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)

• Type of Material: Article
• Authors: Richard Omore, Kenya Medical Research Institute; Jacqueline E. Tate, US Centers for Disease Control and Prevention; Ciara O'Reilly, Emory University; Tracy Ayers, US Centers for Disease Control and Prevention; John Williamson, US Centers for Disease Control and Prevention; Feny Moke, Kenya Medical Research Institute; Katie Schilling, US Centers for Disease Control and Prevention; Alex Awuor, Kenya Medical Research Institute; Peter Jaron, Kenya Medical Research Institute; John Ochieng, Kenya Medical Research Institute; Joseph Oundo, US Centers for Disease Control and Prevention; Umesh Parashar, US Centers for Disease Control and Prevention; Michele Parsons, US Centers for Disease Control and Prevention; Cheryl Bopp, US Centers for Disease Control and Prevention; Dilruba Nasrin, University of Maryland; Tamer Farag, University of Maryland; Karen Kotloff, University of Maryland; James Nataro, University of Maryland; Sandra Panchalingam, University of Maryland; Myron Levine, University of Maryland; Kayla Laserson, US Centers for Disease Control and Prevention; J. Nuorti, University of Tampere; Eric Mintz, US Centers for Disease Control and Prevention; Robert Breiman, Emory University
• Language: English
• Date: 2016-08-05
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2016, Public Library of Science. All rights reserved.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0160060
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 11
• Issue: 8
• Start Page: e0160060
• End Page: e0160060
• Grant/Funding Information: 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.; Bill and Melinda Gates Foundation Grants # 38874 (GEMS) and #OPP10333572 (GEMS1A) to Myron M. Levine.
• Keywords: VACCINE; DEVELOPING-COUNTRIES; MORTALITY; YOUNG-CHILDREN; GASTROENTERITIS; Science & Technology - Other Topics; DISEASE; Multidisciplinary Sciences; Science & Technology; SURVEILLANCE; PREVALENCE; BURDEN; EFFICACY
• Research Categories: Health Sciences, General; Health Sciences, Public Health

Abstract

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.