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Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005

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Date
2008
Author
Amador, Juan José
Vicari, Andrea
Turcios-Ruiz, Reina M
Melendez D., Ana Christian
Malek, Mark
Michel, Fabiana
Aldighieri, Sylvain
Kerin, Tara
Bresee, Joseph S
Glass, Roger I
Andrus, Jon K
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Abstract
OBJECTIVES: We investigated a nationwide outbreak of severe rotavirus gastroenteritis in Nicaragua in children under 5 years old, leading to many consultations, hospitalizations, and deaths. We questioned whether a vaccine might have prevented these illnesses and deaths, sought to identify risk factors for death, and developed a clinical profile of children hospitalized with diarrhea. METHODS: We conducted a case-control study to determine whether children who died had access to routine immunizations, a proxy predicting access to a rotavirus vaccine. We identified risk factors for death among children who died in the outbreak compared with surviving age-matched controls with diarrhea. We collected stools, clinical data, and immunization data on children hospitalized for diarrhea to test for rotavirus, develop the profile, and forecast future access to a rotavirus vaccine. RESULTS: The outbreak from February to April 2005 caused 47 470 consultations and 52 deaths. Approximately 80 percent of cases and controls and 60 percent of children hospitalized with diarrhea had access to routine immunizations and would likely have had access to a rotavirus vaccine. With a vaccine efficacy of 85 percent, up to 51 percent of severe rotavirus cases and up to 68 percent of deaths could have been prevented if a rotavirus vaccine were available as part of routine child-hood immunizations. Study of 35 case-control pairs indicated that severe illnesses, malnutrition, and care by traditional healers were risk factors for death. Rotavirus was found in 42 percent of samples from hospitalized children and was associated with severe disease and dehydration. CONCLUSIONS: The impact of the seasonal outbreaks of rotavirus disease could be diminished with a rotavirus vaccine, improvements in oral rehydration programs, and training of traditional healers in the proper management of children with acute diarrhea.(AU)
 
OBJETIVOS: Se investigó un brote nacional de gastroenteritis grave por rotavirus en niños menores de 5 años de edad que provocó numerosas consultas, hospitalizaciones y muertes en Nicaragua. Se analizó si la vacunación habría evitado estos casos de enfermedad y fallecimiento, se buscaron factores de riesgo de muerte y se elaboró un perfil clínico de los niños hospitalizados con diarrea. MÉTODOS: Se realizó un estudio de casos y controles para determinar si los niños que murieron tuvieron acceso a programas de vacunación, como medida indirecta del acceso a la vacuna contra rotavirus. Se identificaron los factores de riesgo de muerte en los niños que fallecieron durante el brote en comparación con los controles con diarrea sobrevivientes, emparejados según la edad. Se tomaron muestras de heces fecales, datos clínicos y de vacunación de los niños hospitalizados con diarrea para realizar el diagnóstico de rotavirus, elaborar el perfil clínico y pronosticar el acceso futuro a una vacuna contra rotavirus. RESULTADOS: El brote ocurrido entre febrero y abril de 2005 ocasionó 47 470 consultas y 52 muertes. Aproximadamente 80 por ciento de los casos y controles y 60 por ciento de los niños hospitalizados con diarrea tuvieron acceso a la vacunación programada y posiblemente tuvieron acceso a una vacuna contra rotavirus. Si en los programas de vacunación se hubiera dispuesto de una vacuna de 85 por ciento de eficacia, se hubieran prevenido hasta 51 por ciento de los casos graves de rotavirus y hasta 68 por ciento de las muertes. El estudio de 35 pares de casos y controles demostró que la enfermedad grave, la desnutrición y la atención por curanderos tradicionales fueron los factores de riesgo de muerte. Se encontró rotavirus en 42 por ciento de las muestras de niños hospitalizados, asociado con la enfermedad grave y la deshidratación. CONCLUSIONES: El efecto de los brotes estacionales de la enfermedad por rotavirus podría reducirse mediante la vacunación...(AU)
 
Series
Rev Panam Salud Publica;23(4),abr. 2008
Subject
Rotavirus; Gastroenteritis; Epidemiology; Rotavirus vaccines; Nicaragua; Rotavirus; Gastroenteritis; Epidemiología; Vacunas contra Rotavirus; Nicaragua; Surtos de Doenças; Gastroenterite; Gastroenterite; Infecções por Rotavirus; Estudos de Casos e Controles; Gastroenterite; Nicarágua; Infecções por Rotavirus
URI
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000400008
https://iris.paho.org/handle/10665.2/9990
Citation
Amador, Juan José,Vicari, Andrea,Turcios-Ruiz, Reina M,Melendez D., Ana Christian,Malek, Mark,Michel, Fabiana,Aldighieri, Sylvain,Kerin, Tara,Bresee, Joseph S,Glass, Roger I,Andrus, Jon K (2008) Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005. Rev Panam Salud Publica;23(4) 277-284,abr. 2008. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892008000400008
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