Department of Medicine, Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Clin Infect Dis. 2023 Apr 19;76(76 Suppl1):S49-S57. doi: 10.1093/cid/ciac948.
Studies conducted before rotavirus vaccine introduction found that moderate-to-severe diarrhea (MSD) in children aged <5 years was associated with stunting at follow-up. It is unknown whether the reduction in rotavirus-associated MSD following vaccine introduction decreased the risk of stunting.
The Global Enteric Multicenter Study (GEMS) and the Vaccine Impact on Diarrhea in Africa (VIDA) study, two comparable matched case-control studies, were conducted during 2007-2011 and 2015-2018, respectively. We analyzed data from 3 African sites where rotavirus vaccine was introduced after GEMS and before starting VIDA. Children with acute MSD (<7 days onset) were enrolled from a health center and children without MSD (diarrhea-free for ≥7 days) were enrolled at home within 14 days of the index MSD case. The odds of being stunted at a follow-up visit 2-3 months after enrollment for an episode of MSD was compared between GEMS and VIDA using mixed-effects logistic regression models controlling for age, sex, study site, and socioeconomic status.
We analyzed data from 8808 children from GEMS and 10 579 from VIDA. Among those who were not stunted at enrollment in GEMS, 8.6% with MSD and 6.4% without MSD became stunted during the follow-up period. In VIDA, 8.0% with MSD and 5.5% children without MSD developed stunting. An episode of MSD was associated with higher odds of being stunted at follow-up compared with children without MSD in both studies (adjusted odds ratio [aOR], 1.31; 95% confidence interval [CI]: 1.04-1.64 in GEMS and aOR, 1.30; 95% CI: 1.04-1.61 in VIDA). However, the magnitude of association was not significantly different between GEMS and VIDA (P = .965).
The association of MSD with subsequent stunting among children aged <5 years in sub-Saharan Africa did not change after rotavirus vaccine introduction. Focused strategies are needed for prevention of specific diarrheal pathogens that cause childhood stunting.
在轮状病毒疫苗问世之前进行的研究发现，5 岁以下儿童中出现中度至重度腹泻（MSD）与随访时的发育迟缓有关。目前尚不清楚轮状病毒相关 MSD 发病率的降低是否会降低发育迟缓的风险。
全球肠道感染性疾病监测网络（GEMS）和疫苗对非洲腹泻影响（VIDA）研究是两项在 2007-2011 年和 2015-2018 年期间进行的具有可比性的病例对照研究。我们对 GEMS 之后和 VIDA 开始之前在三个非洲地点引入轮状病毒疫苗的研究数据进行了分析。在卫生中心招募急性 MSD（发病<7 天）的患儿，在索引 MSD 病例发生后 14 天内在家中招募无 MSD（腹泻缓解≥7 天）的患儿。采用混合效应逻辑回归模型，控制年龄、性别、研究地点和社会经济地位，比较 GEMS 和 VIDA 中与 MSD 发作相关的随访时发生发育迟缓的可能性。
我们对 GEMS 的 8808 名儿童和 VIDA 的 10579 名儿童的数据进行了分析。在 GEMS 中，在未发生 MSD 时未出现发育迟缓的儿童中，8.6%的 MSD 患儿和 6.4%的无 MSD 患儿在随访期间出现发育迟缓。在 VIDA 中，8.0%的 MSD 患儿和 5.5%的无 MSD 患儿出现发育迟缓。与无 MSD 患儿相比，在两项研究中，MSD 发作与随访时发育迟缓的几率更高（GEMS 的调整比值比 [aOR]，1.31；95%置信区间 [CI]：1.04-1.64；VIDA 的 aOR，1.30；95% CI：1.04-1.61）。但是，GEMS 和 VIDA 之间的关联程度没有显著差异（P=.965）。
在撒哈拉以南非洲地区，5 岁以下儿童 MSD 与后续发育迟缓之间的关联在轮状病毒疫苗问世后并未改变。需要采取有针对性的策略来预防引起儿童发育迟缓的特定腹泻病原体。
