Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya
复制标题
DOI：
10.1371/journal.pmed.0050153
复制
发表时间：
2008-07-01
期刊：
影响因子：
15.8
通讯作者：
Williams, Thomas N.
中科院分区：
文献类型：
--
作者：
Nokes, D. James;Abwao, John;Williams, Thomas N.
背景轮状病毒（主要为 A 组）是全世界严重腹泻的主要原因，生活在欠发达国家的幼儿负担最重。针对这种病毒的疫苗在最近的试验中显示出希望，并且正在撒哈拉以南非洲地区进行有效性评估。在该地区，关于严重 A 组轮状病毒疾病的发病率和临床特征的儿童数据有限。对相关人群中轮状病毒儿科入院率和严重程度的准确基线估计将有助于疫苗干预的倡导和实施后有效性的解释。该研究的目的是在资源匮乏的环境中准确确定 A 组轮状病毒疾病的发病率和严重程度，以便就疫苗预防的必要性做出明智的决定。方法和结果 2002 年至 2004 年，我们在肯尼亚沿海基利菲地区医院对 A 组轮状病毒感染进行了前瞻性监测。 13 岁儿童如果因腹泻入院则符合“病例”资格，如果入院无腹泻则符合“对照”资格。我们使用基利菲区 220,000 人的人口统计监测研究数据计算了 A 组轮状病毒入院的发生率。在 15,347 名入院儿童中，有 3,296 名（22%）患有腹泻，2,039 名接受了 A 组轮状病毒抗原检测，其中 588 名（29%）呈阳性。 372 例（63%）轮状病毒阳性病例是婴儿。在 620 名对照中，有 19 名（3.1%，95% 置信区间 [CI] 1.9 - 4.7）呈轮状病毒阳性。婴儿轮状病毒阳性入院的年发病率（每 100,000 名儿童）为 1,431 例（95% CI 1,275 - 1,600），5 岁以下儿童为 478 例（437 - 521 例），且在医院附近发生率最高。与轮状病毒阴性腹泻的儿童相比，轮状病毒阳性病例合并疾病的可能性较小，并且更有可能出现酸中毒（46％对17％）和严重电解质失衡（低钠血症除外）。轮状病毒阳性儿童的院内病死率为 2%，轮状病毒阴性儿童的院内病死率为 9%。基利菲的结论。 2% 的儿童在出生后 5 年内因 A 组轮状病毒腹泻入院。这意味着肯尼亚每年有超过 28,000 例疫苗可预防的住院病例，而且很可能被大大低估。 A 组轮状病毒腹泻与其他健康儿童的急性危及生命的代谢紊乱有关。尽管在这种临床研究环境中死亡率较低，但在缺乏快速和适当管理的非洲医院中，情况可能并非如此。
BackgroundRotavirus, 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 FindingsBetween 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.ConclusionsIn 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.