莫桑比克南部农村地区（艾滋病毒高发地区），疫苗引入前幼儿轮状病毒疾病负担。
Rotavirus disease burden pre-vaccine introduction in young children in Rural Southern Mozambique, an area of high HIV prevalence.
机构信息
Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
出版信息
PLoS One. 2021 Apr 8;16(4):e0249714. doi: 10.1371/journal.pone.0249714. eCollection 2021.
BACKGROUND
Rotavirus vaccines have been adopted in African countries since 2009, including Mozambique (2015). Disease burden data are needed to evaluate the impact of rotavirus vaccine. We report the burden of rotavirus-associated diarrhea in Mozambique from the Global Enteric Multicenter Study (GEMS) before vaccine introduction.
METHODS
A case-control study (GEMS), was conducted in Manhiça district, recruiting children aged 0-59 months with moderate-to-severe diarrhea (MSD) and less-severe-diarrhea (LSD) between December 2007 and November 2012; including 1-3 matched (age, sex and neighborhood) healthy community controls. Clinical and epidemiological data and stool samples (for laboratory investigation) were collected. Association of rotavirus with MSD or LSD was determined by conditional logistic regression and adjusted attributable fractions (AF) calculated, and risk factors for rotavirus diarrhea assessed.
RESULTS
Overall 915 cases and 1,977 controls for MSD, and 431 cases and 430 controls for LSD were enrolled. Rotavirus positivity was 44% (217/495) for cases and 15% (160/1046) of controls, with AF = 34.9% (95% CI: 32.85-37.06) and adjusted Odds Ratio (aOR) of 6.4 p< 0.0001 in infants with MSD compared to 30% (46/155) in cases and 14% (22/154) in controls yielding AF = 18.7%, (95% CI: 12.02-25.39) and aOR = 2.8, p = 0.0011 in infants with LSD. The proportion of children with rotavirus was 32% (21/66) among HIV-positive children and 23% (128/566) among HIV-negative ones for MSD. Presence of animals in the compound (OR = 1.9; p = 0.0151) and giving stored water to the child (OR = 2.0, p = 0.0483) were risk factors for MSD; while animals in the compound (OR = 2.37, p = 0.007); not having routine access to water on a daily basis (OR = 1.53, p = 0.015) and washing hands before cooking (OR = 1.76, p = 0.0197) were risk factors for LSD.
CONCLUSION
The implementation of vaccination against rotavirus may likely result in a significant reduction of rotavirus-associated diarrhea, suggesting the need for monitoring of vaccine impact.
背景
自 2009 年以来，非洲国家已采用轮状病毒疫苗，包括莫桑比克（2015 年）。需要疾病负担数据来评估轮状病毒疫苗的影响。我们报告了在引入疫苗之前，全球肠道多中心研究（GEMS）在莫桑比克的轮状病毒相关腹泻负担。
方法
一项病例对照研究（GEMS）于 2007 年 12 月至 2012 年 11 月在马希奇区进行，招募了 0-59 个月龄的中度至重度腹泻（MSD）和轻度腹泻（LSD）儿童，包括 1-3 名年龄、性别和邻里相匹配的健康社区对照。收集临床和流行病学数据以及粪便样本（用于实验室检查）。通过条件逻辑回归确定轮状病毒与 MSD 或 LSD 的相关性，并计算调整归因分数（AF），评估轮状病毒腹泻的危险因素。
结果
共纳入 MSD 病例 915 例和对照 1977 例，LSD 病例 431 例和对照 430 例。病例中轮状病毒阳性率为 44%（217/495），对照中为 15%（160/1046），AF=34.9%（95%CI：32.85-37.06），MSD 婴儿的调整比值比（aOR）为 6.4，p<0.0001，而 LSD 婴儿中为 30%（46/155），14%（22/154），AF=18.7%（95%CI：12.02-25.39），aOR=2.8，p=0.0011。HIV 阳性儿童中轮状病毒的比例为 32%（21/66），HIV 阴性儿童中为 23%（128/566）。住所内有动物（OR=1.9；p=0.0151）和给孩子喝储存水（OR=2.0，p=0.0483）是 MSD 的危险因素；而住所内有动物（OR=2.37，p=0.007）、日常无规律获得水（OR=1.53，p=0.015）和做饭前洗手（OR=1.76，p=0.0197）是 LSD 的危险因素。
结论
实施轮状病毒疫苗接种可能会显著降低轮状病毒相关腹泻的发生率，这表明需要监测疫苗的效果。
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