Ichihara Maria Yury T, Rodrigues Laura C, Santos Carlos A S T, Teixeira Maria da Glória L C, Barreto Mauricio L
Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela Salvador, CEP 40110-040, Salvador, Bahia, Brazil
London School of Hygiene & Tropical Medicine, London, United Kingdom.
Trans R Soc Trop Med Hyg. 2015 Jul;109(7):454-61. doi: 10.1093/trstmh/trv041. Epub 2015 Jun 4.
Rotavirus has been the leading cause of severe cases of acute diarrhoea (AD) among children worldwide; however, in the same areas, a large reduction in AD related to rotavirus has been observed after the introduction of the rotavirus vaccine. In Brazil, where there is a high rotavirus vaccine coverage, AD caused by pathogens other than rotavirus is still a frequent cause of outpatient visits and hospitalisations among children under 5 years.
A hospital-based case-control study enrolled children aged 4 to 24 months admitted to 10 hospitals from all five Brazilian Regions. Cases (n=1178) were children admitted with diarrhoea who tested negative for rotavirus in a stool sample. Controls (n=2515) were children admitted without diarrhoea, frequency matched to cases by sex and age group. We estimated odds ratios using logistic regression, in a hierarchical approach according to a previously defined conceptual framework. Population-attributable fractions (PAF) were estimated for each variable, each block and for all significant variables in the latter model adjusted.
The factors studied accounted for 41% of the non-rotavirus AD hospital admissions and the main risk factors included lack of adequate excreta disposal (PAF=12%), untreated drinking water (PAF=11%) and a history of previous hospitalization due to AD (PAF=21%). Low socio-economic conditions, no public water supply, crowding and low weight-for-age made smaller contributions.
These findings further our knowledge of risk factors associated with severe AD in the post-rotavirus vaccination era. We recommend further increase in coverage of basic sanitation, improvements in water quality and further expansion of primary healthcare coverage to reduce the occurrence of non-rotavirus severe diarrhoea and subsequent hospitalization of Brazilian children.
轮状病毒一直是全球儿童严重急性腹泻（AD）病例的主要病因；然而，在同一地区，引入轮状病毒疫苗后，与轮状病毒相关的急性腹泻病例大幅减少。在巴西，轮状病毒疫苗接种率很高，由非轮状病毒病原体引起的急性腹泻仍是5岁以下儿童门诊就诊和住院的常见原因。
一项基于医院的病例对照研究纳入了来自巴西所有五个地区10家医院的4至24个月大的儿童。病例组（n = 1178）为因腹泻入院且粪便样本轮状病毒检测呈阴性的儿童。对照组（n = 2515）为未患腹泻入院的儿童，按性别和年龄组与病例组进行频率匹配。我们根据先前定义的概念框架，采用分层方法，通过逻辑回归估计比值比。对每个变量、每个模块以及后一个调整模型中的所有显著变量估计人群归因分数（PAF）。
所研究的因素占非轮状病毒急性腹泻住院病例的41%，主要危险因素包括缺乏适当的排泄物处理（PAF = 12%）、未经处理的饮用水（PAF = 11%）以及既往因急性腹泻住院史（PAF = 21%）。社会经济条件差、无公共供水、拥挤以及年龄别体重低的影响较小。
这些发现增进了我们对轮状病毒疫苗接种后时代与严重急性腹泻相关危险因素的认识。我们建议进一步提高基本卫生设施的覆盖率，改善水质，并进一步扩大初级医疗保健覆盖范围，以减少巴西儿童非轮状病毒严重腹泻的发生及随后的住院情况。
