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Rotavirus infection uncommon in Nicaragua after routine rotavirus vaccination
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Following the introduction of the pentavalent rotavirus vaccine in Leon, Nicaragua, rotavirus was not commonly detected among children with diarrhea, according to study findings in The Pediatric Infectious Disease Journal.
Sylvia Becker-Dreps, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues assessed diarrheal episodes of children aged younger than 5 years in Leon. The study cohort consisted of the 826 children, of which 354 experienced 677 episodes of diarrhea. Researchers collected 337 stool samples from children with diarrhea and 106 stool samples from healthy children.
Sylvia Becker-Dreps
Of the 826 children eligible to receive pentavalent rotavirus vaccine (RV5; RotaTeq, Merck), 630 (82.2%) received at least one dose. Most of the children in the study (97%) had an indoor connection to the municipal water supply source.
Among the 354 children who experienced diarrhea, 45% had one episode, 34% had two episodes, and 20.9% reported three or more episodes.
At least one enteropathogen was detected among 61.1% of stool samples from children with diarrhea, and 41.5% of stool samples from healthy children. Among children with diarrhea, the most commonly detected enteropathogens included norovirus (20.4%); sapovirus (16.6%); enteropathogenic Escherichia coli (11.3%); Entamoeba histolytica/dispar (8.3%); Giardia lamblia (8%); and enterotoxigenic E. coli (7.7%). Rotavirus was detected among 5.3% of children with diarrhea.
Bacterial infections caused by Shigella, Campylobacter and Salmonella were uncommon among children.
Norovirus was the most common enteropathogen detected among all age groups. However, norovirus was more frequently detected in children aged younger than 24 months, while G. lamblia was more frequently detected in children aged older than 24 months.
Eight of the 68 children who experienced norovirus diarrhea had another episode 1 to 10 months after their first episode. Almost half of children with norovirus were coinfected with another enteropathogen. The most commonly detected coinfections were sapovirus (n=10); G. lamblia (n=8); enteropathogenic E. coli (n=4); enterotoxigenic E. coli (n=4); and Entamoeba histolytica/dispar (n=4).
Thirty-five of 56 children with sapovirus had coinfections, most commonly norovirus, enteropathogenic E. coli and enterotoxigenic E. coli.
Most children with G. lamblia (19 of 27) had coinfections, most commonly norovirus, sapovirus or enteropathogenic E. coli.
Among children with diarrhea, 18 had rotavirus. Of these, six had not been immunized against rotavirus, one was partially immunized, and 11 had received all three doses of RV5. The mean age of rotavirus detection was 34.6 months.
“We found that rotavirus was not a common cause of childhood diarrhea in this developing world community setting following RV5 introduction. Instead, caliciviruses were most commonly detected among children with diarrhea. The high detection frequency of caliciviruses argues against the empiric use of antibiotics for the treatment of diarrhea in this setting. Future research should focus on effective prevention of these enteric viruses to reduce the remaining burden of childhood diarrhea in Nicaragua, and perhaps elsewhere in Latin America,” the researchers concluded.
Disclosure: See the full study for a list of disclosures.
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