Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements

Abstract

BackgroundRotavirus is a leading cause of diarrhoeal mortality in children but there is considerable disagreement about how many deaths occur each year.Methods and findingsWe compared CHERG, GBD and WHO/CDC estimates of age under 5 years (U5) rotavirus deaths at the global, regional and national level using a standard year (2013) and standard list of 186 countries. The global estimates were 157,398 (CHERG), 122,322 (GBD) and 215,757 (WHO/CDC). The three groups used different methods: (i) to select data points for rotavirus-positive proportions; (ii) to extrapolate data points to individual countries; (iii) to account for rotavirus vaccine coverage; (iv) to convert rotavirus-positive proportions to rotavirus attributable fractions; and (v) to calculate uncertainty ranges. We conducted new analyses to inform future estimates. We found that acute watery diarrhoea was associated with 87% (95% CI 83–90%) of U5 diarrhoea hospitalisations based on data from 84 hospital sites in 9 countries, and 65% (95% CI 57–74%) of U5 diarrhoea deaths based on verbal autopsy reports from 9 country sites. We reanalysed data from the Global Enteric Multicenter Study (GEMS) and found 44% (55% in Asia, and 32% in Africa) rotavirus-positivity among U5 acute watery diarrhoea hospitalisations, and 28% rotavirus-positivity among U5 acute watery diarrhoea deaths. 97% (95% CI 95–98%) of the U5 diarrhoea hospitalisations that tested positive for rotavirus were entirely attributable to rotavirus. For all clinical syndromes combined the rotavirus attributable fraction was 34% (95% CI 31–36%). This increased by a factor of 1.08 (95% CI 1.02–1.14) when the GEMS results were reanalysed using a more sensitive molecular test.ConclusionsWe developed consensus on seven proposals for improving the quality and transparency of future rotavirus mortality estimates.

Emergence of Rare Bovine–Human Reassortant DS-1-Like Rotavirus A Strains with G8P[8] Genotype in Human Patients in the Czech Republic

“…The most prevalent detected genotypes were G1P [8] (42.7%), G3P [8] (11.1%), G9P [8] (9.8%), G2P [4] (4.4%), and G4P [8] and G12P [8] (each 1.3%). Apart from these expected genotypes, which are considered to be the most prevalent global strains [32], a substantial percentage (9.3%, 21/225) of rare RVA strains with G8P [8] genotype were detected.…”

“…Since the WHO recommended the universal vaccination of infants against RVA in 2009, the burden of the disease significantly decreased in countries with an RVA vaccination scheme [3]. Still, according to recent estimates, RVA is considered to be responsible for 122,000-216,000 deaths globally per year in children under five years of age [4,5].…”

“…Theoretically, many G/P combinations are possible within the binary system that is utilized to classify RVA genotypes. However, according to the latest report of the European rotavirus surveillance net (EuroRotaNet), there are six main genotypes, G1P [8], G2P [4], G3P [8], G4P [8], G9P [8], and the recently emerged G12P [8], which have been recognized as the most epidemiologically relevant human RVA strains in Europe [8,9].…”

“…The most widespread human rotavirus strains belong to the Wa-like genogroup (G1P [8], G3P [8], G4P [8], and G9P [8]) and share a majority of genotypes with porcine rotavirus strains. On the other hand, DS-1-like human RVA strains include G2P [4] genotypes and share the majority of genotypes of other segments with bovine strains. The third minor human AU-1-like genogroup has genomic constellation G3-P[9]-I3-R3-C3-M3-A3-N3-T3-E3-H3 and it is believed to have a close evolutionary relationship with canine and feline rotavirus strains [11].…”

Genetic characterization of G12P[6] and G12P[8] rotavirus strains in six African countries

“…Diarrhoeal disease is a major cause of death in infants and young children below the age of ve and rotavirus is the most signi cant pathogen associated with that mortality [1]. Rotavirus is associated with 122,232 − 215,757 Under 5 deaths annually [2]. Furthermore, it has been estimated that diarrhoeal diseases are signi cantly more severe in immunocompromised children, especially those infected with HIV which is relevant to sub-Saharan Africa [3].…”