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Rotavirus Infection and Disease in a Multisite Birth Cohort: Results From the MAL-ED Study
Venkata Raghava Mohan1, Ramanujam Karthikeyan2, Sudhir Babji2
1Department of Community Health.
Insights
Rotavirus infection is common in young children, with vaccination offering some protection. However, vaccine effectiveness may decrease in the second year of life, especially in high-transmission areas.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Rotavirus is a leading cause of severe diarrheal disease in infants globally.
- Understanding rotavirus epidemiology is crucial for vaccine development and public health strategies.
Purpose of the Study:
- To describe rotavirus infection incidence and risk factors in a multicountry birth cohort.
- To evaluate the impact of rotavirus vaccination programs on infection rates and disease severity.
Main Methods:
- A birth cohort study followed 1737 children from birth to 24 months.
- Monthly surveillance and stool sample collection were performed.
- Enzyme immunoassays were used to detect rotavirus in stools and sera.
Main Results:
- Rotavirus was detected in 5.5% of diarrheal stools; 19.8% of children experienced rotavirus gastroenteritis.
- Household overcrowding and high pathogen load were significant risk factors.
- Three prior infections provided 74% protection against subsequent infection in unvaccinated sites.
Conclusions:
- Rotavirus infection and disease are prevalent but vary significantly by location.
- Vaccine protection may wane in the second year of life in high-transmission settings.
Background:
In a multicountry birth cohort study, we describe rotavirus infection in the first 2 years of life in sites with and without rotavirus vaccination programs.
Methods:
Children were recruited by 17 days of age and followed to 24 months with collection of monthly surveillance and diarrheal stools. Data on sociodemographics, feeding, and illness were collected at defined intervals. Stools were tested for rotavirus and sera for antirotavirus immunoglobulins by enzyme immunoassays.
Results:
A total of 1737 children contributed 22646 surveillance and 7440 diarrheal specimens. Overall, rotavirus was detected in 5.5% (408/7440) of diarrheal stools, and 344 (19.8%) children ever had rotavirus gastroenteritis. Household overcrowding and a high pathogen load were consistent risk factors for infection and disease. Three prior infections conferred 74% (P < .001) protection against subsequent infection in sites not using vaccine. In Peru, incidence of rotavirus disease was relatively higher during the second year of life despite high vaccination coverage.
Conclusions:
Rotavirus infection and disease were common, but with significant heterogeneity by site. Protection by vaccination may not be sustained in the second year of life in settings with high burdens of transmission and poor response to oral vaccines.
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