Author
Affilliation
Abstract
Background. The etiology of acute watery diarrhea remains poorly characterized, particularly after rotavirus vaccine
introduction.
Methods. We performed quantitative polymerase chain reaction for multiple enteropathogens on 878 acute watery diarrheal
stools sampled from 14 643 episodes captured by surveillance of children <5 years of age during 2013–2014 from 16 countries.
We used previously developed models of the association between pathogen quantity and diarrhea to calculate pathogen-specific
weighted attributable fractions (AFs).
Results. Rotavirus remained the leading etiology (overall weighted AF, 40.3% [95% confidence interval {CI}, 37.6%–44.3%]),
though the AF was substantially lower in the Americas (AF, 12.2 [95% CI, 8.9–15.6]), based on samples from a country with universal
rotavirus vaccination. Norovirus GII (AF, 6.2 [95% CI, 2.8–9.2]), Cryptosporidium (AF, 5.8 [95% CI, 4.0–7.6]), Shigella (AF, 4.7
[95% CI, 2.8–6.9]), heat-stable enterotoxin-producing Escherichia coli (ST-ETEC) (AF, 4.2 [95% CI, 2.0–6.1]), and adenovirus 40/41
(AF, 4.2 [95% CI, 2.9–5.5]) were also important. In the Africa Region, the rotavirus AF declined from 54.8% (95% CI, 48.3%–61.5%)
in rotavirus vaccine age-ineligible children to 20.0% (95% CI, 12.4%–30.4%) in age-eligible children.
Conclusions. Rotavirus remained the leading etiology of acute watery diarrhea despite a clear impact of rotavirus vaccine introduction.
Norovirus GII, Cryptosporidium, Shigella, ST-ETEC, and adenovirus 40/41 were also important. Prospective surveillance
can help identify priorities for further reducing the burden of diarrhea.
Publisher
Oxford University Press
Citation
OPERARIO, Darwin J. et al. Etiology of Severe Acute Watery Diarrhea in Children in the Global Rotavirus Surveillance Network Using Quantitative Polymerase Chain Reaction. The Journal of Infectious Diseases, v.216, p.220-227, July 2017.
DOI
10.1093/infdis/jix294
ISSN
0022-1899
Notes
AUTORES: Darwin J. Operario1,a, James A. Platts-Mills1,a, Sandrama Nadan,2 Nicola Page,2 Mapaseka Seheri,3 Jeffrey Mphahlele,3 Ira Praharaj,4 Gagandeep Kang,4
Irene T. Araujo,5 Jose Paulo G. Leite,5 Daniel Cowley,6 Sarah Thomas,6 Carl D. Kirkwood,6 Francis Dennis,7 George Armah,7 Jason M. Mwenda,8
Pushpa Ranjan Wijesinghe,9 Gloria Rey,10 Varja Grabovac,11 Chipo Berejena,12 Chibumbya J. Simwaka,13 Jeannine Uwimana,14 Jeevan B. Sherchand,15
Hlaing Myat Thu,16 Geethani Galagoda,17 Isidore J. O. Bonkoungou,18 Sheriffo Jagne,19 Enyonam Tsolenyanu,20 Amadou Diop,21 Christabel Enweronu-
Laryea,22 Sam-Aliyah Borbor,23 Jie Liu,1 Timothy McMurry,1 Benjamin Lopman,24 Umesh Parashar,25 John Gentsch,25 A. Duncan Steele,26 Adam Cohen,27
Fatima Serhan,27 and Eric R. Houpt1. INSTITUTIONS: 1University of Virginia, Charlottesville; 2National Institute for Communicable Diseases, Johannesburg, and 3South African Medical Research Council/Diarrhoeal Pathogens
Research Unit, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa; 4Christian Medical College, Vellore, India; 5Instituto Oswaldo Cruz/
Fiocruz, Rio de Janeiro, Brazil; 6Murdoch Childrens Research Institute, Melbourne, Australia; 7Noguchi Memorial Institute for Medical Research, Accra, Ghana; 8World Health
Organization (WHO) Regional Office for Africa, Brazzaville, Republic of the Congo; 9WHO Regional Office for South-East Asia, New Delhi, India; 10WHO Regional Office for the
Americas, District of Columbia; 11WHO Regional Office for the Western Pacific, Manila, the Philippines; 12University of Zimbabwe, Harare; 13University Teaching Hospital, Lusaka,
Zambia; 14Ministry of Health, Kigali, Rwanda; 15Tribhuvan University, Kathmandu, Nepal; 16Department of Medical Research, Yangon, Myanmar; 17Medical Research Institute,
Colombo, Sri Lanka; 18Laboratoire National de Santé Publique, Ouagadougou, Burkina Faso; 19National Public Health Laboratories, Fajara, The Gambia; 20Sylvanus Olympio
Teaching Hospital, Lomé, Togo; 21Albert Royer National Paediatric Hospital Laboratory, Dakar, Senegal; 22University of Ghana Medical School, Accra; 23University of Sierra Leone,
Freetown; 24Emory University, and 25Centers for Disease Control and Prevention, Atlanta, Georgia; 26Bill & Melinda Gates Foundation, Seattle, Washington; and 27World Health
Organization, Geneva, Switzerland.
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