Prevalence of rotavirus infection among children with acute diarrhoea after rotavirus Vaccine introduction in Kenya

Abstract

Background Rotavirus is the commonest cause of severe and fatal diarrhoea among young children in the world with mortality occurring more in Sub-Saharan Africa and Southern Asia. Majority of these deaths are due to severe dehydration which is often not treated adequately due to the unavailability of timely and optimal medical care. The prevalence rates in Kenya are reported to be ranging from 30-40% among hospitalized children in the pre-vaccination era. Rotavirus vaccine is considered the most successful public health strategy in preventing infection and mitigating the severity of gastroenteritis. Rotavirus vaccination was introduced in Kenya in 2014. There has not been a study post introduction of the rotavirus vaccine in Kenyatta national hospital to determine whether there is any change in the profile of children being treated with acute diarrhea. Objectives The primary aim of the study was to determine the prevalence of rotavirus infection among children aged 3-24 months presenting with acute diarrhoea at Kenyatta National Hospital after introduction of the rotavirus vaccine. The secondary objectives was to determine the severity of the rotavirus associated diarrhoea using the Vesikari Clinical Severity Scoring System and to determine the rotavirus vaccination status among the children. Methods This was a short hospital-based longitudinal study at Kenyatta National Hospital among children aged 3-24 months presenting with acute diarrhea. The patients who met the inclusion criteria were enrolled sequentially. We acquired information on rotavirus vaccination status, nutritional status (z-scores), feeding practices, sociodemographic characteristics such as age, gender and caretaker characteristics such as age, level of education and relationship with the child and entered into a pre- structured questionnaire followed by a full clinical evaluation. The gastroenteritis severity was assessed using the 20 point Vesikari Clinical Severity Scoring System. The children who were admitted were followed up for 7 days using hospital ward registers. Comorbid conditions were established from patient’s physical examination and medical records. Stool specimen from study participants was tested for rotavirus using enzyme linked immunosorbent immunoassay (ELISA). The data collected was entered and managed in Excel while data analysis was done with STATA version 13 software package and presented in figures and tables as applicable. Results Three hundred and sixty five children aged 3-24 months presenting with acute diarrhoea were recruited. Rotavirus was positive in 53/365 children, giving a prevalence of 14.5% (95% CI 11.1 -18.6). Of the 53 children who tested rotavirus positive, 28.3% (n=15) had severe rotavirus associated diarrhea, scored using the Vesikari Clinical Severity Scoring System, 32.0% (n=17) had moderate rotavirus associated diarrhoea and 39.6% (n=21) had mild rotavirus associated diarrhea. Three hundred and fifty six children (97.5%) were fully vaccinated against rotavirus, with only 9 (2.5%) receiving partial or no vaccination. Conclusion The prevalence of rotavirus infection among children with acute diarrhea at Kenyatta National Hospital is 14.5%. Twenty-eight percent of the children who tested rotavirus positive had severe rotavirus associated diarrhea as scored by the Vesikari Clinical Severity Scoring scale. The rotavirus vaccination status among the children was 97.5%, having received 2 doses of rotarix vaccine. Recommendation Advocacy on use of the Rotavirus vaccine should continue due to the observed reduction in the prevalence of rotavirus associated diarrhea.