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)

Abstract

ObjectiveTo 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.MethodsWe 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.ResultsFrom 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).ConclusionsDiarrhea caused by rotavirus is associated with severe symptoms leading to hospitalization. Consistent with other settings, infants had the greatest burden of disease.

The seasonality of diarrheal pathogens: A retrospective study of seven sites over three years

“…Shorter seasons may make detecting the association between weather and pathogens difficult, since the pathogen would have less time to respond (e.g., amplify, transmit) to changes in weather conditions. The Kenya site has two rainy and two dry seasons per year, thus weather covariates had bi-annual rather than annual periodicity, and rotavirus and norovirus GII prevalence had significant bi-annual periodicity, but previous studies noted that the seasonality of rotavirus disease is subtle in Kenya [38]. Weather might also mediate complex transmission pathways [12]; for example, Shigella had been observed to peak in April–June at the GEMS study site in Bangladesh and was associated with seasonal peaks in housefly density in February and March [39].…”

Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus vaccine introduction in Kenya, a hospital cross-sectional study

“…The Vesikari clinical severity scoring system (VCSSS) has been used in clinical trials in assessing rotavirus vaccine efficacy and effectiveness as a tool for defining the primary end point, which is severe rotavirus gastroenteritis [ 11 ]. It has also been used in clinical studies as a measure of acute gastroenteritis severity [ 12 – 14 ]. The parameters and categories of this severity scale are shown in Table 1 .…”

Low Endemic Frequency of Adenovirus, Rotavirus and Norovirus in Pediatric Diarrhea Samples from Central Iran

“…In this study, abdominal pains, vomiting, fever, watery diarrhea, and dehydration were the most common particular symptoms in patient with norovirus infections, almost similar to previously reported study. There are reports indicating that vomiting in a common symptom of rotavirus infection (34,35). However, in Burkina Faso, fever was viewed to be the most prevalent symptom (36).…”