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RESEARCHARTICLEOpenAccessEpidemiologyofrotavirusinfectionamongyoungchildrenwithacutediarrhoeainBurkinaFasoIsidoreJOBonkoungou1,2*,IdrissaSanou3,4,FabienneBon5,BenoitBenon6,SheickOCoulibaly2,4,KaisaHaukka7,AlfredSTraoré1,NicolasBarro1AbstractBackground:Inanticipationofvaccineintroduction,weassessedepidemiologyofrotavirusdiseaseamongchildrenvisitingmedicalcentreduetoacutediarrhoeainOuagadougou,BurkinaFaso.
Methods:BetweenNovember2008andFebruary2010,stoolspecimensfrom447childrenlessthan5yearsofagesufferingfromdiarrhoeaweretestedforthepresenceofrotavirusbyantigendetectionusinganimmunochromatographictest.
Sociodemographic,environmentalandclinicalfactorswereassessedduringthestudy.
Results:Rotavirusantigenwasdetectedin151(33.
8%)ofthepatients.
Mostofthecases(94.
2%)wereinchildren<24monthsofage.
Feverandvomitingwerethesymptomsmostcommonlyreportedinassociationwithrotavirusdiarrhoeaandthepatientswereoftenhospitalized.
Rotavirus-associateddiarrhoeaoccurredmostlyduringtheseasonfromDecembertoApril(dryseason).
Rotavirusinfectionwassignificantlylessfrequentinbreast-fedthanamongbottle-fedbabies.
Conclusions:TheresultsofthisstudyunderscoretheneedtocontrolrotavirusinfectionsamongyoungchildreninBurkinaFasoandmayargueadecisionontheintroductionofrotavirusvaccineinBurkinaFaso.
BackgroundRotavirusisamajorcauseofacutegastroenteritisininfantsandyoungchildrenworldwide[1].
Ithasbeenestimatedthatabout39%ofchildhooddiarrhoeahospita-lizationsarecausedbyrotavirusesandnearlyhalfamil-lionchildrendiefromrotavirusinfectionseachyear[2].
Furthermore,rotavirusmortalityisconcentratedinthedevelopingcountriesontheAsiansubcontinent,Africa,andLatinAmericawhereaccesstohealthcarefacilitiesislimited[3].
Thismayresultinasignificantdiseasebur-denandeconomiceffectofdirectmedicalcosts,lossofwork,qualityoflifeandmortality.
Inotherdiarrhoealdiseases,improvementofhygieneandsanitationmayreducetheincidence,butthesemeasuresareunlikelysuf-ficientforrotaviruscontrol.
Vaccinationistheonlycon-trolmeasurelikelytohaveasignificantimpactontheincidenceofseverelydehydratingrotavirusdisease[4].
Twonewlive-attenuatedrotavirusvaccines(RotarixandRotaTeq)havedemonstratedverygoodsafetyandeffi-cacyprofilesinlargeclinicaltrialsintheWesternindus-trializedcountriesandinLatinAmerica[5-9].
Trialsonthesevaccinesarenowinprogressinsub-SaharanAfricatoassesstheireffectivenessandefficacy.
InBurkinaFaso,veryfewdataonillnesscausedbyrotavirushavebeenpublishedandthesestudiesindi-catedthat14%ofacutediarrhoeainchildrenundertheageof5yearsisduetorotavirusinfectionbutepide-miologicaldataarestillincomplete[10].
Theobjectivesofthisstudyweretodescribe,forthefirsttime,epidemiologyofrotavirusdiseaseamongchil-drenvisitingalocalhealthcentrebecauseofacutegas-troenteritisinOuagadougouinBurkinaFasotoprovidebackgroundknowledgeonthediseasebeforevaccineintroductionandtoinformthepolicymakersontheneedfortheintroductionofnewrotavirusvaccines.
MethodsStudypopulationandspecimensThestudywasconductedatCentreMédicalavecAntenneChirugicale(CMA)duSecteur30inthecapital*Correspondence:ouindgueta@gmail.
com1LaboratoiredeBiochimieetBiologieMoléculaire,CRSBAN/UFR-SVT,UniversitédeOuagadougou,03BP7021,Ouagadougou,BurkinaFasoFulllistofauthorinformationisavailableattheendofthearticleBonkoungouetal.
BMCPediatrics2010,10:94http://www.
biomedcentral.
com/1471-2431/10/942010Bonkoungouetal;licenseeBioMedCentralLtd.
ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.
org/licenses/by/2.
0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
cityofOuagadougou,BurkinaFaso.
CMAdusecteur30,locatedintheBogodogodistrictisoneofthefoursec-ondaryhealthcarecentersinOuagadougouanditspae-diatricwardhasacapacityof30bedsandadmitsover2260childreneachyear.
Ouagadougouhasapopulationofnearlytwomillions,whereastheBogodogodistricthasapopulationofabout548000with81000(15%)chil-dren<5yearsofagehttp://www.
sante.
gov.
bf.
ThestudyprotocolwasapprovedbytheEthicsCommitteeofBurkinaFaso.
Parentsofallthepaediatricpatientswereinformedonthestudydetailsandtheiroralconsentwasobtainedbeforestoolspecimenandepidemiologicaldatacollectionduringthecourseoftreatment.
Writtencon-sentwasobtainedfromparentsofthecontrolgroup.
Allchildrenundertheageof5yearvisitingthepaediatricservicefortreatmentofgastroenteritisfromNovember2008toFebruary2010wereincludedinthestudy.
Diar-rhoeawasdefinedasthepassageofthreeormorelooseorwaterystoolsinthepreceding24h.
Duringthisstudy,471patientswereincludedassoonastheywereseenbyaphysicianandfreshstoolsampleswerecol-lectedandtransferredtotheMicrobiologyLaboratoryattheNationalPublicHealthLaboratory,Ouagadougou,forrotavirusandadenovirusdetection.
Controlstoolsampleswerecollectedfrom60randomlyselectedchil-drencomingtothesamehealthcentreforroutineimmunizationandnotpresentinggastroenteritissymp-toms.
Theageofthecontrolwaspairedwiththepatient'sage.
Informationregardingtheage,sex,typeofnutrition(breast-fedand/orbottle-fed),hospitalizationandclinicalsymptomssuchasfever,vomitinganddehy-dration,andthecharacteristicsofstoolwererecordedforeachchild.
Alsohygienefactorssuchassourceofdrinkingwaterofthechildwerecollectedduringthestudy.
DetectionofrotavirusinstoolsamplesAllstoolsampleswereanalyzedforgroupArotavirususingonesteprotavirusandadenovirusserotypes40/41testfordeterminationofrotavirusandadenovirusinhumanfeces(SDBiolineRota/Adeno;Standarddiag-nostics,Inc.
,Korea)followingthemanufacturer'sinstructions.
Statisticalanalysesc2testwasusedtoanalyzethedataandthepvaluelessthan0.
05wasconsideredstatisticallysignificant.
ResultsRotavirusprevalenceOutofthe471childrenwithacutediarrheainitiallyincludedinthestudy,24weresubsequentlyexcludedbecausefor19ofthemnosamplewascollectedandfor5ofthemnoepidemiologicaldatawereavailable.
Ofthe447stoolspecimensanalysed,151(33.
8%)werefoundtocontainrotavirus.
Onlyone(1.
7%)outofthe60stoolspecimenscollectedfromhealthychildrenwaspositivebyimmunochromatographictest(ICG)(p<0.
0001).
Adenoviruswasdetectedin17of447(3.
8%)stoolsam-plesandmixedinfectionswithbothrotavirusandade-noviruswereobservedin11(2.
5%)stoolsamples.
AgeandsexdistributionofpatientswithrotavirusinfectionTheagedistributionofchildrenwithrotavirusisshowninFigure1.
Mostcasesofrotavirusinfection(94.
2%)occurredamongchildrenlessthan2yearsofage.
Thehighestincidencewasobservedinchildrenbetween6and11monthsofage.
Themedianageforrotavirusinfectionwas8months.
Thereweremoremales(52.
8%)thanfemales,butthesexratioamongtherotavirusdiar-rheapatientswasnotsignificant(p=0.
1).
SeasonaldistributionofrotavirusinfectionsDuringthewholeperiodofsurveillance,theincidenceofrotavirusinfectionsvariedsignificantlyaccordingtoseasons(warmandcold)(p=0.
0001).
Rotavirusinfec-tionsoccurredmostlyduringtheseasonfromDecembertoApril,correspondingtothedryseasonandrelativelycoldperiod(Figure2).
HospitalizationandclinicalpresentationofrotavirusinfectionOfthe217outpatientchildren,48(22.
1%)wereinfectedandofthe230inpatientchildren,103(44.
8%)wereinfectedwithrotavirus.
Therotavirusinfectionpreva-lencewassignificantlyhigheramonghospitalizedchil-dren(p=0.
0001)illustratingasignificantrelationshipbetweenrateofhospitalization-severityofillnessanddiarrhoeaassociatedwithrotavirusinfection.
Inaddi-tion,feverwasthesymptommostcommonlyreportedinassociationwithrotavirusdiarrhoea(82.
1%),followedbyvomiting(72.
8%)anddehydration(48.
3%)(Table1).
NutritionanddrinkingwaterAmongtheinfants≤9monthsofage,whohadrota-virusdiarrhoeaandforwhomthemethodoffeedingwasrecorded,55outof154werebreast-fed(35.
7%)and32outof61werebottle-fed(52.
5%)(p=0.
01).
Analysisofhygienefactorssuchasthesourceofdrinkingwatershowedthatchildrendrinkingmunicipalwaterweremoreaffectedbyrotavirusdiarrhoeathanchildrendrinkingmineralwatersoldinbottles(p=0.
0001)(Table1).
DiscussionThiswasthefirststudyinBurkinaFasotoinvestigatetheprevalence,clinicalcharacteristicandriskfactorsofBonkoungouetal.
BMCPediatrics2010,10:94http://www.
biomedcentral.
com/1471-2431/10/94Page2of6rotavirusgastroenteritisamongchildren.
Regardlessourresults,rotavirusdiarrhoeaappearstobeamajorpublichealthproblemforchildreninBurkinaFaso,asintheotherdevelopingcountries.
Ourresultsshowthatasig-nificantproportionofacutediarrhoeaisduetorotavirus(33.
8%)androtavirusmayberesponsibleforalmostone-half(44.
8%)ofallhospitalizationsfordiarrheainchildren<5yearsofageinBurkinaFaso.
ThedetectedprevalenceappearstobesimilartothosereportedfromotherWestAfricancountries,whichrangedfrom33%to39%[11-13].
Inaddition,acumulativeexperiencefrom15AfricancountriessuggestedthatrotavirusisthemostimportantcauseofseverediarrhoeainAfricanchildren[14].
Asobservedintheotherpartsoftheworld,thebur-denofrotavirusdiseaseispredominantlybornebychil-drenlessthan2yearsofage[15]withahighincidenceamongchildren6-11monthsofage.
Thiscanbeexplainedbytheprotectiveeffectofmaternalantibodiesin<6monthsold,andthedevelopmentofnaturalimmunityafterrepeatedinfectionsinchildrenover2yearsofage[16,17].
OurresultsshowedthatrotavirusoccurredmostlyduringtheseasonfromDecembertoApril,correspond-ingtothedryseasonandrelativelycoldperiod,ashasbeenreportedfromNorthernGhananearBurkinaFaso[13]andGuinea-Bissau[11].
SomestudiesconductedinotherAfricancountriesindicatedthatrotavirusinfec-tionsarepresentthroughouttheyear,butwithmuchhigherprevalenceinacertainperiodofayear[14].
Comparisonoftheclinicalcharacteristicsandseverityoftheacutegastroenteritisamongtherotavirus-positiveandrotavirus-negativepatientsindicatedthatvomiting,feveranddehydrationweremorefrequentlyobservedamongdiarrhealchildrenwithrotavirusthanamongthosewithoutrotavirusinfection,asreportedintheothercountries[11,18].
Ourconfirmationofapreviousobservationmadeintheotherpartsoftheworldthatduringthefirstyearoflifebreastfeedingisassociatedwithalowerincidenceofrotavirusdiarrhoealepisodesaddstothemultitudeofbenefitsthathavebeenassociatedwithbreastfeeding[19,20].
Inaddition,ithasbeenshownthatevenifthebreast-fedinfantsgetinfectedwithrotavirus,amilderdiseaseoccursandhospitalizationrateissignificantlylower[21].
Anotherimportantissue,whichwasshowninthisstudy,isasignificantassociationbetweenrotavirusdiar-rheaandmunicipaldrinkingwater.
ThismaybeduetothepossiblecontaminationofmunicipalwaterforDetectionrate(%)Age(months)6.
0%47.
0%23.
2%0.
6%4.
0%18%0.
6%0.
6%0.
0%0.
0%Figure1Proportionofrotavirusinfectionsbyagegroupsamongthe447childrensufferingofgastroenteritis,betweenNovember2008toFebruary2010.
Bonkoungouetal.
BMCPediatrics2010,10:94http://www.
biomedcentral.
com/1471-2431/10/94Page3of6Figure2Seasonalityoftheacutegastroenteritisandtherotavirusinfectionsamongthe447childrensufferingofgastroenteritis,betweenNovember2008toFebruary2010.
Table1ClinicalandepidemiologicalfeaturesofchildrenwithandwithoutrotavirusdetectedinthediarrhealstoolsampleEpidemiologicalandclinicalcharacteristicsRotavirusDiarrheaNonRotavirusDiarrheap(N=151)(N=296)SexMale71(47.
0%)165(55.
7%)p=0.
1Female80(53.
0%)131(44.
8%)Meanage(months)10.
916.
6PatientstatusInpatient103(44.
8%)127(55.
2%)p=0.
0001Outpatient48(22.
1%)169(77.
9%)SymptomFever124(82.
1%)161(54.
4%)p=0.
0001Vomiting110(72.
8%)80(27.
0%)p=0.
0001Dehydration73(48.
3%)54(18.
2%)p=0.
0001Season*Warm5(2.
9%)168(97.
1%)p=0,0001Cold146(53.
3%)128(46.
7%)Breastfeeding**Yes59(59.
0%)105(75.
5%)p=0.
010No41(41.
0%)34(24.
5%)DrinkingwatersourceMunicipalsupply108(71.
5%)142(48.
0%)p=0.
0001Bottledwater43(28.
5%)154(52.
0%)*Percentageofrotavirusdiarrheaversusnon-rotavirusdiarrheaforbothseasons.
**Percentageofrotavirusdiarrheaversusnon-rotavirusdiarrheaaccordingtomethodoffeedingamonginfants≤9monthsofage.
Bonkoungouetal.
BMCPediatrics2010,10:94http://www.
biomedcentral.
com/1471-2431/10/94Page4of6humanconsumptionorininter-humancontaminationwhichdrinkingwatermaybeapotentialriskofrota-virustransmission.
Rotavirushasbeendescribedasacausativeagentinseveralwaterborneoutbreaksintheindustrializedcountries[22-25],indicatinggoodsurvivalofrotavirusinwater.
InBurkinaFaso,theevaluationofdrinkingwaterqualitydoesnotrequiretestingforrota-virusbutourresultsshowtheimportanceofincludingroutinevirologicalanalysisofdrinkingwaterduringrotavirusseason.
ConclusionsInconclusion,thisstudyprovidesinformationontheepidemiologyandtheextentofrotavirusinfectionsinBurkinaFaso.
Ourresultsindicatethatgastroenteritiscausedbyrotavirusinthecountryisanimportanthealthproblem,particularlyamongchildrenlessthan2yearsofageandduringthecoldseason.
ThesedatawillbeusefulformakinganinformeddecisionabouttheintroductionofrotavirusvaccineinBurkinaFasoandwillprovideabaselineagainstwhichtheimpactofthevaccineintroductioncanbemeasuredinthefuture.
AcknowledgementsThisstudywassupportedbytheLaboratoryofBiochemstryandMolecularBiologyofCRSBAN/UFR-SVT(UniversityofOuagadougou)andtheNationalPublicHealthLaboratoryinBurkinaFaso.
WethankthestaffofCentreMédicalduSecteur30deOuagadougou,allthechildrenandtheirparentswhoparticipatedinthisresearch.
WeexpressourgratitudetoDrFidèleTiendrébéogoforthetechnicalassistanceinthestatisticalanalysis.
Authordetails1LaboratoiredeBiochimieetBiologieMoléculaire,CRSBAN/UFR-SVT,UniversitédeOuagadougou,03BP7021,Ouagadougou,BurkinaFaso.
2LaboratoireNationaldeSantéPublique,09BP24,Ouagadougou,BurkinaFaso.
3LaboratoiredeBactériologieetVirologieduCHU-YalgadoOuédraogo,03BP7022Ouagadougou,BurkinaFaso.
4UFRSciencesdelaSanté,UniversitédeOuagadougou,03BP7021,Ouagadougou,BurkinaFaso.
5LaboratoireInteractionsMuqueuses-AgentsTransmissibles-UFRMédecine,21079Dijon,France.
6Servicedepédiatrie,CentreMédicalduSecteur30deOuagadougou,Ouagadougou,BurkinaFaso.
7DepartmentofInfectiousDiseaseSurveillanceandControl,BacteriologyUnit,NationalInstituteforHealthandWelfare,P.
O.
Box30,00271Helsinki,Finland.
Authors'contributionsIJOB,ISandNBconceivedthestudy;BBandIJOBwereinchargeofrecruitment,examination,treatmentandfollow-upofpatients,controlsandundertooklaboratoryanalysis;IJOB,ISandNBanalyzedthedataandpreparedthemanuscript;NB,IS,FB,SOC,KHandASTsecuredthestudyexecutionandprovidedideasandcommentsduringmanuscriptpreparation.
Allauthorshavereadandapprovedthefinalmanuscript.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
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