Ahead of Print -Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012 - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC

full-text ►

Ahead of Print -Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012 - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 4—April 2014

Research

Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012

Article Contents

• Patients and Methods
• Results
• Discussion
• Acknowledgments
• References
• Figure
• Table 1
• Table 2
• Table 3
• Table 4
• Table 5
• Technical Appendix - 49 KB 
• Suggested Citation

Anne-Laure Page , Viviane Jusot, Abdoul-Aziz Mamaty, Lagare Adamou, Jérôme Kaplon, Pierre Pothier, Ali Djibo, Mahamane L. Manzo, Brahima Toure, Céline Langendorf, Jean-Marc Collard, and Rebecca F. Grais

Author affiliations: Epicentre, Paris, France (A.-L. Page, C. Langendorf, R.F. Grais); Epicentre, Niamey, Niger (V. Jusot, A.-A. Mamaty, B. Toure); Centre de Recherche Médicale et Sanitaire (CERMES), Niamey (L. Adamou, J.-M. Collard); University Hospital of Dijon, Dijon, France (J. Kaplon, P. Pothier); Ministry of Health, Niamey (A. Djibo, M.L. Manzo); Niamey University, Niamey (A. Djibo)

Suggested citation for this article

Abstract

Knowledge of rotavirus epidemiology is necessary to make informed decisions about vaccine introduction and to evaluate vaccine impact. During April 2010–March 2012, rotavirus surveillance was conducted among 9,745 children <5 years of age in 14 hospitals/health centers in Niger, where rotavirus vaccine has not been introduced. Study participants had acute watery diarrhea and moderate to severe dehydration, and 20% of the children were enrolled in a nutrition program. Of the 9,745 children, 30.5% were rotavirus positive. Genotyping of a subset of positive samples showed a variety of genotypes during the first year, although G2P[4] predominated. G12 genotypes, including G12P[8], which has emerged as a predominant strain in western Africa, represented >80% of isolates during the second year. Hospitalization and death rates and severe dehydration among rotavirus case-patients did not differ during the 2 years. The emergence of G12P[8] warrants close attention to the characteristics of associated epidemics and possible prevention measures.

As the leading cause of severe gastroenteritis in children, rotavirus is responsible for ≈450,000 deaths each year among children <5 years of age, mainly in low-income countries (1,2). Two rotavirus vaccines that have been prequalified by the World Health Organization, Rotarix (GlaxoSmithKline Biologicals, Rixensart, Belgium) and Rotateq (Merck, Whitehouse Station, NJ, USA), have been introduced widely in high- and middle-income countries, where their effect on rotavirus-related hospital admissions and deaths has been demonstrated (3). These vaccines are being introduced in several low-income countries in Africa and Asia, where their efficacy is lower (4–6) and impact data are limited (7).

Four rotavirus genotypes were historically recognized as predominant: G1P[8], G2P[4], G3P[8], and G4P[8]. These genotypes represented 88% of all rotavirus strains worldwide, and genotype G1P[8] has been responsible for >70% of the rotavirus infections in North America, Europe, and Australia (8). Since 2000, the prevalence of G1 strains has been declining, and other genotypes, such as G9 and G12, have emerged (9). In Africa, G12 strains were first detected in southern Africa, mostly in association with P[6] (10–12), and G12P[8] recently emerged as a predominant strain in western Africa (13,14) and some regions of Spain (15), Argentina (16), and the United States (17).

Because questions remain about vaccine efficacy and impact in low-resource settings, countries planning to introduce rotavirus vaccine must have knowledge of rotavirus epidemiology and circulating genotypes to evaluate the potential effect of vaccine programs. Niger is one of 34 countries approved by GAVI Alliance for financial support, but rotavirus vaccine has not yet been introduced in the country. We present rotavirus surveillance data for children <5 years of age in 14 hospitals and health centers in urban and rural Niger.

Dr Page is a biologist and epidemiologist at Epicentre/Médecins Sans Frontières, Paris, France. Her primary research interests are the etiology and diagnosis of infectious diseases.

Acknowledgments

We thank the children and their families and communities for their participation in the study. We are grateful to Francisco Luquero for fruitful discussions, and we thank Florence Fermon, Myriam Henkens, Jean Rigal, Pedro Pablo Palma, Eric Comte, and Bertrand Draguez for promoting the study and for their interest in the results. We also thank Céline Fremy for technical assistance.

This work was funded by Médecins Sans Frontières.

References

1. Sanchez-Padilla E, Grais RF, Guerin PJ, Steele AD, Burny ME, Luquero FJ. Burden of disease and circulating serotypes of rotavirus infection in sub-Saharan Africa: systematic review and meta-analysis. Lancet Infect Dis. 2009;9:567–76. DOIPubMed
2. Tate JE, Burton AH, Boschi-Pinto C, Steele AD, Duque J, Parashar UD. 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12:136–41 . DOIPubMed
3. Patel MM, Glass R, Desai R, Tate JE, Parashar UD. Fulfilling the promise of rotavirus vaccines: how far have we come since licensure? Lancet Infect Dis. 2012;12:561–70. DOIPubMed
4. Armah GE, Sow SO, Breiman RF, Dallas MJ, Tapia MD, Feikin DR, Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in sub-Saharan Africa: a randomised, double-blind, placebo-controlled trial.Lancet. 2010;376:606–14 . DOIPubMed
5. Madhi SA, Cunliffe NA, Steele D, Witte D, Kirsten M, Louw C, Effect of human rotavirus vaccine on severe diarrhea in African infants. N Engl J Med. 2010;362:289–98. DOIPubMed
6. Zaman K, Dang DA, Victor JC, Shin S, Yunus M, Dallas MJ, Efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in infants in developing countries in Asia: a randomised, double-blind, placebo-controlled trial. Lancet. 2010;376:615–23 . DOIPubMed
7. Msimang VM, Page N, Groome MJ, Moyes J, Cortese M, Seheri M, Impact of rotavirus vaccine on childhood diarrheal hospitalization following introduction into the South African public immunization program. Pediatr Infect Dis J. Epub 2013Aug 8.
8. Santos N, Hoshino Y. Global distribution of rotavirus serotypes/genotypes and its implication for the development and implementation of an effective rotavirus vaccine.Rev Med Virol. 2005;15:29–56. DOIPubMed
9. Bányai K, Laszlo B, Duque J, Steele AD, Nelson EA, Gentsch JR, Systematic review of regional and temporal trends in global rotavirus strain diversity in the pre rotavirus vaccine era: insights for understanding the impact of rotavirus vaccination programs.Vaccine. 2012;30(Suppl 1):A122–30 . DOIPubMed
10. Mwenda JM, Ntoto KM, Abebe A, Enweronu-Laryea C, Amina I, Mchomvu J, Burden and epidemiology of rotavirus diarrhea in selected African countries: preliminary results from the African Rotavirus Surveillance Network. J Infect Dis. 2010;202(Suppl):S5–11. DOIPubMed
11. Cunliffe NA, Ngwira BM, Dove W, Thindwa BD, Turner AM, Broadhead RL, Epidemiology of rotavirus infection in children in Blantyre, Malawi, 1997–2007. J Infect Dis.2010;202(Suppl):S168–74. DOIPubMed
12. Page NA, de Beer MC, Seheri LM, Dewar JB, Steele AD. The detection and molecular characterization of human G12 genotypes in South Africa. J Med Virol. 2009;81:106–13. DOIPubMed
13. Ndze VN, Papp H, Achidi EA, Gonsu KH, Laszlo B, Farkas S, One year survey of human rotavirus strains suggests the emergence of genotype G12 in Cameroon. J Med Virol.2013;85:1485–90. DOIPubMed
14. Oluwatoyin Japhet M, Adeyemi AO, Famurewa O, Svensson L, Nordgren J. Molecular epidemiology of rotavirus and norovirus in Ile-Ife, Nigeria: high prevalence of G12P[8] rotavirus strains and detection of a rare norovirus genotype. J Med Virol.2012;84:1489–96 . DOIPubMed
15. Cilla G, Montes M, Gomariz M, Alkorta M, Iturzaeta A, Perez-Yarza EG, Rotavirus genotypes in children in the Basque Country (north of Spain): rapid and intense emergence of the G12[P8] genotype. Epidemiol Infect. 2013;141:868–74. DOIPubMed
16. Stupka JA, Degiuseppe JI, Parra GI. Increased frequency of rotavirus G3P[8] and G12P[8] in Argentina during 2008–2009: whole-genome characterization of emerging G12P[8] strains. J Clin Virol. 2012;54:162–7. DOIPubMed
17. Payne DC, Szilagyi PG, Staat MA, Edwards KM, Gentsch JR, Weinberg GA, Secular variation in United States rotavirus disease rates and serotypes: implications for assessing the rotavirus vaccination program. Pediatr Infect Dis J. 2009;28:948–53. DOIPubMed
18. 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. DOIPubMed
19. World Health Organization. Handbook: IMCI integrated management of childhood illness. Geneva: the Organization; 2005.
20. Ruuska T, Vesikari T. Rotavirus disease in Finnish children: use of numerical scores for clinical severity of diarrhoeal episodes. Scand J Infect Dis. 1990;22:259–67. DOIPubMed
21. Iturriza Gómara M, Wong C, Blome S, Desselberger U, Gray J. Molecular characterization of VP6 genes of human rotavirus isolates: correlation of genogroups with subgroups and evidence of independent segregation. J Virol. 2002;76:6596–601. DOIPubMed
22. Steele AD, Neuzil KM, Cunliffe NA, Madhi SA, Bos P, Ngwira B, Human rotavirus vaccine Rotarix provides protection against diverse circulating rotavirus strains in African infants: a randomized controlled trial. BMC Infect Dis. 2012;12:213. DOIPubMed
23. Groome MJ, Madhi SA. Five-year cohort study on the burden of hospitalisation for acute diarrhoeal disease in African HIV-infected and HIV-uninfected children: potential benefits of rotavirus vaccine. Vaccine. 2012;30(Suppl 1):A173–8. DOIPubMed
24. Puliyel JM, Mathew JL. Should India launch a national immunisation programme against rotavirus? No. BMJ. 2012;345:e7832. DOIPubMed
25. Bon F, Kaplon J, Metzger MH, Pothier P. Evaluation of seven immunochromatographic assays for the rapid detection of human rotaviruses in fecal specimens [in French].Pathol Biol (Paris). 2007;55:149–53. DOIPubMed
26. de Rougemont A, Kaplon J, Billaud G, Lina B, Pinchinat S, Derrough T, Sensitivity and specificity of the VIKIA Rota-Adeno immuno-chromatographic test (bioMerieux) and the ELISA IDEIA Rotavirus kit (Dako) compared to genotyping [in French]. Pathol Biol (Paris).2009;57:86–9. DOIPubMed

Figure

• Figure. . Number of rotavirus cases and extrapolated number of the 2 most frequent genotypes, G2P[4] and G12P[8], identified each month during a 2-year surveillance study in urban and rural areas...

Tables

• Table 1. Sociodemographic and clinical and treatment characteristics of children in a rotavirus surveillance study in Niamey and Maradi region, Niger, April 2010–March 2012
• Table 2. Number of rotavirus-positive study participants identified during a 2-year surveillance study in Niamey and Maradi region, Niger, April 2010–March 2012
• Table 3. Number and percentage of rotavirus-positive study participants in a surveillance study in urban and rural areas of Niger, April 2010–March 2012
• Table 4. Age and clinical characteristics of study participants in a 2-year rotavirus surveillance study in urban and rural areas of Niger, April 2010–March 2012
• Table 5. Weighted analysis of rotavirus genotypes identified during a 2-year surveillance study in Niamey and Maradi region, Niger, April 2010–March 2012

Technical Appendix

• Technical Appendix. . Age distribution of rotavirus-positive and -negative children and number of rotavirus cases per month in Niamey and Maradi region, Niger, April 2010–March 2012.  49 KB 

Suggested citation for this article: Page AL, Jusot V, Mamaty AA, Adamou L, Kaplon J, Pothier P, et al. Rotavirus surveillance in urban and rural areas of Niger, April 2010–March 2012. Emerg Infect Dis. 2014 Apr [date cited]. http://dx.doi.org/10.3201/eid2004.131328

DOI: 10.3201/eid2004.131328