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Etiology of Childhood Diarrhea After Rotavirus Vaccine Introduction A Prospective, Population-based Study in Nicaragua
University of N Carolina, NC 27599 USA.
National Autonomous University of Nicaragua, Nicaragua.
National Autonomous University of Nicaragua, Nicaragua.
Centre Epidemiol and Health CIDS, Nicaragua.
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2014 (English)In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 33, no 11, 1156-1163 p.Article in journal (Refereed) Published
Abstract [en]

Background: Nicaragua was the first developing nation to implement routine immunization with the pentavalent rotavirus vaccine (RV5). In this RV5-immunized population, understanding infectious etiologies of childhood diarrhea is necessary to direct diarrhea treatment and prevention efforts. Methods: We followed a population-based sample of children less than5 years in Leon, Nicaragua for diarrhea episodes through household visits. Information was obtained on RV5 history and sociodemographics. Stool samples collected during diarrhea episodes and among healthy children underwent laboratory analysis for viral, bacterial and parasitic enteropathogens. Detection frequency and incidence of each enteropathogen was calculated. Results: The 826 children in the cohort experienced 677 diarrhea episodes during 607.5 child-years of exposure time (1.1 episodes per child-year). At least 1 enteropathogen was detected among 61.1% of the 337 diarrheal stools collected. The most common enteropathogens among diarrheal stools were: norovirus (20.4%), sapovirus (16.6%), enteropathogenic Escherichia coli (11.3%), Entamoeba histolytica/dispar (8.3%), Giardia lamblia (8.0%) and enterotoxigenic E. coli (7.7%), with rotavirus detected among 5.3% of diarrheal stools. Enteropathogenic Escherichia coli and enterotoxigenic E. coli were frequently detected among stools from healthy children. Among children with diarrhea, norovirus was more commonly detected among younger children (less than2 years) and G. lamblia was more commonly detected among older children (2-4 years). The mean age of rotavirus detection was 34.6 months. Conclusions: In this Central American community after RV5 introduction, rotavirus was not commonly detected among children with diarrhea. Prevention and appropriate management of norovirus and sapovirus should be considered to further reduce the burden of diarrheal disease.

Place, publisher, year, edition, pages
Lippincott, Williams andamp; Wilkins , 2014. Vol. 33, no 11, 1156-1163 p.
Keyword [en]
childhood; community; diarrhea; Nicaragua; Rotavirus vaccine
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-112630DOI: 10.1097/INF.0000000000000427ISI: 000344354400017PubMedID: 24879131OAI: diva2:769380

Funding Agencies|Merck Investigator-Initiated Studies Program; Thrasher Research Fund; Fogarty International Center at the National Institutes of Health [5K01TW008401-04]; NETROPICA [05-N-2010]

Available from: 2014-12-08 Created: 2014-12-05 Last updated: 2014-12-08

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Nordgren, JohanSvensson, Lennart
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Division of Microbiology and Molecular MedicineFaculty of Health Sciences
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