Clinical and Epidemiologic Features of Cryptosporidium-Associated Diarrheal Disease Among Young Children Living in Sub-Saharan Africa: The Vaccine Impact on Diarrhea in Africa (VIDA) Study

Abstract

Background As part of the Vaccine Impact on Diarrhea in Africa (VIDA) Study, we examined the prevalence, clinical presentation, and seasonality of Cryptosporidium in children to understand its relative burden after the introduction of rotavirus vaccine. Methods VIDA was a 3-year, age-stratified, matched case-control study of medically attended acute moderate-to-severe diarrhea (MSD) in children aged 0–59 months residing in censused populations at sites in Kenya, Mali, and The Gambia. Clinical and epidemiologic data were collected at enrollment, and a stool sample was tested for enteropathogens by quantitative PCR. An algorithm was created based on the organism's cycle threshold (Ct) and association with MSD to identify the subset of Cryptosporidium PCR-positive (Ct <35) cases most likely to be attributed to MSD. Clinical outcomes were assessed at 2–3 months after enrollment. Results One thousand one hundred six (22.9%) cases of MSD and 873 controls (18.1%) were PCR positive for Cryptosporidium; 465 cases (42.0%) were considered attributable to Cryptosporidium, mostly among children 6–23 months. Cryptosporidium infections peaked in The Gambia and Mali during the rainy season, while in Kenya they did not have clear seasonality. Compared with cases with watery MSD who had a negative PCR for Cryptosporidium, cases with watery MSD attributed to Cryptosporidium were less frequently dehydrated but appeared more severely ill using a modified Vesikari scale (38.1% vs 27.0%; P < 0.001), likely due to higher rates of hospitalization and intravenous fluid administration, higher prevalence of being wasted or very thin very thin (23.4% vs 14.7%; P < 0.001), and having severe acute malnutrition (midupper arm circumference <115 mm, 7.7% vs 2.5%; P < 0.001). On follow-up, Cryptosporidium-attributed cases had more prolonged and persistent episodes (43.2% vs 32.7%; P <0 .001) and linear growth faltering (change in height-for-age z score between enrollment and follow-up: −0.29 vs −0.17; P < 0.001). Conclusions The burden of Cryptosporidium remains high among young children in sub-Saharan Africa. Its propensity to cause illness and further impact children longer term by compromising nutritional status early in life calls for special attention to enable appropriate management of clinical and nutritional consequences.

Multiplex PCR for bacterial, viral and protozoal pathogens in persistent diarrhoea or persistent abdominal pain in Côte d’Ivoire, Mali and Nepal

“…In contrast to our study, in which Cryptosporidium spp. was not highly prevalent, cryptosporidiosis was identified as one of the most significant infections in the MAL-ED, GEMS and VIDA studies 24 – 27 . However, a direct comparison between our study and the GEMS and MAL-ED studies is difficult, as the majority (77.9%) of all patients presenting with persistent digestive disorders in our investigation were children and adolescents presenting with persistent abdominal pain rather than diarrhoea as the main symptomatology.…”

The Enterics for Global Health (EFGH) Shigella Surveillance Study in The Gambia

“…MRCG participated into 2 large diarrhea burden and etiology studies carried out between 2008 and 2018, namely, the Global Enterics Multicenter Study (GEMS) [ 3 , 4 ] and the Vaccine Impact on Diarrhea in Africa (VIDA) study [ 5 , 6 ]. Other research achievements include a large trial on the efficacy of Haemophilus influenzae type B vaccine [ 7 ] and the subsequent near-elimination of the disease, pioneering studies on the impact of insecticide-treated bed nets against malaria that supported their worldwide use [ 8 , 9 ], studies demonstrating the impact of conjugate pneumococcal vaccines on pneumonia [ 10 , 11 ] and child mortality, and the reduction of Hepatitis B carriage in The Gambia following vaccination [ 12 ].…”