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Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
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Nokes, D. James, Abwao, John, Pamba, Allan, Peenze, Ina, Dewar, John, Maghenda, J. Kamino, Gatakaa, Hellen, Bauni, Evasius, Scott, J. Anthony G., Maitland, Kathryn and Williams, Thomas N. (2008) Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya. PL o S Medicine, Vol.5 (No.7). doi:10.1371/journal.pmed.0050153 ISSN 1549-1277.
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Official URL: http://dx.doi.org/10.1371/journal.pmed.0050153
Abstract
Background
Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with
the greatest burden falling on young children living in less-developed countries. Vaccines
directed against this virus have shown promise in recent trials, and are undergoing
effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are
available on the incidence and clinical characteristics of severe group A rotavirus disease.
Advocacy for vaccine intervention and interpretation of effectiveness following implementation
will benefit from accurate base-line estimates of the incidence and severity of rotavirus
paediatric admissions in relevant populations. The study objective was to accurately define the
incidence and severity of group A rotavirus disease in a resource-poor setting necessary to
make informed decisions on the need for vaccine prevention.
Methods and Findings
Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus
infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as
"cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated
the incidence of hospital admission with group A rotavirus using data from a demographic
surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296
(22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%)
were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95%
confidence interval [CI] 1.9–4.7) were rotavirus positive. The annual incidence (per 100,000
children) of rotavirus-positive admissions was 1,431 (95% CI 1,275–1,600) in infants and 478
(437–521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with
rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting
illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance
except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9%
among rotavirus-negative children.
Conclusions
In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first
5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across
Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is
associated with acute life-threatening metabolic derangement in otherwise healthy children.
Although mortality is low in this clinical research setting this may not be generally true in
African hospitals lacking rapid and appropriate management.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > RA Public aspects of medicine | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) > Biological Sciences ( -2010) | ||||
Library of Congress Subject Headings (LCSH): | Rotavirus infections -- Kenya -- Kilifi District, Children -- Diseases -- Kenya -- Kilifi District, Public health surveillance -- Kenya | ||||
Journal or Publication Title: | PL o S Medicine | ||||
Publisher: | Public Library of Science | ||||
ISSN: | 1549-1277 | ||||
Official Date: | 22 July 2008 | ||||
Dates: |
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Volume: | Vol.5 | ||||
Number: | No.7 | ||||
DOI: | 10.1371/journal.pmed.0050153 | ||||
Status: | Peer Reviewed | ||||
Access rights to Published version: | Open Access (Creative Commons) | ||||
Funder: | Wellcome Trust (London, England), Kenya Medical Research Institute, Medical Research Council (Great Britain) (MRC) | ||||
Grant number: | 061584 (Wellcome), 076278 (Wellcome) |
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