Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.
Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana.
PLoS One. 2020 Oct 2;15(10):e0240258. doi: 10.1371/journal.pone.0240258. eCollection 2020.
Rotavirus is the most common cause of fatal diarrhoeal disease among children under the age of five globally and is responsible for millions of hospitalizations each year. Although nutritional status and environmental enteric dysfunction (EED) are recognized as important predictors of susceptibility to diarrhoeal disease, no research to date has examined the mechanisms by which undernutrition and EED may protect against prevalence of rotavirus infection.
We utilized data collected from a study evaluating the effectiveness of Rotarix™ vaccine against severe gastroenteritis among children under the age of 5 in Zambia. The prevalence of malnutrition, wasting, and stunting at the time of study enrollment was calculated using WHO child growth standards. Commercial ELISA kits were used to assess levels of faecal biomarkers for EED: alpha-1-antitrypsin and myeloperoxidase, and calprotectin. Separate multivariate logistic regression models were used to examine each measure of nutritional status and rotavirus diarrhoea including and excluding adjustment for EED.
In models that did not include adjustment for EED, malnourished children had 0.66 times the odds of having rotavirus diarrhoea compared to children with normal nutritional status (95% CI: 0.42, 1.0; p = 0.07). EED severity score was significantly higher among controls asymptomatic for diarrhoeal disease compared to cases with rotavirus diarrhoea (p = 0.02).
The morphological changes associated with EED may confer protection against rotavirus infection and subsequent diarrhoeal disease among children. Further research is critically needed to better understand the complex mechanisms by which nutritional status and EED may impact susceptibility to rotavirus in early life.
轮状病毒是全球 5 岁以下儿童致命性腹泻病的最常见病因，每年导致数百万人住院。尽管营养状况和肠黏膜屏障功能障碍（EED）被认为是易患腹泻病的重要预测因素，但迄今为止尚无研究探讨营养不良和 EED 如何预防轮状病毒感染的流行。
我们利用了一项评估 Rotarix™疫苗在赞比亚 5 岁以下儿童中预防严重胃肠炎效果的研究中收集的数据。使用世界卫生组织儿童生长标准计算研究入组时营养不良、消瘦和发育迟缓的患病率。使用商业 ELISA 试剂盒评估粪便 EED 生物标志物的水平：α-1-抗胰蛋白酶和髓过氧化物酶，以及钙卫蛋白。分别使用多变量逻辑回归模型来检查营养状况和轮状病毒腹泻的每个指标，包括和不包括 EED 的调整。
在未调整 EED 的模型中，与营养状况正常的儿童相比，营养不良的儿童患轮状病毒腹泻的几率是其 0.66 倍（95%CI：0.42，1.0；p = 0.07）。与轮状病毒腹泻病例相比，无症状腹泻疾病对照者的 EED 严重程度评分显著更高（p = 0.02）。
与 EED 相关的形态学变化可能为儿童提供针对轮状病毒感染和随后发生的腹泻病的保护。迫切需要进一步研究，以更好地理解营养状况和 EED 如何影响生命早期对轮状病毒易感性的复杂机制。
