risk factor for severe diarrhea (OR = 3.2; 95% CI: 1.9–5.4). We found no significant association between severe diarrhea and the nutritional status of the children at follow-up visits, but evident wasting at enrolment was associated with a higher risk of severe diarrhea (OR = 9; 95% CI: 4.5–17.9).</p><p>Conclusions</p><p>Severe childhood diarrhea is mostly caused by rotavirus infection. An anti-rotavirus vaccine has already been introduced in Madagascar and should be promoted more widely. However, post-licensing surveillance is required. Interventions to improve the nutritional status of children, preventive measures focused on household and personal hygiene and nutritional rehabilitation during severe diarrheal disease should be reinforced.</p></div

Clinical symptoms associated with the enteric pathogens isolated from children with diarrhea in Antananarivo and Moramanga, 2011–2014.

<p>Clinical symptoms associated with the enteric pathogens isolated from children with diarrhea in Antananarivo and Moramanga, 2011–2014.</p

Individual and household characteristics of the cases and controls from Antananarivo and Moramanga, 2011–2014.

<p>Individual and household characteristics of the cases and controls from Antananarivo and Moramanga, 2011–2014.</p

Additional file 2 of Enterovirus detection in different regions of Madagascar reveals a higher abundance of enteroviruses of species C in areas where several outbreaks of vaccine-derived polioviruses occurred

Additional file 2: Figure S1. Detection of NPEVs on RD and HEp-2c cells

Additional file 3 of Enterovirus detection in different regions of Madagascar reveals a higher abundance of enteroviruses of species C in areas where several outbreaks of vaccine-derived polioviruses occurred

Additional file 3: Figure S2. Phylogenetic trees of Madagascan EV-Cs based on the 5′UTR, the VP1- and the 3D-encoding sequences. The isolates are colour-coded according to their respective type; triangles indicate isolates from this study, circles isolates from previous works