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Mado S, Giwa F, Abdullahi S, Alfa A, Yaqub Y, Usman Y, Wammanda R, Mwenda J, Isiaka A, Yusuf K, Lawali N. Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria. Ann Afr Med 2022; 21:283-287. [PMID: 36204917 PMCID: PMC9671188 DOI: 10.4103/aam.aam_31_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Rotavirus infection is a significant cause of gastroenteritis in developing countries and, in severe cases even leads to death. The impact of rotavirus vaccine introduction in reducing the rotavirus disease burden in children was well known. The study was aimed to determine the prevalence and clinical characteristics of rotavirus gastroenteritis before the introduction of rotavirus vaccine into Nigeria's routine immunization program. Materials and Methods: We conducted a cross-sectional hospital-based study involving 735 children aged 0–59 months with acute gastroenteritis hospitalized at the Ahmadu Bello University Teaching Hospital Zaria from September 2017 to August 2020. Relevant sociodemographic and clinical data were obtained and entered into the World Health Organization standardized case investigation forms. Stool specimens were tested for rotavirus Group A antigen using the ProSpecT™ Rotavirus Microplate Assay by Thermoscientific Oxoid Microbiology UK. Results: One hundred and fifty-three stool samples tested positive for rotavirus giving a prevalence of 20.8%. One hundred and two (66.7%) children with rotavirus gastroenteritis were infants. There were 87 males and 66 females with M: F ratio of 1.3:1. Only 30 (19.6%) children with rotavirus-associated diarrhea presented with severe dehydration. The presence of vomiting was significantly associated with rotavirus diarrhea (P = 0.001). More cases of rotavirus diarrhea occurred in September through February. None of the studied children were vaccinated against rotavirus. Conclusion: The prevalence of rotavirus diarrhea remains high in this study. Infants were recognized as a high-risk group, and none of them were vaccinated against rotavirus and this underscores the urgent need for implementing the rotavirus vaccine in the national vaccination program to reduce the disease burden in the country.
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Raboba JL, Rahajamanana VL, Andriatahirintsoa EPR, Razafindrakoto AC, Andrianarivelo AM, Nimpa Mengouo M, Vuo Masembe Y, Weldegebriel GG, de Gouveia L, Mwenda JM, Robinson AL. Decline in Vaccine-Type Streptococcus pneumoniae Serotypes Following Pneumococcal Conjugate Vaccine Introduction in Madagascar. J Infect Dis 2021; 224:S285-S292. [PMID: 34469557 PMCID: PMC8409527 DOI: 10.1093/infdis/jiab226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 10-valent conjugate vaccine (PCV10) was introduced into the Extended Program on Immunization in Madagascar. We assessed the impact of PCV10 on the targeted pneumococcal serotypes among children < 5 years of age at Centre Hospitalier Universitaire Mère Enfant Tsaralalàna. METHOD Between 2012 and December 2018, cerebrospinal fluid (CSF) samples were collected and tested for S. pneumoniae by culture, and antigen tests. The Sentinel Site Laboratory (SSL) referred available CSF samples to the Regional Reference Laboratory (RRL) for real-time polymerase chain reaction confirmatory testing and serotyping. RESULTS In total, 3616 CSF specimens were collected. The SSL referred 2716 to the RRL; 125 were positive for S. pneumoniae. At the RRL, 115 samples that tested positive for S. pneumoniae were serotyped; PCV10 serotypes accounted for 20%. Compared to the pre-PCV period, the proportion of S. pneumoniae detected declined from 22% to 6.6%, (P < .05), the proportion of PCV10 serotypes as the cause of pneumococcal meningitis cases declined by 26% following vaccine introduction. CONCLUSIONS In our findings, PCV10 introduction resulted in a decline of meningitis caused by S. pneumoniae and PCV10 vaccine serotypes.
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Affiliation(s)
- Julia L Raboba
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - Vonintsoa L Rahajamanana
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | | | - Ainamalala C Razafindrakoto
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - Andry M Andrianarivelo
- Teaching Hospital, Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar
| | | | | | - Goitom G Weldegebriel
- World Health Organization Inter-Country Support Team East and Southern Africa, Harare, Zimbabwe
| | - Linda de Gouveia
- Regional Reference Laboratory, National Institute of Communicable Diseases, Centre for Respiratory Diseases and Meningitis, Johannesburg, South Africa
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Annick L Robinson
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
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Rotavirus A infection in pre- and post-vaccine period: Risk factors, genotypes distribution by vaccination status and age of children in Nampula Province, Northern Mozambique (2015-2019). PLoS One 2021; 16:e0255720. [PMID: 34358275 PMCID: PMC8345880 DOI: 10.1371/journal.pone.0255720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 07/22/2021] [Indexed: 02/03/2023] Open
Abstract
Mozambique introduced the monovalent rotavirus vaccine (Rotarix®, GSK Biologicals, Rixensart, Belgium) in September 2015. Previous analysis, showed that Nampula province continues reporting a high frequency of Rotavirus A (RVA) infection and the emergence of G9P[6], G9P[4] and G3P[4] genotypes. This analysis aimed to determine the RVA frequency; risk factors; genotype distribution by vaccination status and age between pre- and post-vaccine periods in children under-five years old with diarrhea in Nampula. A cross-sectional, hospital-based surveillance study was conducted in the Hospital Central de Nampula in Mozambique. Socio-demographic and clinical data were collected to assess factors related to RVA infection in both periods. Stool specimens were screened to detect RVA by ELISA, and positive samples were genotyped. Between 2015 (pre-vaccine period) and 2016–2019 (post-vaccine period), 614 stool specimens were collected and tested for RVA in which 34.9% (67/192) were positive in pre-vaccine period and 21.8% (92/422) in post-vaccine (p = 0.001). In the post-vaccine period, age, year, and contact with different animal species (chicken, duck, or multiple animals) were associated with RVA infection. RVA infection was higher in children partially vaccinated (40.7%, 11/27) followed by the fully vaccinated (29.3%, 56/191) and the unvaccinated (15.3%, 21/137) (p = 0.002). G1P[8] and G9P[4] were common in vaccinated children less than 12 months. The present analysis showed that RVA infection reduced slightly in the post-vaccine period, with a high proportion of infection and genotype diversity in children, under 12 months of age, vaccinated. Further research on factors associated with RVA infection on vaccinated compared to unvaccinated children and vaccination optimization should be done.
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4
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Evans MV, Bonds MH, Cordier LF, Drake JM, Ihantamalala F, Haruna J, Miller AC, Murdock CC, Randriamanambtsoa M, Raza-Fanomezanjanahary EM, Razafinjato BR, Garchitorena AC. Socio-demographic, not environmental, risk factors explain fine-scale spatial patterns of diarrhoeal disease in Ifanadiana, rural Madagascar. Proc Biol Sci 2021; 288:20202501. [PMID: 33653145 PMCID: PMC7934917 DOI: 10.1098/rspb.2020.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Precision health mapping is a technique that uses spatial relationships between socio-ecological variables and disease to map the spatial distribution of disease, particularly for diseases with strong environmental signatures, such as diarrhoeal disease (DD). While some studies use GPS-tagged location data, other precision health mapping efforts rely heavily on data collected at coarse-spatial scales and may not produce operationally relevant predictions at fine enough spatio-temporal scales to inform local health programmes. We use two fine-scale health datasets collected in a rural district of Madagascar to identify socio-ecological covariates associated with childhood DD. We constructed generalized linear mixed models including socio-demographic, climatic and landcover variables and estimated variable importance via multi-model inference. We find that socio-demographic variables, and not environmental variables, are strong predictors of the spatial distribution of disease risk at both individual and commune-level (cluster of villages) spatial scales. Climatic variables predicted strong seasonality in DD, with the highest incidence in colder, drier months, but did not explain spatial patterns. Interestingly, the occurrence of a national holiday was highly predictive of increased DD incidence, highlighting the need for including cultural factors in modelling efforts. Our findings suggest that precision health mapping efforts that do not include socio-demographic covariates may have reduced explanatory power at the local scale. More research is needed to better define the set of conditions under which the application of precision health mapping can be operationally useful to local public health professionals.
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Affiliation(s)
- Michelle V Evans
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Matthew H Bonds
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.,PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | | | - John M Drake
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Felana Ihantamalala
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA.,PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | - Justin Haruna
- PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA
| | - Ann C Miller
- Department of Global Health and Social Medicine, Blavatnik Institute at Harvard Medical School, Boston, MA, USA
| | - Courtney C Murdock
- Odum School of Ecology, University of Georgia, Athens, GA, USA.,Center for Ecology of Infectious Diseases, University of Georgia, Athens, GA, USA.,Department of Infectious Diseases, College of Veterinary Medicine, University of Georgia, Athens, GA, USA.,Department of Entomology, College of Agriculture and Life Sciences, Cornell University, Ithaca, NY, USA
| | | | | | | | - Andres C Garchitorena
- PIVOT, Ranomafana, Madagascar.,PIVOT, Boston, MA, USA.,MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France
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5
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Burnett E, Rahajamanana VL, Raboba JL, Weldegebriel G, Vuo Masembe Y, Mwenda JM, Parashar UD, Tate JE, Robinson AL. Diarrhea hospitalization costs among children <5 years old in Madagascar. Vaccine 2020; 38:7440-7444. [PMID: 33051040 DOI: 10.1016/j.vaccine.2020.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/22/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Following a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost. METHODS In this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child's hospital record was reviewed. RESULTS In total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household's monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household's monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations. CONCLUSIONS Our findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.
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Affiliation(s)
- Eleanor Burnett
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA.
| | - Vonintsoa Lalaina Rahajamanana
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | - Julia Liliane Raboba
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
| | | | - Yolande Vuo Masembe
- World Health Organization Madagascar Country Office, Antananarivo, Madagascar
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, People's Republic of Congo
| | - Umesh D Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Jacqueline E Tate
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| | - Annick Lalaina Robinson
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Antananarivo, Madagascar
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6
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Andriatahirintsoa EJPR, Raboba JL, Rahajamanana VL, Rakotozanany AL, Nimpa MM, Vuo Masembe Y, Weldegebriel G, De Gouveia L, Mwenda JM, Robinson AL. Impact of 10-Valent Pneumococcal Conjugate Vaccine on Bacterial Meningitis in Madagascar. Clin Infect Dis 2020; 69:S121-S125. [PMID: 31505632 PMCID: PMC6761316 DOI: 10.1093/cid/ciz504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced in Madagascar in 2012. The objective of this study was to determine the impact of PCV10 on bacterial meningitis in hospitalized children <5 years of age. METHODS During 2010-2017, data from the hospital admission logbook were recorded for bacterial meningitis and pneumonia hospitalizations in children <5 years of age. Between April 2011 and December 2017, 3312 cerebrospinal fluid (CSF) samples collected from children who fulfilled the World Health Organization case definition of suspected bacterial meningitis were analyzed at the sentinel site laboratory (SSL) by microscopy, culture, and antigen detection tests. A total of 2065 CSF samples were referred to the regional reference laboratory for real-time polymerase chain reaction (RT-PCR) analysis. 2010-2011 was defined as the prevaccine period, 2012 as vaccine introduction year, and 2013-2017 the postvaccine period. The number of cases, causative agent, and pneumonia hospitalizations were compared before and after PCV10 introduction. RESULTS In the prevaccine period, bacterial meningitis and pneumonia hospitalizations accounted for 4.5% and 24.5% of all hospitalizations while there were 2.6% and 19%, respectively, in the postvaccine period (P < .001). In samples tested at the SSL, 154 were positive with 80% Streptococcus pneumoniae and 20% other bacteria. Pneumococcal meningitis diagnosed by RT-PCR declined from 14% in 2012 to 3% in 2017. Also, 14% of children with pneumococcal meningitis died. CONCLUSIONS Following PCV10 introduction, pneumococcal meningitis, bacterial meningitis, and pneumonia hospitalizations declined. Surveillance should continue to monitor the impact of PCV10.
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Affiliation(s)
| | - Julia Liliane Raboba
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant TsaralàlanaAntananarivo, Madagascar
| | - Vonintsoa Lalaina Rahajamanana
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant TsaralàlanaAntananarivo, Madagascar
| | - Ando Lalaina Rakotozanany
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant TsaralàlanaAntananarivo, Madagascar
| | - Mengouom M Nimpa
- World Health Organization (WHO) Country Office, Antananarivo, Madagascar
| | | | - Goitom Weldegebriel
- WHO Intercountry Support Team for East and Southern Africa, Harare, Zimbabwe
| | - Linda De Gouveia
- Regional Reference Laboratory, Centre for Respiratory Diseases and Meningitis, National Institute of Communicable Diseases, Johannesburg, South Africa
| | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Annick Lalaina Robinson
- Department of Child Health, Teaching Hospital, Centre Hospitalier Universitaire Mère Enfant TsaralàlanaAntananarivo, Madagascar
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7
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Lambisia AW, Onchaga S, Murunga N, Lewa CS, Nyanjom SG, Agoti CN. Epidemiological Trends of Five Common Diarrhea-Associated Enteric Viruses Pre- and Post-Rotavirus Vaccine Introduction in Coastal Kenya. Pathogens 2020; 9:pathogens9080660. [PMID: 32824245 PMCID: PMC7459961 DOI: 10.3390/pathogens9080660] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022] Open
Abstract
Using real-time RT-PCR, we screened stool samples from children aged <5 years presenting with diarrhea and admitted to Kilifi County Hospital, coastal Kenya, pre- (2003 and 2013) and post-rotavirus vaccine introduction (2016 and 2019) for five viruses, namely rotavirus group A (RVA), norovirus GII, adenovirus, astrovirus and sapovirus. Of the 984 samples analyzed, at least one virus was detected in 401 (40.8%) patients. Post rotavirus vaccine introduction, the prevalence of RVA decreased (23.3% vs. 13.8%, p < 0.001) while that of norovirus GII increased (6.6% vs. 10.9%, p = 0.023). The prevalence of adenovirus, astrovirus and sapovirus remained statistically unchanged between the two periods: 9.9% vs. 14.2%, 2.4% vs. 3.2 %, 4.6% vs. 2.6%, (p = 0.053, 0.585 and 0.133), respectively. The median age of diarrhea cases was higher post vaccine introduction (12.5 months, interquartile range (IQR): 7.9–21 vs. 11.2 months pre-introduction, IQR: 6.8–16.5, p < 0.001). In this setting, RVA and adenovirus cases peaked in the dry months while norovirus GII and sapovirus peaked in the rainy season. Astrovirus did not display clear seasonality. In conclusion, following rotavirus vaccine introduction, we found a significant reduction in the prevalence of RVA in coastal Kenya but an increase in norovirus GII prevalence in hospitalized children.
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Affiliation(s)
- Arnold W. Lambisia
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (S.O.); (N.M.); (C.S.L.); (C.N.A.)
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Juja 62000-00200, Kenya;
- Correspondence: ; Tel.: +254-708-164-077
| | - Sylvia Onchaga
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (S.O.); (N.M.); (C.S.L.); (C.N.A.)
| | - Nickson Murunga
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (S.O.); (N.M.); (C.S.L.); (C.N.A.)
| | - Clement S. Lewa
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (S.O.); (N.M.); (C.S.L.); (C.N.A.)
| | - Steven Ger Nyanjom
- Department of Biochemistry, Jomo Kenyatta University of Agriculture and Technology, Juja 62000-00200, Kenya;
| | - Charles N. Agoti
- Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi 230-80108, Kenya; (S.O.); (N.M.); (C.S.L.); (C.N.A.)
- School of Health and Human Sciences, Pwani University, Kilifi 195-80108, Kenya
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8
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Mwanga MJ, Owor BE, Ochieng JB, Ngama MH, Ogwel B, Onyango C, Juma J, Njeru R, Gicheru E, Otieno GP, Khagayi S, Agoti CN, Bigogo GM, Omore R, Addo OY, Mapaseka S, Tate JE, Parashar UD, Hunsperger E, Verani JR, Breiman RF, Nokes DJ. Rotavirus group A genotype circulation patterns across Kenya before and after nationwide vaccine introduction, 2010-2018. BMC Infect Dis 2020; 20:504. [PMID: 32660437 PMCID: PMC7359451 DOI: 10.1186/s12879-020-05230-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Kenya introduced the monovalent G1P [8] Rotarix® vaccine into the infant immunization schedule in July 2014. We examined trends in rotavirus group A (RVA) genotype distribution pre- (January 2010-June 2014) and post- (July 2014-December 2018) RVA vaccine introduction. METHODS Stool samples were collected from children aged < 13 years from four surveillance sites across Kenya: Kilifi County Hospital, Tabitha Clinic Nairobi, Lwak Mission Hospital, and Siaya County Referral Hospital (children aged < 5 years only). Samples were screened for RVA using enzyme linked immunosorbent assay (ELISA) and VP7 and VP4 genes sequenced to infer genotypes. RESULTS We genotyped 614 samples in pre-vaccine and 261 in post-vaccine introduction periods. During the pre-vaccine introduction period, the most frequent RVA genotypes were G1P [8] (45.8%), G8P [4] (15.8%), G9P [8] (13.2%), G2P [4] (7.0%) and G3P [6] (3.1%). In the post-vaccine introduction period, the most frequent genotypes were G1P [8] (52.1%), G2P [4] (20.7%) and G3P [8] (16.1%). Predominant genotypes varied by year and site in both pre and post-vaccine periods. Temporal genotype patterns showed an increase in prevalence of vaccine heterotypic genotypes, such as the commonly DS-1-like G2P [4] (7.0 to 20.7%, P < .001) and G3P [8] (1.3 to 16.1%, P < .001) genotypes in the post-vaccine introduction period. Additionally, we observed a decline in prevalence of genotypes G8P [4] (15.8 to 0.4%, P < .001) and G9P [8] (13.2 to 5.4%, P < .001) in the post-vaccine introduction period. Phylogenetic analysis of genotype G1P [8], revealed circulation of strains of lineages G1-I, G1-II and P [8]-1, P [8]-III and P [8]-IV. Considerable genetic diversity was observed between the pre and post-vaccine strains, evidenced by distinct clusters. CONCLUSION Genotype prevalence varied from before to after vaccine introduction. Such observations emphasize the need for long-term surveillance to monitor vaccine impact. These changes may represent natural secular variation or possible immuno-epidemiological changes arising from the introduction of the vaccine. Full genome sequencing could provide insights into post-vaccine evolutionary pressures and antigenic diversity.
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Affiliation(s)
- Mike J Mwanga
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya.
| | - Betty E Owor
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - John B Ochieng
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Mwanajuma H Ngama
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - Billy Ogwel
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Clayton Onyango
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jane Juma
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Regina Njeru
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - Elijah Gicheru
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - Grieven P Otieno
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Charles N Agoti
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya
| | - Godfrey M Bigogo
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - O Yaw Addo
- Global Health Institute, Emory University, Atlanta, GA, USA
| | - Seheri Mapaseka
- Department of Virology, South African Medical Research Council/Diarrheal Pathogens Research Unit, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Jacqueline E Tate
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Umesh D Parashar
- Division of Viral Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth Hunsperger
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | | | - D James Nokes
- Wellcome Trust Research Programme, Kenya Medical Research Institute, Kilifi, Kenya.
- School of Life Science, and Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER), University of Warwick, Coventry, CV47AL, UK.
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9
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Raqib R, Sarker P, Zaman K, Alam NH, Wierzba TF, Maier N, Talukder K, Baqui AH, Suvarnapunya AE, Qadri F, Walker RI, Fix A, Venkatesan MM. A phase I trial of WRSS1, a Shigella sonnei live oral vaccine in Bangladeshi adults and children. Hum Vaccin Immunother 2019; 15:1326-1337. [PMID: 30794051 DOI: 10.1080/21645515.2019.1575165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Shigella sonnei live vaccine candidate, WRSS1, which was previously evaluated in US, Israeli and Thai volunteers, was administered orally to Bangladeshi adults and children to assess its safety, clinical tolerability and immunogenicity. In a randomized, placebo-controlled, dose-escalation, age-descending study, 39 adults (18-39 years) and 64 children (5-9 years) were enrolled. Each adult cohort (n = 13) received one dose of 3x104, or three doses of 3 × 105 or 3 × 106 colony forming unit (CFU) of WRSS1 (n = 10) or placebo (n = 3). Each child cohort (n = 16) received one dose of 3x103, or three doses of 3x104, 3x105, or 3 × 106 CFU WRSS1 (n = 12) or placebo (n = 4). WRSS1 elicited mostly mild and transient reactogenicity events in adults and children. In the 3 × 106 dose group, 50% of the adults shed the vaccine; no shedding was seen in children. At the highest dose, 100% of adults and 40% of children responded with a ≥ 4-fold increase of S. sonnei LPS-specific IgA antibody in lymphocyte supernatant (ALS). At the same dose, 63% of adults and 70% of children seroconverted with IgA to LPS, while in placebo, 33% of adults and 18% of children seroconverted. Both the vaccinees and placebos responded with fecal IgA to LPS, indicating persistent exposure to Shigella infections. In conclusion, WRSS1 was found safe up to 106 CFU dose and immunogenic in adults and children in Bangladesh. These data indicate that live, oral Shigella vaccine candidates, including WRSS1 can potentially be evaluated in toddlers and infants (<2 years of age), who comprise the target population in an endemic environment.
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Affiliation(s)
- Rubhana Raqib
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Protim Sarker
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - K Zaman
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Nur Haque Alam
- b Nutrition and Clinical Services Division , icddr,b , Dhaka , Bangladesh
| | - Thomas F Wierzba
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Nicole Maier
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Kaisar Talukder
- d Laboratory Sciences and Services Division , icddr,b , Dhaka , Bangladesh
| | - Abdullah Hel Baqui
- e Johns Hopkins Bloomberg School of Public Health , Johns Hopkins University , Baltimore , MD , USA
| | - Akamol E Suvarnapunya
- f Bacterial Diseases Branch , Walter Reed Army Institute of Research , Silver Spring , MD , USA
| | - Firdausi Qadri
- a Infectious Diseases Division , icddr,b , Dhaka , Bangladesh
| | - Richard I Walker
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Alan Fix
- c Center for Vaccine Innovation and Access , PATH , Washington , DC , USA
| | - Malabi M Venkatesan
- f Bacterial Diseases Branch , Walter Reed Army Institute of Research , Silver Spring , MD , USA
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10
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Mwenda JM, Parashar UD, Cohen AL, Tate JE. Impact of rotavirus vaccines in Sub-Saharan African countries. Vaccine 2018; 36:7119-7123. [PMID: 29914848 DOI: 10.1016/j.vaccine.2018.06.026] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/25/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
By the end of 2017, 32 (68%) of 47 countries in the World Health Organization's African Region had introduced rotavirus vaccine into their national immunization programs, including 27 countries that received financial support from the Gavi, the Vaccine Alliance. Several early introducing African countries previously evaluated the impact, vaccine effectiveness, and/or cost effectiveness of their routine rotavirus vaccination programs and found that rotavirus vaccine was effective and resulted in substantial declines in hospitalizations due to rotavirus. This Special Issue of Vaccine provides additional rotavirus vaccine effectiveness and impact data from a broader range of African countries, describes the longer term impact and potential indirect benefits of rotavirus vaccination programs, describes trends in circulating genotypes in the pre- and post-vaccine introduction eras, and evaluates the cost-effectiveness of a rotavirus vaccination program in a post-introduction setting. As countries begin transitioning from Gavi support, the findings of these studies provide evidence of the impact and effectiveness of rotavirus vaccination programs under conditions of routine use.
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Affiliation(s)
- Jason M Mwenda
- World Health Organization Regional Office for Africa, (WHO/AFRO), Brazzaville, Congo
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