Impact of rotavirus vaccine on acute gastroenteritis in children under 5 years in Senegal: Experience of sentinel site of the Albert Royer Children's Hospital in Dakar

BackgroundAcute gastroenteritis (AGE) is a leading cause of morbidity and mortality among children <5 years of age in developing countries, with rotavirus being the most common infectious etiology. In November 2014, monovalent rotavirus vaccine was introduced in Senegal. We determined the impact of rotavirus vaccine on hospitalizations for all-cause and rotavirus related AGE in children <60 months of age.MethodsWe examined two data sources from the national referral hospital. Using sentinel surveillance data from March 2011 to February 2017, we examined the proportion of AGE hospitalizations among children <60 months of age attributable to rotavirus, stratified by age groups (0–11, 12–23 and 24–59 months). Using pediatric logbook data from March 2010 to February 2017, we examined the proportion of all childhood hospitalizations attributable to AGE, among the same age groups.ResultsIn sentinel surveillance, 673 patients <60 months were hospitalized for AGE, with 30% (203/673) due to rotavirus. In pre-vaccine years, the median proportion of rotavirus-positive hospitalizations was 42%; this proportion declined by 76% to 10% rotavirus positive in 2015–2016 (p < .001) and by 59% to 17% in 2016–2017 (p < .001). From the logbook data, among all children <60 months, a median of 11% of all hospitalizations in the pre-vaccine period were due to AGE, with 2015–2016 seeing a 16% decline (p < .001), to 9% of all hospitalizations, and 2016–2017 seeing a 39% decline (p < .001), to 7% of all hospitalizations. Declines in both rotavirus-associated and all-cause AGE hospitalizations were most marked among infants, with a suggestion of herd effect among older children seen in the surveillance data.ConclusionRotavirus vaccine demonstrated a significant impact on rotavirus-associated hospitalizations and all-cause AGE hospitalizations in the first two seasons after vaccine introduction in Senegal. Our data support the continued use of this vaccine in national immunization program.     

Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012–2016

IntroductionRotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction.MethodsWe conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2 years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described.ResultsOverall 153 cases of intussusception among children <2 years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2 years of age. One hundred twelve cases (73%) were male; the median age was 7 months; and the median duration of hospitalization was 7 days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died.ConclusionsConfirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.     

Distribution of rotavirus genotypes in Dhaka,Bangladesh, 2012–2016: Re-emergence of G3P[8] after over a decade of interval

Group A rotavirus causes a substantial proportion of diarrhoea related deaths worldwide among children under five years. We analyzed rotavirus prevalence and genotypes distribution among patients admitted with diarrhoea at icddr,b hospital in Dhaka during 2012–16. Stool specimens (n = 1110) were collected from diarrhoea patients and tested for RVA antigen using enzyme immunoassay. Rotavirus positive samples were G (VP7) and P (VP4) genotyped by RT-PCR and sanger sequencing. Data on clinical manifestations were collected from icddr,b hospital surveillance system. A total of 351 (32%) patients were positive for rotavirus antigen, about half of those were children under two years old. During the study period, G1P[8] (27%) was the most prevalent strain, followed by G12P[8] (15%) and G9[P4] (9%). Mixed G or P genotypes were identified in a substantial proportion (23%) with few strains of rare combinations such as G1P[4], G1P[6], G2P[6], G2P[8], G9P[6]. The genotypic fluctuation was noteworthy; G12P[8] was the major strain in 2012–14 but sharply decreased in 2015–16 when G1P[8] became the most common strain. G3P[8] re-emerged (17%) in 2016 after 11 years. Since the Government of Bangladesh has planned to include rotavirus vaccine in national immunization programme from 2018, our data will provide baseline information on rotavirus genotypes in the pre-vaccination era to observe the selection pressure on genotypes in the post vaccination epoch.     

Impact of pentavalent rotavirus vaccine against severe rotavirus diarrhoea in The Gambia

IntroductionRotavirus vaccines protect against the leading cause of severe childhood diarrhoea, and have been introduced in many low-income African countries. The Gambia introducedRotateq® (RV5) into their national immunization program in 2013. We revieweddata from an active rotavirus sentinel surveillancesitefor early evidence of vaccine impact.MethodsWe compared rotavirus prevalence in diarrhoeal stool in children< 5 years of age admittedat the Edward Francis Small Teaching Hospital sentinel surveillance site before (2013) andafterRV5 introduction (2015–2016) in the Gambia. The rotavirus-percent positive was separately compared for all diarrhoealhospitalizations and for hospitalizations with severe symptoms. Rotavirus prevalence was compared annually for the pre-vaccine year of 2013 with post-vaccine years of 2015 and 2016 using chi-square or Fisher’s exact tests and the p-value to establish significant relationship was set at p < 0.05. All analyses were completed in SAS 9.3 (SAS Analytics, North Carolina).ResultsRotavirus prevalence among all diarrhoeahospitalizations decreased from 22% in 2013 to 11% in 2015 (p = 0.04), while remaining unchanged in 2016 (18%, p = 0.56). For hospitalizations that were clinically severe and/or treated with intravenous fluids (mean of 46 per year), the rotavirus prevalence decreased from 33% in 2013 to 8% in 2015 (p = 0.04), and to 15% in 2016 (p = 0.08). The children with age <1 year accounted for 45% the population infected with rotavirus in both pre and post rotavirus vaccination periods.ConclusionsRotavirus vaccine introduction in the Gambia could be among factors resulting in decreased diarrhea hospitalizations among children at the Edward Francis Small Teaching Hospital, particularly those with severe disease. These results support the continuation of rotavirus vaccine and additional monitoring of rotavirus hospitalization trends in the country.     

维生素K_1联合门冬氨酸洛美沙星注射液治疗急性胃肠炎临床效果分析

目的:观察维生素K1联合门冬氨酸洛美沙星注射液治疗急性胃肠炎的临床疗效。方法:选择2012年8月—2013年10月收治的急性胃肠炎患者96例,随机分为治疗组和对照组,每组48例,其中对照组给予门冬氨酸洛美沙星注射液0.4 g加入5%葡萄糖注射液250 mL中静脉滴注,每日1次;治疗组给予维生素K180 mg联合门冬氨酸洛美沙星注射液0.4 g加入5%葡萄糖注射液250 mL中静脉滴注,每日1次,两组均为3 d一个疗程。结果:治疗组显效43例,有效3例,无效2例,显效率89.6%,总有效率95.8%;对照组显效34例,有效5例,无效9例,显效率为70.8%,总有效率81.2%,两组间比较差异有统计学意义(P<0.05)。结论:维生素K1联合门冬氨酸洛美沙星注射液治疗急性胃肠炎临床效果显著,进一步研究需大样本的临床观察。     

婴幼儿腹泻病原菌分布特点及药敏分析

目的：研究青岛市2013年儿童感染性腹泻的病原菌的分布、流行病学特征及对抗菌药物的敏感情况,为临床预防以及合理用药提供参考依据。方法对2013年1月~2013年12月临床初步诊断为感染性腹泻患儿的新鲜粪便标本进行细菌分离培养和血清分型鉴定,采用纸片扩散法进行药敏试验,并以免疫层析双抗体夹心法定性检测A群轮状病毒抗原。结果526份粪便培养共检出病原菌6种80株,检出率为15.2%（80/526）。检出沙门菌38株（47.5%）,志贺菌8株（10.0%）,致泻性大肠杆菌8株（10.0%）,金黄色葡萄球菌4株（5.0%）,铜绿假单胞菌19株（23.7%）,白假丝酵母菌3株（3.75%）。8株志贺菌7株为福氏志贺菌,1株鲍氏志贺菌。沙门菌和志贺菌的耐药率分别为氨苄西林（68.7%、76.9%）、复方新诺明（21.1%、38.5%）、环丙沙星（15.8%、15.4%）、头孢曲松（6.25%、15.3%）。526份标本中A群轮状病毒阳性107份。结论2013年青岛市儿童细菌性腹泻的病原菌以沙门菌为主,易感人群以2岁以下婴幼儿为主;而金黄色葡萄球菌感染以1岁以下婴儿为主;铜绿假单胞菌和白假丝酵母菌引起的腹泻主要是由于长期应用广谱抗生素使肠道菌群失调所导致;A群轮状病毒是引起婴幼儿秋冬季腹泻的主要病原。应规范临床用药,加强细菌耐药监测。     

消旋卡多曲联合蒙脱石散治疗儿童轮状病毒性肠炎的疗效研究

目的：探讨消旋卡多曲联合蒙脱石散治疗儿童轮状病毒性肠炎的临床疗效。方法选取我院2013年2月—2014年2月收治的78例轮状病毒性肠炎患儿,随机分为对照组和观察组,各39例。对照组给予蒙脱石散治疗,观察组给予消旋卡多曲联合蒙脱石散治疗。比较两组患儿治疗总有效率,止吐、止泻、退热时间及住院时间和不良反应发生率。结果观察组患儿总有效率为94.9%（37/39）,高于对照组的82.1%（32/39）,差异有统计学意义（P〈0.05）;观察组患儿止吐、止泻、退热及住院时间均短于对照组（P〈0.05）。两组患儿均未发生严重的不良反应。结论消旋卡多曲联合蒙脱石散治疗儿童轮状病毒性肠炎疗效确切,不良反应小。     

秋泻灵颗粒与蒙脱石散联合治疗轮状病毒肠炎的效果观察

目的探讨秋泻灵颗粒与蒙脱石散口服治疗轮状病毒肠炎的效果。方法抽取本院2010年9月1日~12月31日、2011年9月1日~12月31日、2012年9月1日~12月31日住院治疗的小儿轮状病毒肠炎患儿100例,分为治疗组和对照组各50例,对照组给予蒙脱石散口服,利巴韦林抗病毒,补液、纠酸、调节肠道菌群等治疗,治疗组在对照组治疗基础上加用秋泻灵颗粒口服,治疗期间观察患儿的发热、呕吐、大便次数及性状,比较两组的临床疗效。结果两组均未出现不良反应,治疗组主要症状、体征消失时间较对照组短,差异有统计学意义(P<0.01);治疗组与对照组的总有效率分别为90%、60%,两组差异有统计学意义(χ2=12.0,P<0.01)。结论秋泻灵颗粒联合蒙脱石散口服治疗轮状病毒肠炎的止泻疗效确切,较单独用蒙脱石散口服止泻治疗能快速减轻临床症状,缩短病程,提高治愈率,有利于患儿生长发育。     

飞扬肠胃炎片联合左氧氟沙星治疗急慢性胃肠炎的效果观察

目的探讨飞扬肠胃炎片联合左氧氟沙星治疗急慢性胃肠炎的效果。方法选取本院2012年1~12月收治的急慢性胃肠炎患者100例,随机分为对照组和观察组,每组50例,对照组采用常规对症支持加左氧氟沙星治疗,观察组在对照组基础上,采用飞扬肠胃炎片治疗,比较两组疗效、相关症状及体征积分、生活质量评分。结果对照组总有效率为88.0%,观察组总有效率为98.0%,差异有统计学意义(P<0.05)。观察组治疗后症状及体征积分明显低于治疗前及对照组,差异有统计学意义(P<0.05)。观察组生理功能、社会功能、生理问题对功能的限制、心理问题对功能的限制、活力、总体健康评价评分明显高于对照组,差异有统计学意义(P<0.05)。结论飞扬肠胃炎片联合左氧氟沙星治疗急慢性胃肠炎效果显著,可明显改善患者的发热、鼻塞、呕吐、腹泻等症状及体征,提高生活质量,不良反应少,值得临床推广。     

High Heterogeneity of Echoviruses in Brazilian Children with Acute Gastroenteritis

Echoviruses (E) are a diverse group of viruses responsible for various pathological conditions in humans including aseptic meningitis, myocarditis, and acute flaccid paralysis. The detection and identification of echovirus genotypes in clinical samples is challenging due to its high genetic diversity. Here, we report the complete genome sequences of nine echoviruses, obtained by next-generation sequencing of 238 fecal samples from individuals with gastroenteritis in regions of Brazil. Detected viruses were classified into six genotypes: Three E1 sequences (BRA/TO-028, BRA/TO-069 and BRA/TO-236), one E3 (BRA/TO-018), one E11 (BRA/TO-086), one E20 (BRA/TO-016), two E29 (BRA/TO-030 and BRA/TO-193), and one E30 sequence (BRA/TO-032). Phylogenetic analysis indicated that the echoviruses E1 and E29 circulating in Brazil are divergent from strains circulating worldwide. The genotype diversity identified in our study may under-represent the total echovirus diversity in Brazil because of the small sample size and the restricted geographical distribution covered by the survey.