Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)

PLOS ONE, Dec 2019

Objective To evaluate factors associated with rotavirus diarrhea and to describe severity of illness among children <5 years old with non-dysenteric, moderate-to-severe diarrhea (MSD) in rural western Kenya. Methods We analyzed data from children <5 years old with non-dysenteric MSD enrolled as cases in the Global Enteric Multicenter Study (GEMS) in Kenya. A non-dysenteric MSD case was defined as a child with ≥3 loose stools in 24 hrs. and one or more of the following: sunken eyes, skin tenting, intravenous rehydration, or hospitalization, who sought care at a sentinel health center within 7 days of illness onset. Rotavirus antigens in stool samples were detected by ELISA. Demographic and clinical information was collected at enrollment and during a single follow-up home visit at approximately 60 days. We analyzed diarrhea severity using a GEMS 17 point numerical scoring system adapted from the Vesikari score. We used logistic regression to evaluate factors associated with rotavirus infection. Results From January 31, 2008 to September 30, 2012, among 1,637 (92%) non-dysenteric MSD cases, rotavirus was detected in stools of 245 (15.0%). Rotavirus-positive compared with negative cases were: younger (median age, 8 vs. 13 months; p<0.0001), had more severe illness (median severity score, 9 vs 8; p<0.0001) and had to be hospitalized more frequently (37/245 [15.1%] vs. 134/1,392 [9.6%]), p <0.013). Independent factors associated with rotavirus infection included age 0–11 months old (aOR = 5.29, 95% CI 3.14–8.89) and presenting with vomiting ≥3 times/24hrs (aOR = 2.58, 95% CI [1.91–3.48]). Rotavirus was detected more commonly in warm and dry months than in the cool and rainy months (142/691 [20%] vs 70/673 [10%]) p<0.0001). Conclusions Diarrhea caused by rotavirus is associated with severe symptoms leading to hospitalization. Consistent with other settings, infants had the greatest burden of disease.

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Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS)

August Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS) Richard Omore 0 1 2 Jacqueline E. Tate 0 2 Ciara E. O'Reilly 0 2 Tracy Ayers 0 2 John Williamson 0 2 Feny Moke 0 1 2 Katie A. Schilling 0 2 Alex O. Awuor 0 1 2 Peter Jaron 0 1 2 John B. Ochieng 0 1 2 Joseph Oundo 0 2 3 Umesh D. Parashar 0 2 Michele B. Parsons 0 2 Cheryl C. Bopp 0 2 Dilruba Nasrin 0 2 Tamer H. Farag 0 2 Karen L. Kotloff 0 2 James P. Nataro 0 2 Sandra Panchalingam 0 2 Myron M. Levine 0 2 Kayla F. Laserson 0 2 J. Pekka Nuorti 0 2 Eric D. Mintz 0 2 Robert F. Breiman 0 2 3 0 Data Availability Statement: This data was collected confidentially from patients after providing informed voluntary consent that their information would be protected and would not be shared by the study Investigators and the Institutional Review Board (IRB). Please send requests to: Gates Enterics Project, Center for Vaccine Development, University of Maryland , Baltimore, 685 W. Baltimore St., Room 480, Baltimore, MD, 21201, USA; Phone: (410) 706- 5328, Fax: (410) 706-6205 , USA 1 Centre for Global Health Research, Kenya Medical Research Institute , Kisumu , Kenya , 2 Division of Viral Diseases, US Centers for Disease Control and Prevention , Atlanta, GA , United States of America, 3 Division of Foodborne, Waterborne and Environmental Diseases, US Centers for Disease Control and Prevention , Atlanta, GA , United States of America, 4 US Centers for Disease Control and Prevention , Kisumu , Kenya 2 Editor: Donald R. Olson, New York City Department of Health and Mental Hygiene , UNITED STATES 3 Global Disease Detection Division, Kenya Office of the US Centers for Disease Control and Prevention, Nairobi, Kenya, 6 University of Maryland, School of Medicine, Center for Vaccine Development , Baltimore, MD , United States of America, 7 Department of Pediatrics, University of Virginia School of Medicine , Charlottesville, VA , United States of America, 8 CDC India , Delhi , India , 9 University of Tampere School of Health Sciences , Tampere , Finland , 10 Emory Global Health Institute, Emory University , Atlanta Georgia , United States of America - OPEN ACCESS Objective rural western Kenya. Methods To evaluate factors associated with rotavirus diarrhea and to describe severity of illness among children <5 years old with non-dysenteric, moderate-to-severe diarrhea (MSD) in We analyzed data from children <5 years old with non-dysenteric MSD enrolled as cases in the Global Enteric Multicenter Study (GEMS) in Kenya. A non-dysenteric MSD case was defined as a child with 3 loose stools in 24 hrs. and one or more of the following: sunken eyes, skin tenting, intravenous rehydration, or hospitalization, who sought care at a sentinel health center within 7 days of illness onset. Rotavirus antigens in stool samples were detected by ELISA. Demographic and clinical information was collected at enrollment and during a single follow-up home visit at approximately 60 days. We analyzed diarrhea Funding: This study was funded by the Bill and Melinda Gates Foundation, Grants # 38874 (GEMS) and #OPP10333572 (GEMS1A), Myron M. Levine (PI) through the University of Maryland, School of Medicine, Center for Vaccine Development, Baltimore, MD USA. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. severity using a GEMS 17 point numerical scoring system adapted from the Vesikari score. We used logistic regression to evaluate factors associated with rotavirus infection. Results From January 31, 2008 to September 30, 2012, among 1,637 (92%) non-dysenteric MSD cases, rotavirus was detected in stools of 245 (15.0%). Rotavirus-positive compared with negative cases were: younger (median age, 8 vs. 13 months; p<0.0001), had more severe illness (median severity score, 9 vs 8; p<0.0001) and had to be hospitalized more frequently (37/245 [15.1%] vs. 134/1,392 [9.6%]), p <0.013). Independent factors associated with rotavirus infection included age 0–11 months old (aOR = 5.29, 95% CI 3.14–8.89) and presenting with vomiting 3 times/24hrs (aOR = 2.58, 95% CI [1.91–3.48]). Rotavirus was detected more commonly in warm and dry months than in the cool and rainy months (142/691 [20%] vs 70/673 [10%]) p<0.0001). Conclusions Diarrhea caused by rotavirus is associated with severe symptoms leading to hospitalization. Consistent with other settings, infants had the greatest burden of disease. Introduction Diarrhea continues to be the second leading cause of death among children under 5 years worldwide and was responsible for approximately 800,000 (~10.5%) of global deaths in this age group in 2015 [ 1 ]. Of the 7.6 million global deaths reported among children <5 years in 2010, 9.9% were attribute (...truncated)


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Richard Omore, Jacqueline E. Tate, Ciara E. O’Reilly, Tracy Ayers, John Williamson, Feny Moke, Katie A. Schilling, Alex O. Awuor, Peter Jaron, John B. Ochieng, Joseph Oundo, Umesh D. Parashar, Michele B. Parsons, Cheryl C. Bopp, Dilruba Nasrin, Tamer H. Farag, Karen L. Kotloff, James P. Nataro, Sandra Panchalingam, Myron M. Levine, Kayla F. Laserson, J. Pekka Nuorti, Eric D. Mintz, Robert F. Breiman. Epidemiology, Seasonality and Factors Associated with Rotavirus Infection among Children with Moderate-to-Severe Diarrhea in Rural Western Kenya, 2008–2012: The Global Enteric Multicenter Study (GEMS), PLOS ONE, 2016, Volume 11, Issue 8, DOI: 10.1371/journal.pone.0160060