Timing and predictors of severe rotavirus gastroenteritis among unvaccinated infants in low- and middle-income countries

Epidemiol Infect. 2018 Apr;146(6):698-704. doi: 10.1017/S0950268818000626. Epub 2018 Mar 22.

Abstract

Delays in rotavirus vaccine schedule could improve performance in low- and middle-income countries (LMICs). However, delaying the first dose could be detrimental if infants experience severe rotavirus gastroenteritis (RVGE) early in life. Our objective was to describe the timing and predictors of severe RVGE in unvaccinated children in LMICs. We analysed the placebo arms from two clinical trials (cohort 1: NCT00241644; cohort 2: NCT00362648). We estimated the rate, cumulative incidence (per 1000 infants) and age distribution of severe RVGE episodes. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals (CI) for the association between baseline factors and severe RVGE. Cumulative incidence at 6 months of age was 23/1000 (95% CI 15-30) in cohort 1 and 6/1000 (95% CI 3-8) in cohort 2. Early antibiotic use (compared with no use) was associated with 2.03 (95% CI 1.18-3.48) and 1.41 (95% CI 0.80-2.51) times the rate of severe RVGE in cohorts 1 and 2, respectively. The cumulative incidence of severe RVGE was low at 6 months of age, suggesting that a 4-week delay in the vaccination schedule may not result in a large number of severe RVGE episodes prior to vaccine receipt.

Keywords: Epidemiology; gastroenteritis; immunisation (vaccination); rotavirus.

Publication types

  • Clinical Trial, Phase III
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Child, Preschool
  • Clinical Trials as Topic
  • Developing Countries*
  • Female
  • Gastroenteritis / epidemiology*
  • Humans
  • Incidence
  • Infant
  • Male
  • Risk Assessment
  • Risk Factors
  • Rotavirus Infections / epidemiology*
  • Rotavirus Vaccines / administration & dosage

Substances

  • Rotavirus Vaccines

Associated data

  • ClinicalTrials.gov/NCT00241644
  • ClinicalTrials.gov/NCT00362648