Rotavirus Prevalence in the Primary Care Setting in Nicaragua after Universal Infant Rotavirus Immunization (original) (raw)
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International Journal of Infectious Diseases, 2010
Background: In October 2006, a rotavirus vaccine was introduced in Nicaragua for routine immunization of all children. We document the baseline diarrheal disease burden in Nicaragua prior to the vaccine program to facilitate future studies to measure vaccine impact. Methods: We analyzed national data for 2001-2005 on total acute gastroenteritis healthcare visits, hospitalizations, and mortality in Nicaraguan children aged <5 years. Results: Prior to vaccine introduction, by age 5 years, one in four Nicaraguan children required an outpatient consultation, one in 34 were hospitalized, and one in 2487 died from rotavirus-associated diarrhea, representing approximately 41 122 outpatient visits, 4460 hospitalizations, and 60 deaths per year that are preventable through vaccination. Almost half of the total acute gastroenteritis burden was in children <1 year of age. Two distinct seasonal peaks were noted in acute gastroenteritis hospitalizations and deaths. Conclusions: Existing data sources on all-cause acute gastroenteritis could be useful for establishing diarrhea disease burden and monitoring trends after vaccine introduction. Blunting of winter season peaks in rates of diarrhea, particularly among children aged <1-2 years, would be a useful indicator of impact from rotavirus vaccination.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2014
Background-Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods-We followed a population-based sample of children less than 5 years in León, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial, and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results-The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 childyears of exposure time (1.1 episodes per child-year). At least one enteropathogen was detected
Community Diarrhea Incidence Before and After Rotavirus Vaccine Introduction in Nicaragua
The American Journal of Tropical Medicine and Hygiene, 2013
We estimated the incidence of watery diarrhea in the community before and after introduction of the pentavalent rotavirus vaccine in Leó n, Nicaragua. A random sample of households was selected before and after rotavirus vaccine introduction. All children 5 years of age in selected households were eligible for inclusion. Children were followed every 2 weeks for watery diarrhea episodes. The incidence rate was estimated as numbers of episodes per 100 child-years of exposure time. A mixed effects Poisson regression model was fit to compare incidence rates in the prevaccine and vaccine periods. The pre-vaccine cohort (N = 726) experienced 36 episodes per 100 child-years, and the vaccine cohort (N = 826) experienced 25 episodes per 100 child-years. The adjusted incidence rate ratio was 0.60 (95% confidence interval [CI] 0.40, 0.91) during the vaccine period versus the pre-vaccine period, indicating a lower incidence of watery diarrhea in the community during the vaccine period.
The epidemiology of rotavirus diarrhea in Latin America: anticipating rotavirus vaccines
Revista Panamericana de Salud Pública, 2004
Objective. To assess the disease burden and characterize the epidemiology of rotavirus diarrhea in Latin America. Methods. We conducted a literature review of studies of children < 5 years of age who were hospitalized or seen as outpatients for diarrhea and for whom rotavirus was sought as the etiologic agent of the diarrhea. This review included inpatient and outpatient studies published since 1998 that included at least 100 children and reported surveillance activities lasting at least 12 consecutive months. Results. A total of 18 inpatient and 10 outpatient studies met the criteria for inclusion in this review. Rotavirus was detected in a median of 31% of inpatients (range, 16%-52%) and 30.5% of outpatients (range, 4%-42%). The median detection rate was higher in studies that used an enzyme-linked immunosorbent assay (ELISA) (inpatients 38%, outpatients 33%) versus less sensitive methods of detection. The age distribution of rotavirus disease varied among countries, with 65%-85% of children hospitalized in the first year of life. Most countries had rotavirus admissions year round, and rotavirus generally exhibited a winter seasonal peak in both temperate and tropical climates. Conclusions. The heavy burden of disease attributable to rotavirus in Latin America suggests that vaccines currently being tested could have considerable impact in preventing hospitalizations, clinic visits, and deaths. The findings of the young age distribution of patients highlight the importance of early immunization for the success of a vaccine program. The data suggest that future surveillance for rotavirus diarrhea in Latin America should use a standardized surveillance protocol with an ELISA for detection. Data from surveillance studies will be critical to monitor the impact of the future introduction of vaccines. Rotavirus; disease outbreaks; burden of illness; epidemiology; Latin America.
Uptake of Rotavirus Vaccine and National Trends of Acute Gastroenteritis among Children in Nicaragua
The Journal of Infectious Diseases, 2009
Background. In October 2006, a new rotavirus vaccine was introduced in Nicaragua and was available free to all age-eligible children. We assessed vaccine uptake and trends in acute gastroenteritis (AGE) to assess vaccine impact. Methods. We analyzed national data from the period 2001-2007 on the total number of AGE episodes and on RotaTeq vaccine dose administration during 2006-2007. Results. After the introduction of RotaTeq, 1-dose vaccine coverage rates rapidly increased to 80% among age-eligible children. During the 2007 rotavirus season, when combined 2-and 3-dose vaccine coverage among children aged 0-11 months was ∼26%, the total number of AGE episodes among children aged 0-11 months decreased by 23%, compared with a decrease of 6% among unvaccinated children aged 12-59 months. Furthermore, a 12% decrease in the number of all-cause hospitalizations for AGE was noted among children aged 0-11 months, whereas a ∼5% increase was observed among children aged 12-59 months. Conclusions. The high rate of vaccination among age-eligible children soon after vaccine introduction in Nicaragua indicates an efficient immunization program. However, in the age group at risk of rotavirus disease, vaccine coverage during the 2007 rotavirus season had yet to reach a level sufficient for making firm conclusions about vaccine impact. Epidemiologic studies to evaluate vaccine effectiveness and ongoing surveillance as vaccine uptake increases will allow a better assessment of vaccine impact. Rotavirus is the most common cause of severe gastroenteritis in children !5 years of age worldwide, accounting for an estimated 2.4 million hospital admissions and 527,000 deaths each year [1, 2]. Because of the tremendous global burden of rotavirus, vaccine introduction has been a high priority for several international agencies, including the World Health Organization and the GAVI Alliance (formerly known as the Potential conflicts of interest: none reported.