Systematic review of the rotavirus infection burden in the WHO-EMRO region

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ABSTRACT

Rotavirus gastroenteritis imposes a heavy burden on low- and middle-income countries. The World Health Organization defines the Eastern Mediterranean region (WHO-EMRO) as a diverse area in terms of socioeconomic status and health indicators. Rotavirus vaccination has been introduced, at least partially, in 19 out of the 22 EM countries; however, vaccine coverage remains low, and data on rotavirus disease burden is scarce.

Available data on rotavirus prevalence, seasonality, vaccination status, and genotype evolution was systematically compiled following a literature review that identified 165 relevant WHO-EMRO epidemiology studies published between 1990 and 2017.

Although the infectious agents responsible for acute gastroenteritis vary over time, rotavirus remained the leading cause of acute gastroenteritis in children, as seen in 76.3% of reviewed publications. Younger children (<2 years old) were at higher risk and thus increased vaccination coverage and surveillance systems are required to reduce the rotavirus gastroenteritis burden in WHO-EMRO countries.

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Global Illness and Deaths Caused by Rotavirus Disease in Children

Umesh D Parashar, Erik Hummelman, Joseph Bresee … (2003)

To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 60 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, to prevent childhood deaths in developing nations.

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2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis.

Jacqueline E. Tate, Anthony Burton, Cynthia Boschi-Pinto … (2012)

WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection. We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates. Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453,000 deaths (95% CI 420,000-494,000) in children younger than 5 years-37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98,621 deaths). Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Global mortality associated with rotavirus disease among children in 2004.

John Glass, Duncan Steele, Kenji Shibuya … (2009)

As new rotavirus vaccines are being introduced in immunization programs, global and national estimates of disease burden, especially rotavirus-associated mortality, are needed to assess the potential health benefits of vaccination and to monitor vaccine impact. We identified 76 studies that were initiated after 1990, lasted at least 1 full year, and examined rotavirus among >100 children hospitalized with diarrhea. The studies were assigned to 5 groups (A-E) with use of World Health Organization classification of countries by child mortality and geography. For each group, the mean rotavirus detection rate was multiplied by diarrhea-related mortality figures from 2004 for countries in that group to yield estimates of rotavirus-associated mortality. Overall, rotavirus accounted for 527,000 deaths (95% confidence interval, 475,000-580,000 deaths) annually or 29% of all deaths due to diarrhea among children <5 years of age. Twenty-three percent of deaths due to rotavirus disease occurred in India, and 6 countries (India, Nigeria, Congo, Ethiopia, China, and Pakistan) accounted for more than one-half of deaths due to rotavirus disease. The high mortality associated with rotavirus disease underscores the need for targeted interventions, such as vaccines. To realize the full life-saving potential of vaccines, it will be vital to ensure that they reach children in countries with high mortality. These baseline figures will allow future assessment of vaccine impact on rotavirus-associated mortality.

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Author and article information

Journal

Journal ID (nlm-ta): Hum Vaccin Immunother

Journal ID (iso-abbrev): Hum Vaccin Immunother

Journal ID (publisher-id): KHVI

Journal ID (publisher-id): khvi20

Title: Human Vaccines & Immunotherapeutics

Publisher: Taylor & Francis

ISSN (Print): 2164-5515

ISSN (Electronic): 2164-554X

Publication date Collection: 2019

Publication date (Electronic): 17 May 2019

Publication date PMC-release: 17 May 2019

Volume: 15

Issue: 11

Pages: 2754-2768

Affiliations

[a ]MENA, Medical & Clinical Emerging Markets, GSK , Istanbul, Turkey

[b ]Global Medical Affairs Rota/MMRV, GSK , Wavre, Belgium

[c ]EM Central Vaccines Medical/Clinical, GSK , Cairo, Egypt

[d ]EM Central Vaccines Medical/Clinical, GSK , Jeddah, Saudi Arabia

[e ]EM Central Vaccines Medical/Clinical, GSK , Casablanca, Morocco

[f ]EM Central Vaccines Medical/Clinical, GSK , Dubai, United Arab Emirates

[g ]EM Central Vaccines Medical/Clinical, GSK , Karachi, Pakistan

[h ]Epidemiology/Health Economics EM, GSK , Wavre, Belgium

Author notes

CONTACT Selim Badur selim.x.badur@ 123456gsk.com GSK , Levent Plaza No:1 D:173 B Blok Istanbul 34394, Turkey

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Priya Pereira http://orcid.org/0000-0001-7344-310X

Article

Publisher ID: 1603984

DOI: 10.1080/21645515.2019.1603984

PMC ID: 6930073

PubMed ID: 30964372

SO-VID: 4e9e9dd6-769d-4236-a310-a389792d8dbb

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This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 11 December 2018

Date revision received : 21 March 2019

Date accepted : 2 April 2019

Page count

Figures: 3, Tables: 4, References: 185, Pages: 15

Funding

Funded by: GlaxoSmithKline 10.13039/100004330

Award ID: NA

GlaxoSmithKline Biologicals SA funded this study and all costs associated with the development and the publishing of related publications.

Systematic review of the rotavirus infection burden in the WHO-EMRO region

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REPO4EU WP2 Systematic Reviews

Most cited references 175

Global Illness and Deaths Caused by Rotavirus Disease in Children

2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis.

Global mortality associated with rotavirus disease among children in 2004.

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