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Grundy J, Wang X, Hirabayashi KC, Duncan R, Bersonda D, Eltayeb AO, Mindra G, Nandy R. Health and immunisation services for the urban poor in selected countries of Asia. Infect Dis Poverty 2019; 8:26. [PMID: 30999956 PMCID: PMC6471782 DOI: 10.1186/s40249-019-0538-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/26/2019] [Indexed: 04/10/2023] Open
Abstract
Background Asia is a region that is rapidly urbanising. While overall urban health is above rural health standards, there are also pockets of deep health and social disadvantage within urban slum and peri-urban areas that represent increased public health risk. With a focus on vaccine preventable disease and immunisation coverage, this commentary describes and analyses strengths and weaknesses of existing urban health and immunisation strategy, with a view to recommending strategic directions for improving access to immunisation and related maternal and child health services in urban areas across the region. The themes discussed in this commentary are based on the findings of country case studies published by the United Nations Childrens Fund (UNICEF) on the topic of immunisation and related health services for the urban poor in Cambodia, Indonesia, Mongolia, Myanmar, the Philippines, and Vietnam. Main body Although overall urban coverage is higher than rural coverage in selected countries of Asia, there are also wide disparities in coverage between socio economic groups within urban areas. Consistent with these coverage gaps, there is emerging evidence of outbreaks of vaccine preventable diseases in urban areas. In response to this elevated public health risk, there have been some promising innovations in operational strategy in urban settings, although most of these initiatives are project related and externally funded. Critical issues for attention for urban health services access include reaching consensus on accountability for management and resourcing of the strategy, and inclusion of an urban poor approach within the planning and budgeting procedures of Ministries of Health and local governments. Advancement of local partnership and community engagement strategies to inform operational approaches for socially marginalised populations are also urgently required. Such developments will be reliant on development of municipal models of primary health care that have clear delegations of authority, adequate resources and institutional capabilities to implement. Conclusions The development of urban health systems and immunisation strategy is required regionally and nationally, to respond to rapid demographic change, social transition, and increased epidemiological risk. Electronic supplementary material The online version of this article (10.1186/s40249-019-0538-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John Grundy
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Cairns, Australia.
| | - Xiaojun Wang
- UNICEF East Asia and Pacific Regional Office, Bangkok, Thailand
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Mulyani NS, Prasetyo D, Karyana IPG, Sukardi W, Damayanti W, Anggraini D, Palupi-Baroto R, Nirwati H, Wahab A, Mulyadi AWE, Nakamura T, Soenarto Y. Diarrhea among hospitalized children under five: A call for inclusion of rotavirus vaccine to the national immunization program in Indonesia. Vaccine 2018; 36:7826-7831. [DOI: 10.1016/j.vaccine.2018.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/27/2018] [Accepted: 05/04/2018] [Indexed: 01/03/2023]
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Huyen DTT, Hong DT, Trung NT, Hoa TTN, Oanh NK, Thang HV, Thao NTT, Hung DM, Iijima M, Fox K, Grabovac V, Heffelfinger J, Batmunkh N, Anh DD. Epidemiology of acute diarrhea caused by rotavirus in sentinel surveillance sites of Vietnam, 2012-2015. Vaccine 2018; 36:7894-7900. [PMID: 29784467 DOI: 10.1016/j.vaccine.2018.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/10/2018] [Accepted: 05/01/2018] [Indexed: 11/26/2022]
Abstract
A prospective, multicentre study was conducted in four sentinel surveillance hospitals to assess the trend and epidemiology of acute diarrhea caused by Rotavirus in Vietnam. During the period 2012-2015, a total 8,889 children under 5 years of age were enrolled in the surveillance, and 8689 stool samples were collected. Of these cases, Rotavirus was most common pathogen 46.7% (4054 cases); in which 26.6% (1117) rotavirus-positive stool samples were evaluated to identify genotypes. The proportion of rotavirus positive specimens decreased annually from 54.7% in 2012 to 36.6% in 2015. Rotavirus was detected year-round, but most rotavirus gastroenteritis cases (77.1%) occurred between December and May, corresponding to the rotavirus seasonality. It is found that the peaks varied by regions. Rotavirus positivities varied between the youngest and oldest age, but children 6-11 months old (38.8%) and 12-23 months old (38.4%) counted for most cases. A significant higher number of diarrhea within 24 hours (8.3 times, 95%CI: 8.1-8.4 times) and higher proportion of severe dehydration (12.9%) in Rotavirus positive group than that in Rotavirus negative group (7.7 times, 95%CI: 7.6-7.9 times; and 9.7%, respectively). A downtrend of prevalence of G1P[8] was observed from 82% in 2013 to 15% in 2015. However, G2P[4] was found in 5% of samples in 2012, 9% in 2013, 36% in 2014, and 28% in 2015. Rotavirus infection is the most important cause of acute diarrhea among hospitalized children in Vietnam, and a rotavirus vaccination program for children may significantly reduce this disease.
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Affiliation(s)
| | - Duong Thi Hong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | | | | | | | | | | | - Kimberley Fox
- Global Immunization Division, Centers for Diesease Control and Prevention, USA.
| | - Varja Grabovac
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - James Heffelfinger
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - Nyambat Batmunkh
- Expanded Programme on Immunization, Division of Communicable Diseases, Western Pacific Regional Office, Manila, Philippines.
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
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Angkeabos N, Rin E, Vichit O, Chea C, Tech N, Payne DC, Fox K, Heffelfinger JD, Grabovac V, Nyambat B, Diorditsa S, Samnang C, Hossain MS. Pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children: Seven years of active surveillance, 2010-2016. Vaccine 2018; 36:7856-7861. [PMID: 29588120 DOI: 10.1016/j.vaccine.2018.03.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/06/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Each year, approximately 1,066 Cambodian children under five years old die of diarrhea, and 51% of these deaths are due to rotavirus gastroenteritis. Quantifying childhood hospitalizations caused by severe rotavirus infections is also important in demonstrating disease burden caused by this virus. The objective of this study is to update and confirm the current burden of pediatric hospitalizations attributable to rotavirus gastroenteritis among Cambodian children using seven years of continuous active, prospective surveillance from 2010 to 2016. We also characterize the circulating rotavirus genotypic strains during this period. METHODS Active surveillance for rotavirus gastroenteritis was conducted from January 2010 through December 2016 at a national hospital in Phnom Penh, Cambodia. Children <60 months of age who were hospitalized for acute gastroenteritis (AGE) were consented and enrolled. Information on gender, age, clinical characteristics, and month of onset were collected. Stool specimens were collected and tested by enzyme immunoassay for the presence of rotavirus antigen, and genotyping was performed on rotavirus test-positive specimens to characterize predominant rotavirus strains during the surveillance period. RESULTS Of 7007 children enrolled with AGE and having specimens collected, 3473 (50%) were attributed to rotavirus gastroenteritis. The majority of rotavirus hospitalizations occurred in children younger than two years old (92%). Year-round rotavirus transmission was observed, with seasonal peaks during the cooler, dry months between November and May. Genotypic trends in rotavirus were observed over the surveillance period; the predominant rotavirus strains changed from G1P[8] (2010-2012), to G2P[4] (2013-2014), the emergence of genotype G8P[8] in 2015, and G3P[8] in 2016. CONCLUSIONS Rotavirus is the leading cause of severe acute gastroenteritis hospitalizations in Cambodian children under five years old, with 50% of such hospitalizations attributable to rotavirus. Over 90% of rotavirus hospitalizations occurred in children under 2 years of age. Changes in the predominant rotavirus strains occurred over time among these unvaccinated children. This information is important to understand and prioritize the current potential impacts upon child health that could be achieved through the introduction of rotavirus vaccines in Cambodia.
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Affiliation(s)
- Nhep Angkeabos
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - En Rin
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Ork Vichit
- National Immunization Program, Ministry of Health, Phnom Penh, Cambodia
| | - Choeung Chea
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Ngorn Tech
- National Pediatric Hospital, Ministry of Health, Phnom Penh, Cambodia
| | - Daniel C Payne
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Kimberley Fox
- Global Immunization Division, Centers for Disease Control & Prevention, Atlanta, USA
| | - James D Heffelfinger
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Varja Grabovac
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Batmunkh Nyambat
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Sergey Diorditsa
- Expanded Programme on Immunization, Western Pacific Regional Office, Manila, Philippines
| | - Chham Samnang
- Expanded Programme on Immunization, World Health Organization, Phnom Penh, Cambodia
| | - Md Shafiqul Hossain
- Expanded Programme on Immunization, World Health Organization, Phnom Penh, Cambodia.
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Nirwati H, Hakim MS, Aminah S, Dwija IBNP, Pan Q, Aman AT. Identification of Rotavirus Strains Causing Diarrhoea in Children under Five Years of Age in Yogyakarta, Indonesia. Malays J Med Sci 2017; 24:68-77. [PMID: 28894406 DOI: 10.21315/mjms2017.24.2.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rotavirus is an important cause of severe diarrhoea in children. The aims of this study were to identify the rotavirus strains that cause diarrhoea in children in Yogyakarta and to determine the association between rotavirus positivity and its clinical manifestations. METHODS Clinical data and stool samples were collected from children hospitalised at Kodya Yogyakarta Hospital, Indonesia. Rotavirus was detected in stool samples using an enzyme immunoassay (EIA), which was followed by genotyping using reverse transcriptase polymerase chain reaction (RT-PCR). Electropherotyping was performed for the rotavirus-positive samples. RESULTS In total, 104 cases were included in the study, 57 (54.8%) of which were rotavirus-positive. Based on a multiple logistic regression analysis, age group, vomiting and stool mucous were associated with rotavirus positivity. Most of the 56 samples subjected to genotyping were classified as G1 (80.36%) and P[8] (69.64%) genotypes. The genotype combination G1P[8] was identified as the most prevalent strain (66.07%). Of the 19 samples subjected to electropherotyping, 17 G1 isolates and 1 G3 isolate had long patterns, and 1 G1 isolate had a short pattern. CONCLUSION G1P[8] was the most dominant strain of rotavirus causing diarrhoea in children in Yogyakarta. Age group, vomiting and stool mucous were associated with rotavirus positivity.
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Affiliation(s)
- Hera Nirwati
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, 55281 Yogyakarta, Indonesia
| | - Mohamad Saifudin Hakim
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, 55281 Yogyakarta, Indonesia.,Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center and Postgraduate School Molecular Medicine, 3015 CE Rotterdam, The Netherlands
| | - Sri Aminah
- Department of Pediatric, Kodya Yogyakarta Hospital, 55162 Yogyakarta, Indonesia
| | | | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center and Postgraduate School Molecular Medicine, 3015 CE Rotterdam, The Netherlands
| | - Abu Tholib Aman
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, 55281 Yogyakarta, Indonesia
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Silapong S, Sakpaisal P, Bodhidatta L, Lertsethtakarn P, Sethabutr O, Vansith K, Meng CY, Swierczewski BE, Mason CJ. Genotypic Distribution of Rotavirus in Phnom Penh, Cambodia: An Association of G9 with More Severe Diseases. Am J Trop Med Hyg 2017; 96:947-952. [PMID: 28167599 DOI: 10.4269/ajtmh.16-0651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractRotavirus causes significant morbidity and mortality among children worldwide. Stool samples from a previous hospital-based surveillance study to detect diarrhea etiology at the National Pediatric Hospital in Phnom Penh, Cambodia, by Meng and others in 2011 were tested for rotavirus by real-time reverse transcription polymerase chain reaction (PCR) targeting vp6 gene and characterized for G- and P-genotypes of positive samples based on vp7 and vp4 genes, respectively. Rotavirus was detected in 159/531 (30%) of children with diarrhea and none was detected in 287 nondiarrhea controls. All but three of the rotavirus-positive cases were children under the age of 2. The most common genotypes characterized by PCR and sequencing were G1P[8] (69%), G9P[8] (11%), and G2P[4] (11%). Genotype G9 was detected at a relatively high percentage that is consistent with the global trend and found to be associated with hospitalization. Data on disease burden and genotypic distribution are required information for the planning of rotavirus vaccine implementation in Cambodia.
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Affiliation(s)
- Sasikorn Silapong
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Pimmada Sakpaisal
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Ladaporn Bodhidatta
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Paphavee Lertsethtakarn
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Orntipa Sethabutr
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Ket Vansith
- National Pediatric Hospital, Phnom Penh, Cambodia
| | | | - Brett E Swierczewski
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Carl J Mason
- Department of Enteric Diseases, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
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Molecular Epidemiology and Genetic Diversity of Norovirus in Young Children in Phnom Penh, Cambodia. J Trop Med 2016; 2016:2707121. [PMID: 28115947 PMCID: PMC5223043 DOI: 10.1155/2016/2707121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/17/2016] [Indexed: 12/27/2022] Open
Abstract
This study investigated the genetic diversity of noroviruses identified from a previous surveillance study conducted at the National Pediatric Hospital in Phnom Penh, Cambodia, from 2004 to 2006. In the previous study, 926 stool samples were collected from children aged 3–60 months with acute diarrhea (cases) and without diarrhea (controls) with reported 6.7% of cases and 3.2% of controls being positive for norovirus. The initial norovirus diagnostic assay was performed with real-time reverse transcription-polymerase chain reaction (real-time RT PCR) which also distinguished between genogroups I and II (GI and GII). Norovirus infection was most commonly detected in children aged 12–23 months in both cases and controls. Norovirus Genotyping Tool and phylogenetic analysis of partial sequences of the 3′ end of the RNA-dependent RNA Polymerase (RdRp) and the capsid domain region were employed to assign genotypes of the norovirus strains. GII.4 was the most predominant capsid genotype detected at 39.5% followed by GII.6 at 14.9%. The GII.4 Hunter 2004 variant was the predominant strain detected. Six RdRP/capsid recombinants including GII.P7/GII.6, GII.P7/GII.14, GII.P7/GII.20, GII.P12/GII.13, GII.P17/GII.16, and GII.P21/GII.3 were also identified. This study of norovirus infection in young children in Cambodia suggests genetic diversity of norovirus as reported worldwide.
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Fei P, Li L, Cai X, Zhang X, Bai HJ, Jiang YJ, Feng Z, Guo L. Differences in the Biodiversity of the Fecal Microbiota of Infants With Rotaviral Diarrhea and Healthy Infants. Jundishapur J Microbiol 2016; 9:e32356. [PMID: 27279991 PMCID: PMC4895788 DOI: 10.5812/jjm.32356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/23/2015] [Accepted: 12/13/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Rotaviral diarrhea (RD) has been associated with the biodiversity of the fecal microbiota in infants; however, the differences in the biodiversity of the fecal microbiota between infants with RD and healthy (H) infants have not been clearly elucidated. OBJECTIVES This study aimed to reveal the changes in the biodiversity of the fecal microbiota of infants with RD. PATIENTS AND METHODS For this study, 30 fecal samples from 15 RD infants and 15 H infants were collected. The biodiversity of the fecal microbiota from the two groups was compared via polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) and gene sequencing. RESULTS The Shannon-Weaver index showed that the biodiversity of the fecal microbiota from the RD infants was significantly lower (P < 0.05) than that from the H infants. All fifteen RD infants were grouped into one cluster and were separated from the H infants by the un weighted-pair group method, with the arithmetic average (UPGMA) clustering algorithm. In addition, when compared with the healthy infants, the communities of the dominant microbes, Lactobacillus and Bifidobacterium, in the fecal microbiota from the RD infants have obviously changed. CONCLUSIONS With regard to improving the understanding of the differences in the biodiversity of the fecal microbiota between RD infants and H infants, the findings of this study can provide a possible basis to reveal the relationship between RD and intestinal microbiota.
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Affiliation(s)
- Peng Fei
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Lin Li
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Xiaolin Cai
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Xinjie Zhang
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Hong Jian Bai
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Yu Jun Jiang
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Zhen Feng
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
| | - Ling Guo
- Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin, China
- Corresponding author: Ling Guo, Key Laboratory of Dairy Science, Ministry of Education, College of Food Science and Engineering, Northeast Agricultural University, Harbin 150030, China. Tel: +86-45155190459, Fax: +86-45155190577, E-mail:
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Nirwati H, Wibawa T, Aman AT, Wahab A, Soenarto Y. Detection of group A rotavirus strains circulating among children with acute diarrhea in Indonesia. SPRINGERPLUS 2016; 5:97. [PMID: 26848437 PMCID: PMC4731376 DOI: 10.1186/s40064-016-1724-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/15/2016] [Indexed: 12/22/2022]
Abstract
Rotavirus is the major cause of severe diarrhea in children under 5 years old in developed and developing countries. Since improvements in sanitation and hygiene have limited impact on reducing the incidence of rotavirus diarrhea, implementation of a vaccine will be a better solution. We conducted an observational study to determine the disease burden and to identify the genotype of circulating rotavirus in Indonesia. Hospitalized children due to acute diarrhea were enrolled from four teaching hospitals in Indonesia. Stool samples were collected based on WHO protocol and were tested for the presence of group A rotavirus using enzyme immunoassay. Then, rotavirus positive samples were genotyped using RT-PCR. Fisher’s Exact tests, Chi square tests and logistic regression were performed to determine differences across hospital and year in rotavirus prevalence and genotype distribution. There were 4235 samples from hospitalized children with diarrhea during 2006, 2009 and 2010. Among them, the rotavirus positive were 2220 samples (52.42 %) and incidence rates varied between hospitals. The G1P[8], G1P[6], and G2P[4] were recognized as the dominant genotypes circulating strains in Indonesia and the proportion of predominant strains changed by year. Our study showed the high incidence of rotavirus infection in Indonesia with G1P[8], G1P[6], and G2P[4] as the dominant strains circulating in Indonesia. These results reinforce the need for a continuing surveillance of rotavirus strain in Indonesia.
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Affiliation(s)
- Hera Nirwati
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tri Wibawa
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abu Tholib Aman
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Abdul Wahab
- Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yati Soenarto
- Department of Paediatric, Faculty of Medicine, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia
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Kiulia NM, Hofstra N, Vermeulen LC, Obara MA, Medema G, Rose JB. Global occurrence and emission of rotaviruses to surface waters. Pathogens 2015; 4:229-55. [PMID: 25984911 PMCID: PMC4493472 DOI: 10.3390/pathogens4020229] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 01/03/2023] Open
Abstract
Group A rotaviruses (RV) are the major cause of acute gastroenteritis in infants and young children globally. Waterborne transmission of RV and the presence of RV in water sources are of major public health importance. In this paper, we present the Global Waterborne Pathogen model for RV (GloWPa-Rota model) to estimate the global distribution of RV emissions to surface water. To our knowledge, this is the first model to do so. We review the literature to estimate three RV specific variables for the model: incidence, excretion rate and removal during wastewater treatment. We estimate total global RV emissions to be 2 × 1018 viral particles/grid/year, of which 87% is produced by the urban population. Hotspot regions with high RV emissions are urban areas in densely populated parts of the world, such as Bangladesh and Nigeria, while low emissions are found in rural areas in North Russia and the Australian desert. Even for industrialized regions with high population density and without tertiary treatment, such as the UK, substantial emissions are estimated. Modeling exercises like the one presented in this paper provide unique opportunities to further study these emissions to surface water, their sources and scenarios for improved management.
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Affiliation(s)
- Nicholas M Kiulia
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
- Enteric Viruses Research Group, Institute of Primate Research, P.O Box 24481, 00502 Karen, Nairobi, Kenya.
| | - Nynke Hofstra
- Environmental Systems Analysis Group, Wageningen University, P.O. Box 47, 6700 AA, Wageningen, The Netherlands.
| | - Lucie C Vermeulen
- Environmental Systems Analysis Group, Wageningen University, P.O. Box 47, 6700 AA, Wageningen, The Netherlands.
| | - Maureen A Obara
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
| | - Gertjan Medema
- Faculty of Civil Engineering and Geosciences, Delft University of Technology, P.O. Box 5048, 2600 GA, Delft, the Netherlands.
- KWR Watercycle Research Institute, Groningenhaven 7, 3433 PE, Nieuwegein, The Netherlands.
| | - Joan B Rose
- Department of Fisheries and Wildlife, Michigan State University East Lansing, MI 48824, USA.
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Kazi AM, Warraich GJ, Qureshi S, Qureshi H, Khan MMA, Zaidi AKM. Sentinel hospital-based surveillance for assessment of burden of rotavirus gastroenteritis in children in Pakistan. PLoS One 2014; 9:e108221. [PMID: 25295613 PMCID: PMC4189951 DOI: 10.1371/journal.pone.0108221] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 08/27/2014] [Indexed: 01/01/2023] Open
Abstract
Objectives To determine the burden and molecular epidemiology of rotavirus gastroenteritis in children hospitalized with severe acute watery diarrhea in Pakistan prior to introduction of rotavirus vaccine. Methods A cross-sectional study was carried out over a period of two years from 2006 – 2008 at five sentinel hospitals in the cities of Karachi, Lahore, Rawalpindi, and Peshawar. Stool samples collected from children under five years of age hospitalized with severe acute watery diarrhea were tested for rotavirus antigen via enzyme immunoassay (EIA) (IDEA REF K6020 Oxoid Ltd (Ely), Cambridge, United Kingdom). A subset of EIA positive stool samples were further processed for genotyping. Results 6679 children were enrolled and stool specimens of 2039 (30.5%) were positive for rotavirus. Rotavirus positivity ranged from 16.3% to 39.4% in the 5 hospitals with highest positivity in Lahore. 1241 (61%) of all rotavirus cases were in infants under one year of age. Among the strains examined for G-serotypes, the occurrence of G1, G2, G9 and G4 strains was found to be 28%, 24%, 14% and 13%, respectively. Among P-types, the most commonly occurring strains were P6 (31.5%) followed by P8 (20%) and P4 (12%). Prevalent rotavirus genotype in hospitalized children of severe diarrhea were G1P[8] 11.6% (69/593), followed by G2P[4] 10.4% (62/593), and G4P[6] 10.1% (60/593). Conclusions Approximately one third of children hospitalized with severe gastroenteritis in urban centers in Pakistan have rotavirus. Introduction of rotavirus vaccine in Pakistan's national immunization program could prevent many severe episodes and diarrheal deaths.
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Affiliation(s)
| | | | | | - Huma Qureshi
- Pakistan Medical Research Council, Islamabad, Pakistan
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Abstract
BACKGROUND A substantial number of surveillance studies have documented rotavirus prevalence among children admitted for dehydrating diarrhea. We sought to establish global seasonal patterns of rotavirus disease before the introduction of widespread vaccination. METHODS We reviewed studies of rotavirus detection in children with diarrhea published since 1995. We assessed potential relationships between seasonal prevalence and locality by plotting the average monthly proportion of diarrhea cases positive for rotavirus according to geography, country development and latitude. We used linear regression to identify variables that were potentially associated with the seasonal intensity of rotavirus. RESULTS Among a total of 99 studies representing all 6 geographic regions of the world, patterns of year-round disease were more evident in low- and low-middle income countries compared with upper-middle and high-income countries where disease was more likely to be seasonal. The level of country development was a stronger predictor of strength of seasonality (P = 0.001) than geographic location or climate. However, the observation of distinctly different seasonal patterns of rotavirus disease in some countries with similar geographic location, climate and level of development indicate that a single unifying explanation for variation in seasonality of rotavirus disease is unlikely. CONCLUSION While no unifying explanation emerged for varying rotavirus seasonality globally, the country income level was somewhat more predictive of the likelihood of having seasonal disease than other factors. Future evaluation of the effect of rotavirus vaccination on seasonal patterns of disease in different settings may help understand factors that drive the global seasonality of rotavirus disease.
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Desai R, Parashar UD, Lopman B, Helena de Oliveira L, Clark AD, Sanderson CFB, Tate JE, Matus CR, Andrus JK, Patel MM. Potential Intussusception Risk Versus Health Benefits From Rotavirus Vaccination in Latin America. Clin Infect Dis 2012; 54:1397-405. [DOI: 10.1093/cid/cis191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Kawai K, O'Brien MA, Goveia MG, Mast TC, El Khoury AC. Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: a systematic review. Vaccine 2011; 30:1244-54. [PMID: 22212128 DOI: 10.1016/j.vaccine.2011.12.092] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 12/12/2011] [Accepted: 12/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rotavirus is the leading cause of severe diarrhea in children worldwide. We systematically reviewed the burden of rotavirus gastroenteritis (RVGE) and distribution of rotavirus strains in Asia. METHODS We searched MEDLINE, EMBASE and the World Health Organization (WHO) website for the term "rotavirus" and the name of each country. We included studies that were conducted in children between 2000 and 2011 and that examined the epidemiology, health and/or economic burden of RVGE, and G and P-type distribution in Eastern, South East, Southern and Central Asia. Random effects models were used to pool the proportions of RVGE. We also estimated child mortality due to RVGE using the updated WHO and United Nations Children's Fund's mortality estimates in 2008. RESULTS The search identified 113 eligible articles. The incidence rates of rotavirus-related hospitalizations in children under 5 years of age ranged from 2.1 to 20.0 cases per 1000 children per year with the highest rates reported in Bangladesh, South Korea, Taiwan, Thailand, and Vietnam. Rotavirus accounted for 37.5% of year-round hospitalized gastroenteritis cases, with higher proportions reported in South East Asia. Rotavirus was associated with approximately 145,000 deaths every year in Asia, with the greatest numbers occurring in India, Pakistan, and Indonesia. The highest annual societal costs of treating RVGE were reported in China (US$365 million), followed by Japan (US$254 million) and India (US$41-72 million). A diversity of rotavirus G and P-types was observed across Asia and the distribution of strains differed by country and year. The most common strains were G1P[8] (23.6%), G2P[4] (11.8%), G3P[8] (18.9%), and G9P[8] (7.4%). CONCLUSIONS Rotavirus is associated with substantial hospitalizations and deaths among children and causes large healthcare expenditures throughout Asia. Safe and effective rotavirus vaccines could substantially reduce the burden of disease.
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Affiliation(s)
- Kosuke Kawai
- Temple University, School of Pharmacy, 3307N. Broad Street, Philadelphia, PA 19140, USA.
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Pitzer VE, Viboud C, Lopman BA, Patel MM, Parashar UD, Grenfell BT. Influence of birth rates and transmission rates on the global seasonality of rotavirus incidence. J R Soc Interface 2011; 8:1584-93. [PMID: 21508015 PMCID: PMC3177613 DOI: 10.1098/rsif.2011.0062] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rotavirus is a major cause of mortality in developing countries, and yet the dynamics of rotavirus in such settings are poorly understood. Rotavirus is typically less seasonal in the tropics, although recent observational studies have challenged the universality of this pattern. While numerous studies have examined the association between environmental factors and rotavirus incidence, here we explore the role of intrinsic factors. By fitting a mathematical model of rotavirus transmission dynamics to published age distributions of cases from 15 countries, we obtain estimates of local transmission rates. Model-predicted patterns of seasonal incidence based solely on differences in birth rates and transmission rates are significantly correlated with those observed (Spearman's ρ = 0.65, p < 0.05). We then examine seasonal patterns of rotavirus predicted across a range of different birth rates and transmission rates and explore how vaccination may impact these patterns. Our results suggest that the relative lack of rotavirus seasonality observed in many tropical countries may be due to the high birth rates and transmission rates typical of developing countries rather than being driven primarily by environmental conditions. While vaccination is expected to decrease the overall burden of disease, it may increase the degree of seasonal variation in the incidence of rotavirus in some settings.
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Affiliation(s)
- Virginia E Pitzer
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ 08544, USA.
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