Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa.
Vaccine. 2012 Apr 27;30 Suppl 1:A173-8. doi: 10.1016/j.vaccine.2011.08.004.
Diarrhoea remains an important cause of death in children under five years of age, including in areas with high prevalence of HIV infection. Rotavirus contributes significantly to childhood diarrhoea in South Africa but data on the burden of rotavirus disease in HIV-infected children are limited.
This secondary data analysis, involving a cohort of 39,879 children enrolled into a pneumococcal conjugate vaccine efficacy trial, evaluated the incidence of hospitalisation for acute gastroenteritis in HIV-infected and HIV-uninfected children under five years of age from Soweto, South Africa. The data were used to evaluate the potential burden of hospitalisation that would be preventable with rotavirus vaccine.
Acute gastroenteritis (AGE) was identified as a leading cause of hospitalisation in the cohort and was associated with 21% of all hospitalisations. Twenty-six percent of the AGE hospitalisations occurred in HIV-infected children. The incidence of AGE was greatest in the under-6 months age group and 90% of cases occurred within the first two years of life. The overall incidence of AGE was 5.4 fold (CI(95%) 4.9, 6.0) higher in HIV-infected compared to HIV-uninfected children. In addition, the estimates of rotavirus incidence were 2.3 fold (CI(95%) 1.8, 2.9) higher in HIV-infected compared to HIV-uninfected children. HIV-infected children were 1.8 fold (CI(95%) 1.4, 2.4) more likely to have prolonged hospitalisation and the case fatality rate was 4.0 (CI(95%) 2.0, 7.8) fold higher in HIV-infected compared to HIV-uninfected children.
Despite rotavirus reportedly being less frequently identified in hospitalised HIV-infected children, the absolute burden of rotavirus-associated hospitalisation is likely to be greater compared to HIV-uninfected children. The introduction of rotavirus vaccine into the national immunisation program in South Africa is likely to benefit HIV-infected and HIV-uninfected children and reduce the overall burden of AGE hospitalisation in our childhood population.
腹泻仍然是五岁以下儿童死亡的一个重要原因，包括在艾滋病毒感染高发地区。轮状病毒是南非儿童腹泻的重要原因，但艾滋病毒感染儿童的轮状病毒疾病负担数据有限。
本二次数据分析涉及一项纳入 39879 名儿童的肺炎球菌结合疫苗功效试验队列，评估了南非索韦托五岁以下艾滋病毒感染和未感染儿童因急性胃肠炎住院的发病率。该数据用于评估轮状病毒疫苗可预防的住院治疗的潜在负担。
急性胃肠炎（AGE）被确定为该队列住院的主要原因，与所有住院的 21%有关。26%的 AGE 住院发生在艾滋病毒感染儿童中。AGE 的发病率在 6 个月以下年龄组最高，90%的病例发生在生命的头两年内。与未感染 HIV 的儿童相比，感染 HIV 的儿童 AGE 的总发病率高 5.4 倍（95%CI(95%) 4.9, 6.0）。此外，与未感染 HIV 的儿童相比，感染 HIV 的儿童的轮状病毒发病率估计高 2.3 倍（95%CI(95%) 1.8, 2.9）。感染 HIV 的儿童住院时间延长的可能性高 1.8 倍（95%CI(95%) 1.4, 2.4），感染 HIV 的儿童的病死率是未感染 HIV 的儿童的 4.0 倍（95%CI(95%) 2.0, 7.8）。
尽管据报道在住院感染 HIV 的儿童中较少发现轮状病毒，但与未感染 HIV 的儿童相比，轮状病毒相关住院的绝对负担可能更大。轮状病毒疫苗在南非被纳入国家免疫规划，可能使 HIV 感染和未感染的儿童受益，并降低我们儿童人群中急性胃肠炎住院的总体负担。
