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Asare EO, Al-Mamun MA, Armah GE, Lopman BA, Parashar UD, Binka F, Pitzer VE. Modeling of rotavirus transmission dynamics and impact of vaccination in Ghana. Vaccine 2020; 38:4820-4828. [PMID: 32513513 PMCID: PMC8290434 DOI: 10.1016/j.vaccine.2020.05.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/26/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
Background: Rotavirus incidence remains relatively high in low-income countries (LICs) compared to high-income countries (HICs) after vaccine introduction. Ghana introduced monovalent rotavirus vaccine in April 2012 and despite the high coverage, vaccine performance has been modest compared to developed countries. The predictors of low vaccine effectiveness in LICs are poorly understood, and the drivers of subnational heterogeneity in rotavirus vaccine impact are unknown. Methods: We used mathematical models to investigate variations in rotavirus incidence in children <5 years old in Ghana. We fit models to surveillance and case-control data from three different hospitals: Korle-Bu Teaching Hospital in Accra, Komfo Anokye Teaching Hospital in Kumasi, and War Memorial Hospital in Navrongo. The models were fitted to both pre- and post-vaccine data to estimate parameters describing the transmission rate, waning of maternal immunity, and vaccine response rate. Results: The seasonal pattern and age distribution of rotavirus cases varied among the three study sites in Ghana. Our model was able to capture the spatio-temporal variations in rotavirus incidence across the three sites and showed good agreement with the age distribution of observed cases. The rotavirus transmission rate was highest in Accra and lowest in Navrongo, while the estimated duration of maternal immunity was longer (∼5 months) in Accra and Kumasi and shorter (∼3 months) in Navrongo. The proportion of infants who responded to the vaccine was estimated to be high in Accra and Kumasi and low in Navrongo. Conclusions: Rotavirus vaccine impact varies within Ghana. A low vaccine response rate was estimated for Navrongo, where rotavirus is highly seasonal and incidence limited to a few months of the year. Our findings highlight the need to further explore the relationship between rotavirus seasonality, maternal immunity, and vaccine response rate to determine how they influence vaccine effectiveness and to develop strategies to improve vaccine impact.
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Affiliation(s)
- Ernest O Asare
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Mohammad A Al-Mamun
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - George E Armah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Benjamin A Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Umesh D Parashar
- Epidemiology Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Fred Binka
- University of Health and Allied Health Sciences, Ho, Ghana
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
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Changotra H, Vij A. Rotavirus virus-like particles (RV-VLPs) vaccines: An update. Rev Med Virol 2017; 27. [DOI: 10.1002/rmv.1954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Harish Changotra
- Department of Biotechnology and Bioinformatics; Jaypee University of Information Technology; Solan Himachal Pradesh India
| | - Avni Vij
- Department of Biotechnology and Bioinformatics; Jaypee University of Information Technology; Solan Himachal Pradesh India
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Alp Avci G. Selection of superior bifidobacteria in the presence of rotavirus. ACTA ACUST UNITED AC 2016; 49:e5562. [PMID: 27849251 PMCID: PMC5122309 DOI: 10.1590/1414-431x20165562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023]
Abstract
The main purpose of this study was to investigate bifidobacteria flora in fecal
samples from children with rotavirus infection and determine the significance of
their selected probiotic properties for improvement of health status. Enzyme-linked
immunosorbent assay was used to identify rotavirus antigen in fecal samples from 94
patients with gastroenteritis and from 30 without gastroenteritis. Bifidobacteria
were identified by selective media, gram reaction, colony morphology,
fructose-6-phosphate phosphoketolase enzyme activity and classical identification
tests. Exopolysaccharide (EPS) production was identified by phenol-sulphuric acid
method. The modified method was then used to identify the quantity of taurocholic and
glycocholic acid deconjugation and cholesterol elimination of the strains.
Thirty-five of the 94 fecal samples were found positive for rotavirus antigen
(37.23%). Bifidobacteria were identified in 59 of the samples. The EPS production
ranges were 29.56-102.21 mg/L. The cholesterol elimination rates ranged between
8.36-39.22%. Furthermore, a positive and strong correlation was determined between
EPS production and the presence of cholesterol (r=0.984,
P<0.001). The deconjugation rates for the sodium glycocholate group was higher
than the sodium taurocholate group. Rotavirus (+) bifidobacteria strains had higher
EPS production, deconjugation rate and cholesterol elimination compared to
bifidobacteria strains isolated from children in the rotavirus (-) sample and without
gastroenteritis. Significant differences were observed among groups in all parameters
(P<0.05). Given the increased number of rotavirus cases in Turkey and worldwide,
it is very important to add superior bifidobacteria in the diets of infected children
to improve the intestinal and vital functions.
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Affiliation(s)
- G Alp Avci
- Department of Molecular Biology and Genetics, Molecular Microbiology and Biotechnology, Faculty of Science and Arts, Hitit University, Corum, Turkey
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Koukou D, Chatzichristou P, Trimis G, Siahanidou T, Skiathitou AV, Koutouzis EI, Syrogiannopoulos GA, Lourida A, Michos AG, Syriopoulou VP. Rotavirus Gastroenteritis in a Neonatal Unit of a Greek Tertiary Hospital: Clinical Characteristics and Genotypes. PLoS One 2015. [PMID: 26214830 PMCID: PMC4516237 DOI: 10.1371/journal.pone.0133891] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Rotavirus (RV) infection in neonatal age can be mild or even asymptomatic. Several studies have reported that RV is responsible for 31%-87% of pediatric nosocomial diarrhea and causes gastroenteritis outbreaks in pediatric and neonatal units. OBJECTIVES Study clinical characteristics, genotypes and risk factors of RV infection in neonatal age. METHODS A prospective study was conducted from April 2009 till April 2013 in the neonatal special care unit of the largest tertiary pediatric hospital of Greece. Fecal samples and epidemiological data were collected from each neonate with gastrointestinal symptoms. RV antigen was detected with a rapid immunochromatography test. RV positive samples were further genotyped with RT PCR and sequencing using specific VP7 and VP4 primers. RESULTS Positive for RV were 126/415 samples (30.4%). Mean age of onset was 18 days. Seventy four cases (58%) were hospital acquired. Seasonality of RV infection did not differ significantly throughout the year with the exception of 4 outbreaks. Genotypes found during the study period were G4P[8] (58.7%), G1P[8] (14.7%), G12P[8] (9.3%), G3P[8] (9.3%), G12P[6] (5.3%), G9P[8] (1.3%) and G2P[4] (1.3%). RV cases presented with: diarrhea (81%), vomiting (26.2%), fever (34.9%), dehydration (28.6%), feeding intolerance (39.7%), weight loss (54%), whilst 19% of cases were asymptomatic. Comparing community with hospital acquired cases differences in clinical manifestations were found. CONCLUSIONS Significant incidence of nosocomially transmitted RV infection in neonatal age including asymptomatic illness exists. Genotypes causing nosocomial outbreaks are not different from community strains. Circulating vaccines can be effective in prevention of nosocomial RV infection through herd immunity.
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Affiliation(s)
- Dimitra Koukou
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Panagiota Chatzichristou
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | | | - Tania Siahanidou
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Anna-Venetia Skiathitou
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | | | - George A. Syrogiannopoulos
- Department of Pediatrics, University of Thessaly, General University Hospital of Larissa, Larissa, Greece
| | - Athanasia Lourida
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Athanasios G. Michos
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Vassiliki P. Syriopoulou
- First Department of Pediatrics, Athens University, “Aghia Sophia” Children’s Hospital, Athens, Greece
- * E-mail:
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Enweronu-Laryea CC, Boamah I, Sifah E, Diamenu SK, Armah G. Decline in severe diarrhea hospitalizations after the introduction of rotavirus vaccination in Ghana: a prevalence study. BMC Infect Dis 2014; 14:431. [PMID: 25100574 PMCID: PMC4132910 DOI: 10.1186/1471-2334-14-431] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost all diarrhea deaths in young children occur in developing countries. Immunization against rotavirus, the leading cause of childhood severe dehydrating acute diarrhea may reduce the burden of severe diarrhea in developing countries. Ghana introduced rotavirus and pneumococcal vaccination in the national expanded program on immunization in May 2012. METHODS Review of all-cause diarrheal hospitalization data for children aged 59 months and younger at 2 pediatric referral hospitals in southern Ghana from 2008 to 2014. The proportion of acute diarrhea (defined as 3 or more watery, non-bloody stools within 24 hours that has lasted for less than 7 days) cases caused by rotavirus was determined. Temporal trend and age group distribution of all-cause diarrhea and rotavirus gastroenteritis before and after introduction of the new vaccines were compared. RESULTS Of the 5847 children hospitalized with all-cause diarrhea during the 74 months (January 2008 - February 2014), 3963 (67.8%) children were recruited for rotavirus surveillance and stool specimens were tested for rotavirus in 3160/3963 (79.7%). Median monthly hospitalization for all-cause diarrhea reduced from 84 [interquartile range (IQR) 62 - 105] during the 52 months pre-vaccination introduction to 46 (IQR 42 - 57) in the 22 months after implementation of vaccination. Significant decline in all-cause diarrhea hospitalization occurred in children aged 0 - 11 months: 56.3% (2711/4817) vs. 47.2% 486/1030 [p = 0.0001, 95% confidence interval (CI) 0.77 - 0.88] and there was significant reduction of rotavirus gastroenteritis hospitalization: 49.7% (1246/2505) vs. 27.8% (182/655) [p = 0.0001, 95% CI 0.32 - 0.47] before and after vaccine introduction respectively. CONCLUSIONS Implementation of rotavirus vaccination program may have resulted in significant reduction of severe diarrhea hospitalization even though this observational study could not exclude the effect of other confounding factors. Continued surveillance is recommended to monitor the progress of this program.
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Barker SF, Amoah P, Drechsel P. A probabilistic model of gastroenteritis risks associated with consumption of street food salads in Kumasi, Ghana: evaluation of methods to estimate pathogen dose from water, produce or food quality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 487:130-142. [PMID: 24784738 DOI: 10.1016/j.scitotenv.2014.03.108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 03/22/2014] [Accepted: 03/22/2014] [Indexed: 06/03/2023]
Abstract
With a rapidly growing urban population in Kumasi, Ghana, the consumption of street food is increasing. Raw salads, which often accompany street food dishes, are typically composed of perishable vegetables that are grown in close proximity to the city using poor quality water for irrigation. This study assessed the risk of gastroenteritis illness (caused by rotavirus, norovirus and Ascaris lumbricoides) associated with the consumption of street food salads using Quantitative Microbial Risk Assessment (QMRA). Three different risk assessment models were constructed, based on availability of microbial concentrations: 1) Water - starting from irrigation water quality, 2) Produce - starting from the quality of produce at market, and 3) Street - using microbial quality of street food salad. In the absence of viral concentrations, published ratios between faecal coliforms and viruses were used to estimate the quality of water, produce and salad, and annual disease burdens were determined. Rotavirus dominated the estimates of annual disease burden (~10(-3)Disability Adjusted Life Years per person per year (DALYs pppy)), although norovirus also exceeded the 10(-4)DALY threshold for both Produce and Street models. The Water model ignored other on-farm and post-harvest sources of contamination and consistently produced lower estimates of risk; it likely underestimates disease burden and therefore is not recommended. Required log reductions of up to 5.3 (95th percentile) for rotavirus were estimated for the Street model, demonstrating that significant interventions are required to protect the health and safety of street food consumers in Kumasi. Estimates of virus concentrations were a significant source of model uncertainty and more data on pathogen concentrations is needed to refine QMRA estimates of disease burden.
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Affiliation(s)
- S Fiona Barker
- Department of Resource Management and Geography, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Philip Amoah
- International Water Management Institute (IWMI) West Africa Office, PMB CT 112 Accra, Ghana
| | - Pay Drechsel
- International Water Management Institute (IWMI), P.O.B. 2075, Colombo, Sri Lanka
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Severe acute rotavirus gastroenteritis in children less than 5 years in southern Ghana: 2006-2011. Pediatr Infect Dis J 2014; 33 Suppl 1:S9-S13. [PMID: 24343622 DOI: 10.1097/inf.0000000000000045] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rotavirus is a major cause of acute gastroenteritis (AGE) globally. Local data on disease burden will guide recommendations for rotavirus vaccination and monitoring impact of the intervention. METHODS Prospective surveillance for rotavirus gastroenteritis was conducted in 3 hospitals in southern Ghana during the period August 2006 to December 2011, as part of the African Rotavirus Surveillance Network. Clinical data and stool specimens were collected from children <5 years of age and hospitalized with AGE (defined as 3 or more watery stools for up to 7 days). Stool was tested for rotavirus by enzyme immunoassay and rotavirus genotype identified by reverse-transcriptase polymerase chain reaction. RESULTS We tested 3044 stool samples from 3939 children. Rotavirus was detected in 45.6%, 51.3% and 48.5% of cases at the primary, secondary and tertiary care hospital, respectively. Both genders were equally affected; 75% (2954/3939) of the cohort were aged 3-18 months. Overall, rotavirus was detected in 49.4% (1504/3044) of cases, caused over 30% of AGE hospitalizations all year round and up to 70% of cases during peak seasons. Peak season occurred during cool dry months in 2008, 2010 and 2011 and the rainy season in 2009. Mortality from AGE occurred in 1.5% (45/3044) of cases and 48.9% (22/45) of these were rotavirus positive. CONCLUSIONS Rotavirus causes significant morbidity and mortality in young Ghanaian children. As Ghana introduced rotavirus vaccination in the national immunization program in 2012, continued surveillance is required to monitor the impact of this intervention.
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The comparition of the efficacy of two different probiotics in rotavirus gastroenteritis in children. J Trop Med 2012; 2012:787240. [PMID: 22778754 PMCID: PMC3388355 DOI: 10.1155/2012/787240] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/20/2012] [Accepted: 05/03/2012] [Indexed: 12/12/2022] Open
Abstract
Objectives. The aim of the study is to compare the clinical effectiveness of the probiotics—Saccharomyces boulardii and Bifidobacterium lactis—in children who had been diagnosed with rotavirus gastroenteritis. Materials and methods. Seventy five patients aged between 5 months–5 years diagnosed as rotavirus gastroenteritis were included in the study. The patients diagnosed as rotavirus gastroenteritis by latex agglutination test in stool were divided into 3 groups of twenty-five patients each: First group was given oral rehydration therapy and rapid refeeding with a normal diet with Saccharomyces boulardii (spp. I-745), second group was given oral rehydration therapy and rapid refeeding with a normal diet with Bifidobacterium lactis (spp. B94, culture number:N°118529) and third group received only oral rehydration therapy and rapid refeeding with a normal diet. Results. The duration of diarrhea was shorter in the group given oral rehydration therapy and rapid refeeding with a normal diet with Bifidobacterium lactis and Saccharomyces boulardii than the group given only oral rehydration therapy and rapid refeeding with a normal diet. Conclusion. Bifidobacterium lactis has a complemental role in the treatment of rotavirus gatroenteritis and other probiotics may also have a beneficial effect in rotavirus gastroenteritis compared with the therapy included only oral rehydration therapy and rapid refeeding with a normal diet.
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Babji S, Kang G. Rotavirus vaccination in developing countries. Curr Opin Virol 2012; 2:443-8. [PMID: 22698800 DOI: 10.1016/j.coviro.2012.05.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/03/2012] [Accepted: 05/15/2012] [Indexed: 02/06/2023]
Abstract
Although two oral rotavirus vaccines are licensed in many countries, multiple factors may affect decision-making regarding introduction into national immunization programs in developing countries. Financial and logistic challenges to introduction of rotavirus vaccines in countries with limited infrastructure and resources are accompanied by a perceived lack of need and evidence from recent vaccine trials, which demonstrated significantly lower efficacy in high burden countries. Nonetheless, even at a low efficacy, the use of existing vaccines in developing countries is predicted to alleviate considerable rotavirus disease burden and mortality. Potential alternate strategies for improving response to existing vaccines or the development of improved vaccines need to be considered to ensure that the remaining burden of mortality and morbidity can be addressed in the future.
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Affiliation(s)
- Sudhir Babji
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu 632004, India
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Abbott C, Tiede B, Armah G, Mahmoud A. Evaluation of cost-effectiveness of live oral pentavalent reassortant rotavirus vaccine introduction in Ghana. Vaccine 2012; 30:2582-7. [DOI: 10.1016/j.vaccine.2012.01.076] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/18/2012] [Accepted: 01/24/2012] [Indexed: 11/24/2022]
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El Khoury AC, Mast TC, Ciarlet M, Markson L, Goveia MG, Munford V, Rácz ML. Projecting the effectiveness of RotaTeq® against rotavirus-related hospitalisations in Brazil. Mem Inst Oswaldo Cruz 2011; 106:541-5. [DOI: 10.1590/s0074-02762011000500004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 05/24/2011] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Max Ciarlet
- Clinical Research and Development, Novartis Vaccines & Diagnostics, USA
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Page AL, Hustache S, Luquero FJ, Djibo A, Manzo ML, Grais RF. Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey. BMC Public Health 2011; 11:389. [PMID: 21612640 PMCID: PMC3121637 DOI: 10.1186/1471-2458-11-389] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 05/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases. METHODS A cluster survey was done on 35 clusters of 21 children under 5 years of age in each of four districts of the Maradi Region, Niger. Caretakers were asked about diarrhea of the child during the recall period and their health seeking behavior in case of diarrhea. A weighted cluster analysis was conducted to determine the prevalence of diarrhea, as well as the proportion of consultations and types of health structures consulted. RESULTS In total, the period prevalence of diarrhea and severe diarrhea between April 24th and May 21st 2009 were 36.8% (95% CI: 33.7 - 40.0) and 3.4% (95% CI: 2.2-4.6), respectively. Of those reporting an episode of diarrhea during the recall period, 70.4% (95% CI: 66.6-74.1) reported seeking care at a health structure. The main health structures visited were health centers, followed by health posts both for simple or severe diarrhea. Less than 10% of the children were brought to the hospital. The proportion of consultations was not associated with the level of education of the caretaker, but increased with the number of children in the household. CONCLUSIONS The proportion of consultations for diarrhea cases in children under 5 years old was higher than those reported in previous surveys in Niger and elsewhere. Free health care for under 5 years old might have participated in this improvement. In this type of decentralized health systems, the WHO recommended hospital-based surveillance of severe diarrheal diseases would capture only a fraction of severe diarrhea. Lower levels of health structures should be considered to obtain informative data to ensure appropriate care and burden estimates.
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Affiliation(s)
| | | | | | - Ali Djibo
- Ministère de la Santé, Niamey, Niger
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Kim SY, Sweet S, Slichter D, Goldie SJ. Health and economic impact of rotavirus vaccination in GAVI-eligible countries. BMC Public Health 2010; 10:253. [PMID: 20470426 PMCID: PMC2893091 DOI: 10.1186/1471-2458-10-253] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 05/14/2010] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Rotavirus infection is responsible for about 500,000 deaths annually, and the disease burden is disproportionately borne by children in low-income countries. Recently the World Health Organization (WHO) has released a global recommendation that all countries include infant rotavirus vaccination in their national immunization programs. Our objective was to provide information on the expected health, economic and financial consequences of rotavirus vaccines in the 72 GAVI support-eligible countries. METHODS We synthesized population-level data from various sources (primarily from global-level databases) for the 72 countries eligible for the support by the GAVI Alliance (GAVI-eligible countries) in order to estimate the health and economic impact associated with rotavirus vaccination programs. The primary outcome measure was incremental cost (in 2005 international dollars [I$]) per disability-adjusted life year (DALY) averted. We also projected the expected reduction in rotavirus disease burden and financial resources required associated with a variety of scale-up scenarios. RESULTS Under the base-case assumptions (70% coverage), vaccinating one single birth cohort would prevent about 55% of rotavirus associated deaths in the 72 GAVI-eligible countries. Assuming I$25 per vaccinated child (approximately $5 per dose), the number of countries with the incremental cost per DALY averted less than I$200 was 47. Using the WHO's cost-effectiveness threshold based on per capita GDP, the vaccines were considered cost-effective in 68 of the 72 countries (approximately 94%). A 10-year routine rotavirus vaccination would prevent 0.9-2.8 million rotavirus associated deaths among children under age 5 in the poorest parts of the world, depending on vaccine scale-up scenarios. Over the same intervention period, rotavirus vaccination programs would also prevent 4.5-13.3 million estimated cases of hospitalization and 41-107 million cases of outpatient clinic visits in the same population. CONCLUSIONS Our findings suggest that rotavirus vaccination would be considered a worthwhile investment for improving general development as well as childhood health level in most low-income countries, with a favorable cost-effectiveness profile even under a vaccine price ($1.5-$5.0 per dose) higher than those of traditional childhood vaccines.
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Affiliation(s)
- Sun-Young Kim
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
- Harvard Initiative for Global Health, Cambridge, MA, USA
| | - Steve Sweet
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
| | - David Slichter
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
- Harvard Initiative for Global Health, Cambridge, MA, USA
| | - Sue J Goldie
- Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston MA, USA
- Harvard Initiative for Global Health, Cambridge, MA, USA
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