Universidad Peruana Cayetano Heredia

Enteropathogen Changes After Rotavirus Vaccine Scale-up.

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dc.contributor.author Ballard, Sarah-Blythe
dc.contributor.author Requena, David
dc.contributor.author Mayta, Holger
dc.contributor.author Sanchez, Gerardo J.
dc.contributor.author Oyola-Lozada, Maria G.
dc.contributor.author Colquechagua Aliaga, Fabiola D.
dc.contributor.author Cabrera, Lilia
dc.contributor.author Vittet Mondonedo, Macarena D.
dc.contributor.author Taquiri, Carmen
dc.contributor.author Tilley, Capt Drake H.
dc.contributor.author Simons, Cdr Mark P.
dc.contributor.author Meza, Rina A.
dc.contributor.author Bern, Caryn
dc.contributor.author Saito, Mayuko
dc.contributor.author Figueroa-Quintanilla, Dante A.
dc.contributor.author Gilman, Robert Hugh
dc.date.accessioned 2022-02-01T21:18:25Z
dc.date.available 2022-02-01T21:18:25Z
dc.date.issued 2022
dc.identifier.uri https://hdl.handle.net/20.500.12866/11262
dc.description.abstract OBJECTIVES: To inform next steps in pediatric diarrhea burden reduction by understanding the shifting enteropathogen landscape after rotavirus vaccine implementation. METHODS: We conducted a case-control study of 1788 medically attended children younger than 5 years, with and without gastroenteritis, after universal rotavirus vaccine implementation in Peru. We tested case and control stools for 5 viruses, 19 bacteria, and parasites; calculated coinfection-adjusted attributable fractions (AFs) to determine pathogen-specific burdens; and evaluated pathogen-specific gastroenteritis severity using Clark and Vesikari scales. RESULTS: Six pathogens were independently positively associated with gastroenteritis: norovirus genogroup II (GII) (AF 29.1, 95% confidence interval [CI]: 28.0-32.3), rotavirus (AF 8.9, 95% CI: 6.8-9.7), sapovirus (AF 6.3, 95% CI: 4.3-7.4), astrovirus (AF 2.8, 95% CI: 0.0-4.0); enterotoxigenic Escherichia coli heat stable and/or heat labile and heat stable (AF 2.4, 95% CI: 0.6-3.1), and Shigella spp. (AF 2.0, 95% CI: 0.4-2.2). Among typeable rotavirus cases, we most frequently identified partially heterotypic strain G12P[8] (54 of 81, 67%). Mean severity was significantly higher for norovirus GII-positive cases relative to norovirus GII-negative cases (Vesikari [12.7 vs 11.8; P < .001] and Clark [11.7 vs 11.4; P = .016]), and cases in the 6- to 12-month age range relative to cases in other age groups (Vesikari [12.7 vs 12.0; P = .0002] and Clark [12.0 vs 11.4; P = .0016]). CONCLUSIONS: Norovirus is well recognized as the leading cause of pediatric gastroenteritis in settings with universal rotavirus vaccination. However, sapovirus is often overlooked. Both norovirus and sapovirus contribute significantly to the severe pediatric disease burden in this setting. Decision-makers should consider multivalent vaccine acquisition strategies to target multiple caliciviruses in similar countries after successful rotavirus vaccine implementation en_US
dc.language.iso eng
dc.publisher American Academy of Pediatrics
dc.relation.ispartofseries Pediatrics
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject diarrhea en_US
dc.subject gastroenteritis en_US
dc.subject norovirus en_US
dc.subject pathogenic organism en_US
dc.subject rotavirus en_US
dc.subject rotavirus vaccines en_US
dc.subject sapovirus en_US
dc.subject peru en_US
dc.subject atrial fibrillation en_US
dc.subject parasites en_US
dc.title Enteropathogen Changes After Rotavirus Vaccine Scale-up. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1542/peds.2020-049884
dc.relation.issn 1098-4275


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